CARE HOME ADULTS 18-65
Beech Lodge 95 Thorkhill Road Thames Ditton Surrey KT7 0UW Lead Inspector
Graham Cheney Announced 12 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Beech Lodge Address 95 Thorkhill Road, Thames Ditton, Surrey, KT7 0UW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 3985584 Mrs Kathleen Jeetoo To be announced. CRH Care Home 9 Category(ies) of LD Learning Disability, 9 registration, with number of places Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The bedroom accommodation on the first floor may be used by fully ambulant persons only. 2. The age range of the persons to be accommodated will be: 18-65 years. Date of last inspection 13 December 2004 Brief Description of the Service: Beech Lodge is a detached property set in a residential road. There are three single bedrooms on the ground floor plus an open plan lounge/dining room, a kitchen, shower room, WC and a laundry room. A small conservatory adjoins the kitchen, which has been cleared to provide additional sitting space and leads onto the garden to the rear of the premises. On the first floor there are 6 single bedrooms, a staff sleepover room and a small office. There is also a separate staff WC and a service user WC and a bathroom. Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was the home’s first inspection for the year 2005/2006. This was an announced visit, which meant that staff and residents were expecting it to happen. An additional inspection had been made since the last inspection. This was on 8th March 2005 and was arranged to investigate a complaint made by an unknown person. The person had said that they had concerns about the care of residents in the home. The inspectors who looked into this did not find enough evidence to support such concerns. More details are available in the main part of this report. The inspector arranged this visit to arrive at the home at 10.00 a.m. Although three of the residents were out at day activities, he was able to meet with the other two residents and most of the staff. This gave the opportunity to make sure that there were no ongoing problems with the running of the home and that any issues that the home had faced previously were being sorted out. The inspector spent the first part of his visit in discussion with the provider and staff, checking the shared parts of the home. Residents’ rooms were not inspected on this visit. The inspector then had a look at the home’s revised papers, policies, care plans and reports. The second part of the inspection was spent observing staff working with residents, talking to residents, having lunch with staff and one of the residents and discussing life in Beech Lodge. Residents at home seemed happy living at Beech Lodge on this occasion. What the service does well:
The home has been through a difficult period, with some residents moving and the manager leaving. Evidence gathered from this inspection showed that improvements had been made in the way the home worked and the owner thought that things would continue to get better. The service employs a training person who is a registered and experienced nurse to support and train staff in the home. Care and health plans were found to provide a reasonable level of information about each individual, based upon a sound assessment of their needs and wishes, they could be further improved however, please see below.
Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 6 The recording of medication was being maintained to a good standard. Residents were well supported with their personal money. What has improved since the last inspection? What they could do better:
Comment cards returned by residents all said that they would like to be more involved in decision making within the home. The home has recognised this and the need to focus more on the wishes of residents and involve them more in the running of the home. The home’s new brochure states that they operate “Person Centred Planning” (PCP) for residents, these help to make sure that the residents needs and wishes come first in the way the home works. Although care plans provided a reasonable level of information about the needs of residents there was no evidence that PCP had been introduced. A requirement was made that Person Centred Planning must be introduced over the next three months. The fire door leading from the lounge was observed to be wedged open. A requirement was made that the holding open of fire doors must be thoroughly risk assessed, with staff talking to the local fire safety officer to ask for advice. The shower on the ground floor presented a number of risks, such as water being too hot or too cold and tripping over the step. These must be risk assessed. The cupboard containing cleaning materials was found unlocked, a requirement was made.
Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 7 General Health and Safety checks need to be carried out more often to make sure that the home is safe for residents, visitors and staff. 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 Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 On this occasion the home was generally found to be operating effectively in respect of these standards. The availability and quality of information about the home had been reviewed and improved. However there was a concern that the documentation described a model for assessing residents that had not been implemented in practice (please refer to evidence below). This could be misleading to prospective service users and their supporters. EVIDENCE: The home have reviewed and improved their statement of purpose and service user guide and produced a new brochure to provide information about the home to prospective users. The home’s new brochure states that they operate “Person Centred Planning” (PCP) for residents. Although care plans provided a reasonable level of information about the assessed needs of residents there was no evidence that PCP had been introduced. A requirement was made that Person Centred Planning must be introduced over the next three months. Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 The home has recognised this as an area on which they need to focus and improve. Development in this respect will give residents greater autonomy and independence. The introduction of person centred planning should assist in this process. EVIDENCE: In their annual development plan the home’s management have identified the need to develop care planning and for the home’s operation to focus more on the needs of residents and involve them more in the running of the home. This fits in with the CSCI comment cards returned by residents, which said that they would like to be more involved in decision making. As stated above the home’s new brochure states that they operate “Person Centred Planning” (PCP) for residents, these help to make sure that the residents needs and wishes come first in the way the home works. There was no evidence that PCP had been introduced. Please refer to requirements. Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 11 From observations made and discussions with residents and staff there was evidence that the home were already encouraging residents to make decisions and choices about their lives, there appeared to be less controls and more flexibility in the way the home operated on this occasion. For example one of the residents asked to go shopping and at her request had lunch in a burger restaurant. Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,17 This has been an area of concern previously, with doubts that staffing had been sufficient to enable residents to access the local community and leisure activities particularly during the evening. Evidence from this inspection indicated that there had been an improvement in this respect. Indications were that residents were being encouraged and supported to lead more independent and fulfilling lives and there was a commitment from the home to ongoing improvement in this respect. EVIDENCE: As recently as March 2005 CSCI had received an anonymous complaint, which was investigated by inspectors: The person said that resident’s activities were not taking place and that staff did not want to go out with them. Residents told inspectors during the investigation inspection that they were going out during the day and some evenings and that they were happy with this. Staff said at the time that they were happy to stay later to take residents out and those staff on duty confirmed this during this inspection. A member of staff said that although the
Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 13 roster indicated that their shift finished at 8.00 pm, they were willing and able to work later to meet the residents’ needs and that if they did extra hours they were paid for these. The registered provider confirmed this to be the case. The complainant also stated that there were 5 service users at the home, and that the provider only allowed a budget of £80 for food – this included meals for staff members. The actual amount of money for food was found to be about £130 a week. On this inspection lunch was taken with a resident and staff. The resident seemed happy with the food provided and was offered a choice of sandwiches and rolls with salad. Residents’ comments cards indicated that they were generally happy with the food. On previous visits residents were being restricted access to certain foods and the storage cupboards, on this occasion these restrictions were not being applied and cupboards were now open. The owner said that locks on these cupboards would now be removed. Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 Standard 20 was assessed on this occasion and considered to have been met, the home was operating in compliance with the Royal Pharmaceutical Society’s guidance on administering medication. The home was therefore obtaining, storing, administering and recording medication appropriately. Standard 19 was not fully assessed however the home has taken steps to ensure that residents’ health care needs are monitored more effectively. EVIDENCE: The process of administering medication was not observed on this occasion however the process described by a member of staff indicated compliance with the Royal Pharmaceutical Society’s guidance, with the medication apparently being given to service users directly from the prescribed container. Medication administered record sheets were accurately completed. The home has recently purchased “My Health Books” and was looking to start to introduce these. This should help each resident, with the support of staff, to monitor their own physical and emotional health needs better. Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Evidence gathered during this inspection confirmed that the home meets both of the assessed standards. This meant that the home was able to demonstrate that residents were being appropriately protected and that residents’ views were important and acted upon. EVIDENCE: As previously stated an anonymous complaint had been made to CSCI. The issues raised were investigated during an additional unannounced inspection back in March 2005. The complaint related to: • • • • There was no registered manager, the allegation being made that the previous manager had been sacked. There was insufficient money for food. Activities and access to the community were not happening due to staff shortages and staff not wanting to go out with residents. There were not have enough staff, often having only one member of staff on duty per shift and that some staff work too many hours. There was insufficient evidence to uphold any of these concerns, which are more fully reported under the relevant standards. Residents’ comment cards indicated that they generally knew who they could talk to if they were unhappy.
Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,27,28,30 Beech Lodge was a pre-existing, (before 2002) registered care home. Given this the evidence gathered during this inspection confirmed that, with the exception of standard 24 (please see below), the home meets each of the assessed standards and provides a reasonable level of accommodation appropriate to the needs of the current residents. It would not however be suitable for less able residents. Safety concerns meant that standard 24 was not fully met. Requirements have been made to ensure that safety and well being of residents and staff is maintained. EVIDENCE: There are three single bedrooms on the ground floor plus an open plan lounge/dining room, a kitchen, shower room, WC and a laundry room. A small conservatory adjoins the kitchen, which has been cleared to provide additional sitting space, and leads onto the garden to the rear of the premises. On the first floor there are 6 single bedrooms, a staff sleepover room and a small office. There is also a separate staff WC and a service user WC and a bathroom.
Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 17 The fire door leading from the lounge was observed to be wedged open. A requirement was made that the holding open of fire doors must be thoroughly risk assessed, with staff talking to the local fire safety officer to ask for advice. If the door needs to be kept open a magnetic door hold linked to the fire alarm should be fitted. The outcome of this assessment must be adhered to at all times. The risk assessment must include interim actions to ensure the safety of service users, i.e. should the door be held open to allow residents access or could they manage if the door was closed. The risk assessment and evidence of compliance with required actions must be readily available at the next inspection. The shower on the ground floor presented a number of risks, such as water temperature, tripping over the step. These must be risk assessed. The cupboard containing cleaning materials was found unlocked, a requirement was made. General Health and Safety checks need to be carried out more often to make sure that the home is safe for residents, visitors and staff. Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,34,35 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards. Staff on duty appeared to be enthusiastic and committed to supporting residents, with training and development being given a higher priority. EVIDENCE: The anonymous complainant stated that there were shifts when there was only one member of staff on duty for five residents and that there was not enough staff to take residents out as they wished (Comment cards also highlight the latter as a cause for concern). Evidence gathered from the investigation and again confirmed during this inspection indicated that there had been a minimum of two staff on duty during the day and on occasions three staff were deployed. Staff who spoke with the inspector said that there had not been any recent problems with staffing. The registered provider demonstrated through a training plan a commitment to improve training and development opportunities for all staff. Staff appeared to be enthusiastic and keen to develop new skills and knowledge. Opportunities to achieve NVQ were being explored. Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 19 Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,42,43 Evidence gathered during this inspection confirmed that, with the exception of standard 42 (please see below), the home meets each of the assessed standards, with improvements in the overall operation. Standard 42 was not met due to the safety concerns reported under standard 24. EVIDENCE: The anonymous complainant previously referred to stated that there was no manager at the home as the owner had sacked the former manager. This was partly true the manager had left the home in February, but the deputy had taken over and Mrs Jeetoo was often in the home to provide help and guidance. A care consultant who was an experienced and qualified nurse also supported the home. Many of the home’s policies, procedures and other papers have been reviewed, updated and re-organised. The owner said that the staff had worked very hard to sort these out. These included the statement of purpose and service user
Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 21 guide making them more understandable to the residents. A new brochure has also been produced for new residents. Standard 42 was not met due to concerns relating to a fire door being wedged open, hazards associated with the use of the ground floor shower and the auditing of Health & Safety throughout the home, as reported under standard 24. The home’s business plan demonstrated that home would be financial viability with six residents. There were five current residents but the registered provider hoped that with the improvements made to the home places would be filled. In the interim the home was being subsidised by other in the group. Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 3 x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 x x x 3 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Beech Lodge Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 3 H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 23 no 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 YA 6 Regulation 12(1)(a) (3) 14(1)(a) (c)(d)(2) 15 (1)(2) 13 (4) Timescale for action A requirement was made that 3 months Person Centred Planning must be 12/07/05 introduced. A requirement was made that the holding open of fire doors must be thoroughly risk assessed, with staff talking to the local fire safety officer to ask for advice. If the door needs to be kept open a magnetic door hold linked to the fire alarm should be fitted.The outcome of this assessment must be adhered to at all times. The risk assessment must include interim actions to ensure the safety of service users. The shower on the ground floor presented a number of risks, such as water temperature, tripping over the step. These must be risk assessed. The cupboard containing cleaning materials was found unlocked, a requirement was made. Two months 12/06/05, providing an interim risk assess. is in place. Requirement 2. YA 24 3. YA24 13 (4) 4. YA 24 13(4) Two months 12/06/05, providing an interim risk assess. is in place. Ongoing from date of inspection 12/04/05
Page 24 Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 5. YA 42 13(4) General Health and Safety checks need to be carried out more often to make sure that the home is safe for residents, visitors and staff. One month 12/05/05 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 Good Practice Recommendations Beech Lodge H58_S13564_Beech Lodge_v214551_120405 stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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