Inspection on 25/09/06 for Beech Lodge

This inspection was carried out on 25th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Lodge 19/01/06

Beech Lodge 14/07/05

Beech Lodge 24/02/05

Beech Lodge 05/08/04

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Thorndene

Insight - Eastchurch

Southfields

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Seabourne House

33 St John`s Church Road

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

CARE HOME ADULTS 18-65 Beech Lodge Guildford Road Broadbridge Heath Horsham West Sussex RH12 3PW Lead Inspector Ms A Campbell-Currie and Mrs S Gawley Unannounced Inspection 25 September 2006 10:00 th Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 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 Lodge DS0000043443.V305833.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 Adults 18-65. 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 Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Lodge Address Guildford Road Broadbridge Heath Horsham West Sussex RH12 3PW 01403 791725 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) Dr Shafik Hussien Sachedina Mr Shiraz Boghani Mrs Corinne Alison Nikolova Care Home 40 Category(ies) of Learning disability (40), Learning disability over registration, with number 65 years of age (1) of places Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users accommodated in Beech Lodge One, Two and Three may also have a physical disability. Service users accommodated in Redwood House are in the category Learning Disability (LD) requiring personal care only. One named service user in Redwood House is in the category Learning Disability over 65 LD (E). 19th January 2006 Date of last inspection Brief Description of the Service: Beech Lodge is situated in a rural area about five miles from the town of Horsham. There are three buildings on the site. There are two purpose built units that accommodate thirty people on the ground floor and a detached twostorey house that accommodates ten people on the ground and first floors. There is one double room and thirty-seven single rooms. Thirty-one rooms have en-suite facilities. There are communal areas in the three buildings. The communal areas are used for activities and there is a separate activities room adjacent to one of the buildings. A spa pool and sensory room are available on the site. Sussex Health Care own the home; Dr S Sachedina and Mr S Boghani are the responsible individuals. Mrs Corinne Nikolova is the registered manager responsible for the day-to-day running of the home. The fees range from £575 to £2500 per week. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this Key Inspection; one of the inspectors is a Registered Nurse. The manager, deputy manager and senior staff assisted with the inspection and made available all the documents and information required. A tour of the three buildings took place. There were thirty-seven people living at Beech Lodge at the time. The service users who were at home were all seen; some people were taking part in activities arranged by the activities coordinator, others were out at college or day centres. Due to communication difficulties there was no direct feedback from service users however all those seen appeared to be content and well cared for. The parents of two service users were spoken with and six members of staff including the chef. The outcomes for service users were assessed in relation to the key National Minimum Standards for Younger Adults. The Requirement made at the last inspection has been addressed. The judgements have been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Work on the outside area between the three buildings has been completed and provides a pleasant space for service users. A sensory garden provides stimulation for people in the good weather. Redwood House has recently been Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 6 redecorated. A system has been set up to ensure that all staff will have attended two fire lectures within twelve months to ensure that the health and safety of service users is protected. What they could do better: 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 DS0000043443.V305833.R01.S.doc Version 5.2 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 8 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 the following standard(s): 2 Quality in this outcome area is good. Prospective service users’ individual aspirations and needs are assessed before they move to Beech Lodge. EVIDENCE: There is a format for the manager and senior staff to use while carrying out an assessment with prospective service users. A sample of case records were read and the majority showed that a thorough assessment had been carried out before the person moved to Beech Lodge. The records of some people who had lived at the home for many years were not available; the deputy manager said that the case files are being updated and the necessary paperwork would be retrieved from the archive. Three care plans in Oak Lodge were inspected. These showed that a full assessment of need had been carried out and that these needs were clearly recorded. Health, personal and social care needs were included in the assessment. The majority of assessments that were seen included details about all aspects of the person’s life. Information had been sought from health and social care professionals as well as relatives so that staff would fully understand the needs of service users before they move to the home. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 6, 7 and 9 Quality in this outcome area is good. Service users have their assessed and changing needs and personal goals reflected in their care plan. People are supported to make decisions about their lives. People are supported to take risks as part of an independent lifestyle. EVIDENCE: Samples of seven care plans were read. Some care plans had been written with a person centred approach including three that were read in Oak Lodge. The nurse in charge of Oak Lodge and the Deputy Manager were spoken to. Three service users in Oak Lodge, two in Beech Lodge and two in Redwood House were tracked and where possible the key worker was spoken with. The care plans included details of the health and social care needs of each service user and provided clear guidance to staff about how these needs should be met. Health and medical needs were clearly recorded and these were being met with interventions that were clearly recorded. Communication needs were recorded such as the use of an electronic communication unit in the case of one resident Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 10 although this was having the battery recharged, which takes some hours. The need for this to be done at night when the resident is sleeping was discussed with the nurse in charge. It was evident that care plans are kept under review by staff and that formal reviews are held annually with social workers commissioning the placement. A review was being carried out with a service user during the morning. People are encouraged to make day-to-day decisions about their lives within the limits of their understanding and communication skills. Social needs and choices are recorded and the nurse in charge stated that residents have choice in their lives such as when to get up or go to bed, attend activities on offer or attending colleges. One resident who likes to attend church is usually facilitated to do so but the home does not at present have a Sunday driver therefore this resident cannot attend as usual. Risk assessments had been carried out in most aspects of people’s lives with guidance provided to staff about how to minimise risks. Risk assessments were recorded appropriately and moving and handling needs were clearly stated. There is a restraint policy however it was not clear in all cases that risk assessments clearly reflected why restraints were being used for the person’s safety. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. Service users are able to take part in age, peer and culturally appropriate activities. People take part in community activities. People are supported in their relationships with relatives and friends. People’s rights are respected and responsibility recognised in their daily lives. People are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: There is an activities programme in place and residents can choose whether or not to get involved. The activities include arts and crafts, games, barbeques, coffee mornings and holidays. Four staff are employed to coordinate and support people in their chosen activity. Service users can choose to attend college courses, day centres or Rapkyns Day Centre so that they can develop their communication and independence skills. There is a sensory room and two spa pools that can be used. One relative was spoken with and she expressed satisfaction with the manner in which her daughter is cared for. She feels the staff have taken time to get to know her daughter and that they can now meet all of her needs. She feels Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 12 that activities, which were slow to get started in this relatively new unit, are now in place and are appropriate to the residents needs. The home has established links with three local churches. Members of the local clergy visit the home and when a Sunday driver is available residents can be taken to church. Other local facilities that are used include the cinema, theatres, the local pubs and shopping centres. People are supported to maintain contact with their families and several people go home for weekends. Social events are arranged through the year and families and friends are invited. A coffee morning had been arranged to raise funds for a chosen charity. People are supported to make choices to enable them to maintain a level of independence. Advocacy services could be accessed for people who need this support. The kitchen in Beech Lodge provides food for thirty people living in two of the buildings; Redwood House has a separate kitchen and a cook provides a menu to suit the people who live in the house. Nutritional needs are recorded and the menu is on display. Allergies are clearly noted in the care plan but not in the kitchen. This was discussed with the nurse in charge. Residents are weighed monthly. Samples of menus were seen and the head chef spoken with. It was clear that people are provided with a varied and balanced diet and that special dietary requirements are catered for. The speech and language therapist provides advice and guidance for people who have difficulty swallowing. Picture cards have been developed to help people to make choices about their food and drink. The mealtime appeared to be relaxed with staff providing support for those who need help with eating. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 18, 19 and 20 Quality in this outcome area is good. People receive personal support in the way they prefer and require. Peoples’ physical and emotional health needs are met. The home’s medication policies and procedures protect the welfare of service users. EVIDENCE: There is a policy and guidance to staff regarding the way that personal care should be provided. Staff are given further guidance as part of their induction programme. The sample of care plans that were seen showed that individual wishes and needs regarding the way that personal care should be provided had been noted. Risks associated with the provision of personal care had also been identified and guidance provided to staff in order to minimise risk to the service user and member of staff. Seven care plans were inspected and the key worker of one of the residents was spoken with. Health, personal, medical, social and communication needs were recorded, as were interventions. There are no residents with pressure wounds at present. The key worker spoken with explained how she approached her role as key worker and her responsibilities to the resident, which is that of befriending and advocacy as much as care. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 14 Medicines were inspected on all three sites. The policies and procedures on the administration were inspected on a recent visit to head office and were discussed with the heads of care. These policies and procedures were in the units and staff demonstrated an awareness of them. Further to that there are additional policies on the management of PEG feeds and homely medicines and also a policy on covert administration of medicines. Staff confirmed training in these areas. Specific crushable medicines are used if necessary. Staff are aware that not all medicines can be administered in this way. Medicine Administration Charts were inspected and were mostly up to date with the exception of one dose of Senna, in the records seen in Beech Lodge which had not been signed for, but the nurse confirmed had been administered. Also on this unit one chart showed an antibiotic but did not show administration. The nurse stated that this was because the course had finished last month but the drug had not been removed from the chart. The importance of removing or crossing through drugs not to be given was discussed with the nurse in charge. Drugs on all units were stored appropriately with the exception of blister packs, which were on the counters; the nurses stated that they did not fit in the trolleys, which were awaiting modification. By the end of the inspection the manager had rearranged the trolleys to accommodate these blister packs. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 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 the following standard(s): 22 and 23 Quality in this outcome area is good. People can feel that their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. EVIDENCE: There is a complaints policy that is provided in symbol format for those who understand this form of communication. The system for recording complaints was seen and it was evident that complaints had been appropriately investigated and responded to. The West Sussex multi agency policy and procedure for safeguarding adults is available. The manager said that the guidelines would be followed in the event of a concern that abuse may have occurred. The in house policy is currently under review to ensure that guidance to staff is clear. All staff attend some training regarding the protection of vulnerable adults as part of their induction. The majority of staff have attended additional training. The manager recently attended a workshop set up by West Sussex Social and Caring Services about safeguarding vulnerable adults in order to keep her knowledge updated. There is information on abuse available for residents in Makaton symbols. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 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 the following standard(s): 24 and 30 Quality in this outcome area is good. Service users live in a homely, comfortable and safe environment. The home is clean and hygienic. EVIDENCE: The buildings and grounds are well maintained. Two of the buildings have been designed to provide a suitable environment for people who have learning and physical disabilities. Redwood House, which is an older building, has recently been redecorated. The outside area between the three buildings has been developed to provide a sensory garden and a level area that is used in good weather. The manager said that the environmental health officer has recently carried out an inspection in the kitchens; no problems were identified. The requirements made by the fire officer have been addressed and he was satisfied with the work that was carried out. The laundry and sluice facilities are suitable. There is a dedicated member of staff who carries out cleaning and laundry duties. Out of hours and at weekends the care staff are responsible for these tasks. All areas of the home were clean, bright and welcoming. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 17 Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36 Quality in this outcome area is good. Service users are supported and protected by the home’s recruitment policy and practices. The staff are appropriately trained to meet the needs of service users. People benefit from well supported and supervised staff. EVIDENCE: Samples of staff records were seen and showed that all the necessary checks are carried out before people begin work. Staff based at the head office of Sussex Health Care coordinate the recruitment process. The manager is involved in interviewing applicants. There is a training and development plan for all levels of staff. Newly appointed staff follow an induction and foundation programme. The manager of the home is experienced in working with people who have a learning disability and is registered on Part five of the register held by the Nursing and Midwifery Council, however none of the nurses in the units are. The nurse in charge of Oak Lodge stated that they are aware of the need to know how to deal with the communication and emotional needs of this client group. Some carers are doing National Vocational Qualification 2 but not specifically in learning disabilities. Staff confirmed that there is regular training in the organisation on continence, eating and drinking, constipation Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 19 management, epilepsy, mental health and other conditions relevant to these residents. The staff who were spoken with said they had been encouraged to attend training. The staff responsible for organising activities have completed a course that is designed to assist people who work with people who have learning and physical disabilities. The manager said that their knowledge had already had an impact on the types of activities that are planned. There is a supervision programme and the staff who provide supervision have all attended relevant training. Written records are kept and the system is monitored to ensure that all staff have a meeting with their supervisors every two months. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. Service users benefit from a well run home. The views of people living at Beech Lodge are listened to and taken into account in the review and development of the home. The health, safety and welfare of service users are promoted and protected. EVIDENCE: Mrs Nikolova is qualified and experienced to run the home. She is a registered nurse and is qualified to work with people who have learning disabilities. Mrs Nikolova said she is keen to maintain and develop her own skills and has attended training courses as the opportunity arises. Sussex Health Care provides a quality monitoring system whereby questionnaires are sent to a random sample of relatives and staff each month. The manager said that service users’ views are sought on a one-to-one basis and feedback is sought in small groups. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 21 The health and safety records showed that all staff will have attended two lectures on fire safety and will have been involved in a fire drill by the end of the year. Records were also available to show that people have attended the relevant health and safety training. The buildings are well maintained and meet the requirements of the fire officer. Risk assessments have been carried out for all aspects of environmental risks and all equipment is serviced as required. Accidents and incidents are appropriately reported and investigated; the relevant records were seen. Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beech Lodge DS0000043443.V305833.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southampton L O 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW 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. 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