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Inspection on 06/12/05 for Beech Lodge Residential Home

Also see our care home review for Beech Lodge Residential Home for more information

This inspection was carried out on 6th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The acting manager intends to complete new care plans, which would be an improvement but were not filled in for any resident at the time of the inspection. The residents who were able to verbally respond said that the staff were `kind`.

What has improved since the last inspection?

Based on the evidence found at the inspection and the previous inspection report, the service has deteriorated, in regards to the organisation, record keeping and staff supervision and morale since the last inspection.

What the care home could do better:

Three immediate requirements were left at the inspection, they related to the care given to one of the residents and the records kept about that resident.The times medication is administered, as this was late and irregular and regarding staffing to ensure that there were enough staff on duty at all times who could effectively communicate with the residents. Other requirements include the need for Staff to have an induction at the home, and to receive training and supervision. For the residents to have regular baths and showers and for this to be recorded. For heating to be provided at all times and to reduce the risks to the residents, by not using exposed halogen heaters. For effective washing of the residents laundry. For the manager to inform the commission of any event that affects the lives of the residents, this had not been done on several occasions. Need for proper recording of accidents and complaints, and for the providers to maintain good working relationships with the staff. Although the staff said that some activities had taken place they are not recorded.

CARE HOMES FOR OLDER PEOPLE Beech Lodge Residential Home Frogs Abbeygate Holbeach St Johns Holbeach Lincolnshire PE12 8QJ Lead Inspector Kima Sutherland-Dee Unannounced Inspection 8th December 2005 10:45 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 Lodge Residential Home DS0000002671.V270029.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 Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Beech Lodge Residential Home Address Frogs Abbeygate Holbeach St Johns Holbeach Lincolnshire PE12 8QJ 01406 423396 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) Mr Abdul Kachra Mrs Karen Jane Davies Care Home 22 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (21) of places Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users can only be admitted to the home with the written permission of the named representatives of the Commission for Social Care Inspection. 25th August 2005 Date of last inspection Brief Description of the Service: Beech Lodge Residential Home is a large two storey former farmhouse with a purpose built extension. It is situated in farming land in Holbeach Fen approximately three miles from the town centre of Holbeach. There are gardens to the rear and front with a car park at the front. The accommodation has 16 single rooms with 12 providing en-suite facilities and 3 double rooms with en-suite facilities. The home is registered to give care and accommodation for up to 22 residents, one of those having a mental health problem associated with old age. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place at 06.15 am in response to information received form the manager who said the providers intended to reduce night staff. On arrival the deputy manager informed the inspector that the manager had resigned and left the home. The inspection lasted for 6 hours and consisted of talking with and observing the residents and the environment, discussions with the acting manager, deputy manager and staff and a review of a sample of the documents. What the service does well: What has improved since the last inspection? What they could do better: Three immediate requirements were left at the inspection, they related to the care given to one of the residents and the records kept about that resident. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 6 The times medication is administered, as this was late and irregular and regarding staffing to ensure that there were enough staff on duty at all times who could effectively communicate with the residents. Other requirements include the need for Staff to have an induction at the home, and to receive training and supervision. For the residents to have regular baths and showers and for this to be recorded. For heating to be provided at all times and to reduce the risks to the residents, by not using exposed halogen heaters. For effective washing of the residents laundry. For the manager to inform the commission of any event that affects the lives of the residents, this had not been done on several occasions. Need for proper recording of accidents and complaints, and for the providers to maintain good working relationships with the staff. Although the staff said that some activities had taken place they are not recorded. 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 Residential Home DS0000002671.V270029.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 Lodge Residential Home DS0000002671.V270029.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): These standards were not assessed at this inspection. EVIDENCE: Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 9 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): 7,8,9,10 The home is not meeting the resident’s needs, and the record keeping is so poor that the inspector could not determine if the care was delivered. The medication is not given regularly. EVIDENCE: A review of a sample of care plans showed that the records are poor and that staff are not recording the care they give. The plans state the needs of each resident but they do not give staff proper instruction in how and when they are to meet those needs. The acting manager agreed with the inspector’s findings. It was observed that one resident was left in bed from the early evening until 10.30 am and despite a record to say they were at high risk of dehydration and should be encouraged to take fluids this had not been recorded. This resident had also not received food between 5.00p.m and 10.30 a.m. The acting manager said that they used to record residents fluid intake where necessary but they could not find any record of this recently for one of the most vulnerable residents. An immediate requirement was left for an urgent review of this person’s hydration and to improve the records. The staff said that they struggled because they now had to give out the breakfasts. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 10 Medication that was due to be administered at 8.00a.m was being given at 10.00a.m and the staff gave the same reasons as above. An immediate requirement was left to change the administration of medication. The records showed that residents received a bath or shower once a month; although the night staff said they bath people more frequently this was not recorded. The night staff said they had difficulties communicating with some of the staff that were sent from other homes and that they had left one resident to manage their own hygiene when clearly they needed help and had got into difficulties. They also said they had had to help one person to brush their hair and it took a long time because it was so ‘knotted up’. The inspector observed that the staff did treat the resident kindly and spoke to them during care. The resident’s who could respond said that the staff were kind and caring. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 11 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): 12,14,15 The home is not meeting peoples expectations regarding activities or providing adequate food and drink later in the day, and during the night. EVIDENCE: The home has an activities board advertising different daily events. This was found to be out of date and not to have taken place. As this home provides care for residents with dementia it is not meeting peoples needs or stimulating them enough. The staff said that events had taken place but infrequently and not as advertised. The records showed that the residents had gone to see the Christmas lights and there had been a buffet party. The kitchen staff said they had all the equipment they needed and a good quality of food. One resident said they were glad to be at the home as the food was better than the last home they went to. The meal times during breakfast and lunch were flexible but tea is provided at 4.30-5.00 and only residents who are able to ask are given a supper after this. Jugs of juice are provided in the resident’s rooms but this relies on the staff helping those residents who are unable to help themselves, and this was not recorded. The care plans did not demonstrate consultation with the resident regarding their preferences and choices. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 12 Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 13 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): 16,18 The home does have a complaints form and procedure but the staff felt their complaints to the management have not been listened to or taken seriously. EVIDENCE: The staff said that they have requested meetings and the managers have not turned up and that their complaints are not taken seriously. No staff training on adult abuse awareness has taken place and the lack of training and induction of new staff means that they are unaware of abuse issues and how to respond. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 14 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): 19,22,23,25,26 The home was clean and comfortable and without odour, however the staff said that breakdowns in the heating and laundry facilities have caused problems. EVIDENCE: The central heating broke down for 1 week and the staff said it was really cold downstairs, 2 emergency heaters were provided but one was a halogen heater that was a risk to the residents. The tumble dryer also broke down and was out of use for 2 weeks, meaning that when a resident required a change of clothes there were no clean ones available. The communication book for the use of staff mentioned these problems repeatedly. One entry read that the staff should minimise the amount of laundry. The acting manager said they had trouble getting a part for the heating and they didn’t know about the dryer. It was observed that the resident’s bedrooms were comfortably furnished and that they had mobility equipment. A visiting district nurse said they would Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 15 obtain new pressure relieving equipment for one resident. The staff were observed using the hoist correctly to assist a resident. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 16 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): 27,28,29,30 The numbers or skills of the staff do not meet the resident’s needs. The home’s recruitment procedures, whilst correct, do not select staff suitable for the home’s individual needs. Staff training is inadequate. EVIDENCE: On the day of the inspection there were two staff on duty, however the staff and the acting manager said that when there were 10 residents at the home there had been one member of staff on duty and one on call. The duty rota confirmed this. The staff said they were unhappy about this as they had not been able to meet resident’s needs and they had not always been able to contact the sleep in staff. A minority of the staff are overseas workers who are centrally recruited and sent to the home by the provider. The staff files had the relevant documents however some where poor photocopies that were unreadable. The staff said this had caused problems, as they had not always been able to effectively communicate with them. They said one carer had spent 3 days deeply distressed at the home and unable to carry out their duties. This was discussed with the acting manager who said that this had occurred and that the staff should speak more slowly at first. However the inspector pointed out that regardless of the staff’s abilities to communicate there is the issue of the residents being able to communicate their needs. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 17 Training had been inadequate and this had been demonstrated by the lack of proper records and that staff said that some staff had not been lifting correctly or handling the residents appropriately. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 18 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): 31,32,36,37,38 The recent change in management has clearly lead to lowered staff moral and difficulties. Risks are not being appropriately addressed and the record keeping is inadequate. Staff have not received an appropriate induction to the home or supervision EVIDENCE: The manager recently resigned and the area manager is now in place as acting manager with a deputy manager. The deputy manager is competent, but has recently transferred from another home and is still getting to know the staff and residents. The acting manager had previously supervised the manager at the home however problems that were identified during the inspection were blamed on the previous manager. If this was the case then these should have been addressed earlier. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 19 Meetings have taken place between the staff and the management, but they have not always been recorded. The records are poor and disorganised. Staff have not received supervision or support and the residents needs have therefore not been met. The inspector asked to see the induction for a new member of staff. This was not available at the home and had to be looked at by a colleague in another home. All of the criteria on the form had been filled in on the same day and there was no recorded induction into the home they were working at. The acting manager stated that they are determined to sort out the problems and they showed the inspector some new care plans that are to be completed. Where risks have been identified in residents care plans the actions to take to minimise the risks have not been recorded. When incidents such as the heating break down have occurred the manager has failed to inform the commission. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 20 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 x X 3 3 X 2 2 STAFFING Standard No Score 27 1 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X X 2 2 2 Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 21 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 OP8OP7 Regulation 15 & 12(1)(a) 13(2) Requirement The Registered person must ensure that care plans record each residents needs and that these are met. The registered person must ensure that medication is given safely, on time and in accordance with any relevant guidance. The Registered person must ensure that they consult the residents regarding their social preferences, that any advertised activities take place and that there is adequate social stimulation for all the residents who wish to participate and that this is recorded. The Registered person must ensure that adequate quantities of food and drink are provided at suitable times during the day and night to meet the needs of the residents. They must also ensure that staff assist those residents that need help and that this assistance is recorded. The Registered person must ensure that they maintain good DS0000002671.V270029.R01.S.doc Timescale for action 08/12/05 2 OP9 08/12/05 3 OP14OP12 16(1)(m)( n) 30/01/06 4 OP15 16(2)(i) 08/12/05 5 OP16 21(2)&22 12(5)(a) 30/01/06 Beech Lodge Residential Home Version 5.0 Page 22 6 OP18 13(6) 7 OP25OP19 23(1)(a)& (2)(p) 16(2)(e)& 23(2)(c) 8 OP38OP26 9 OP30OP27 18 10 OP29 18 11 OP32OP31 8&9 professional relationships with the staff and that they have a way of bringing forward their concerns regarding care and that these are addressed. The Registered person must ensure that the residents are protected from abuse through staff induction and training. The Registered person must ensure that suitable heating is provided at all times, without risk to the residents. The Registered person must ensure that the residents clothes are laundered and provided clean in adequate quantities and that any equipment is maintained and in good working order. The Registered person must ensure that enough staff are on duty to meet the needs of the residents and that those staff are appropriately supervised, trained and able to communicate with the residents. The Registered person must ensure that staff records are legible and that staff are recruited appropriately to meet the needs of the residents in an individual home. The Registered person must employ a suitably qualified manager. The Registered manager must ensure that the resident’s needs are being met by arranging for the regular supervision and training of staff. The Registered person must ensure that the home’s records are kept up to date and accurate. The Registered manager must ensure that action is taken to DS0000002671.V270029.R01.S.doc 30/02/06 30/01/06 30/01/06 08/12/05 30/01/06 30/02/06 12 OP36 18 30/02/06 13 OP37 17(1)(2)( 3) 13(4)(a)( b)(c)&37 30/01/06 14 OP38 30/01/06 Page 23 Beech Lodge Residential Home Version 5.0 minimise the risks of any activity and of the environment. They must also inform the commission of any event as stated in regulation 37. 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 OP32 Good Practice Recommendations It is recommended that the acting manager demonstrates that they are taking the staff’s views seriously and that they are maintaining good professional relationships. Beech Lodge Residential Home DS0000002671.V270029.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Lodge Residential Home DS0000002671.V270029.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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