Inspection on 21/06/06 for Beech Street Home

This inspection was carried out on 21st June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beech Street Home 01/08/07

Beech Street Home 27/09/05

Beech Street Home 20/05/05

Beech Street Home 14/09/04

Beech Street Home 20/04/04

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

CARE HOMES FOR OLDER PEOPLE Beech Street Home Jarrow Tyne and Wear NE32 5LD Lead Inspector Miss Nic Shaw Key Unannounced Inspection 21st & 26thJune 2006 9:30 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 Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Street Home Address Jarrow Tyne and Wear NE32 5LD 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) 0191 483 5284 0191 489 8549 South Tyneside MBC Maureen Aziz Care Home 35 Category(ies) of Dementia - over 65 years of age (18), Learning registration, with number disability over 65 years of age (1), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (3), Old age, not falling within any other category (35), Physical disability over 65 years of age (5) Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service may from time to time admit persons between the ages of 60 and 65 years of age. The service user categories listed apply to those living in the home only and no other person should be admitted to the home with an assessment of dementia without prior consultation with the Commission for Social Care Inspection. 27th September 2005 Date of last inspection Brief Description of the Service: Beech Street Elderly Persons home is a Local Authority purpose built home which is situated in Jarrow. The home is registered for up to 35 residents, some of whom have a dementia type illness. Nursing care is not provided but district nursing services are accessed as required. Accommodation is over one floor, with level access throughout, and consists of a number of communal areas, including smoking and non smoking lounges, and a separate dining area. Residents have access to a well-equipped reminiscence room and a separate hairdressing facility. There is spacious garden and car parking is available to the front of the home. The entrance to the home is particularly attractive with a water feature, plants and ornaments. The home is situated on Beech Street which is located close to the busy town centre of Jarrow where facilities such as shops, pubs, GP surgerys and places of worship can be easily accessed. The weekly fees for this home range from £94.75 to £408.75. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was carried out over two days in June 2006 and was unannounced. The inspection included information which had been provided by the manager in a pre-inspection questionnaire, four resident surveys and a sample of staff and resident’s records. Time was spent talking to the manager, and home’s line manager, who was present for part of the inspection, approximately twelve residents, six staff, two social workers, two district nurses and two relatives. A meal was taken with the residents and a tour of the building took place. The inspection particularly focussed on four residents with very different needs, know as “case tracking”, and looked at what it was like, from their point of view, living in Beech Street. This involved talking with those residents and where possible their relatives, observing staff’s care practices with them and checking that information obtained from discussion and observation was accurately recorded in the care records. Discussion with the manager confirmed that the people who live in Beech Street prefer to be called residents and this will be reflected throughout the report. What the service does well: The manager and staff make sure that the residents receive the medical attention they need and visiting professionals, such as district nurses commented on how good they thought the staff were at caring for those residents in poor health. The staff make sure that the residents privacy and dignity is respected at all times. Residents are provided with plenty of choices at mealtimes and everyone said that the food was good. Good contact is maintained with family and friends and relatives said they could visit anytime. They also said that they would have no hesitation in making a complaint. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 6 The staff are provided with training so that they know what to do should they witness or suspect abuse. Beech Street is homely and comfortable and there are lots of lounges where residents can choose to sit. WC’s are near to lounges, so that people do not have far to walk, and there is a room filled with reminiscence items, which is good for people with dementia as it helps them to remember and talk about their lives. There is also a nice spacious entrance foyer with furniture so people can sit and watch the comings and goings of the home. The home is managed by a well established management team and there is little turnover of staff which means that the staff and residents are able to get to know each other really well. Residents said: “ I love it here” “the foods lovely” “the manager is lovely” “if I could stay here I would” “I like my room”, Social workers said: “the staff are very approachable” “the staff keep me informed of any changes to my clients needs” “they handled my client’s admission to the home very well”, District Nurses said: “the staff are wonderful, marvellous and very friendly” and relatives said: “my relative has always been happy here” “the staff do their best” “its nice and homely” “the dining tables are always nicely laid”. What has improved since the last inspection? Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 7 Some of the care plans have improved so that the staff know what they need to do to meet the residents needs. There are now a number of activities held in the home each morning, such as games, which provide opportunities for people to socialise as well as to exercise. Signs have been put on WC doors so that people with dementia can more easily find these areas. There are more staff available to help the residents with their personal care needs and this also means that staff have the time to sit and chat with the residents. The majority of staff have completed training on dementia, and this has helped them to better understand the needs of the people living in the home. The staff have also undertaken refresher training in health and safety so that they can make sure that the welfare of the residents is protected. What they could do better: Beech Street provides a home to a number of people who have a dementia type illness. The special arrangements in place to meet the needs of people with dementia needs to be included within the home’s “Statement of Purpose” and “Service User Guide” (or brochures) so that prospective residents and their relatives have all of the information they need to make sure that Beech Street is the right home for them. The manager must not admit any more people to the home who have dementia until the Commission have agreed that this can happen. This is to make sure that the staff have had the right training and that the home is properly adapted to meet the needs of people with this illness. Although some of the care plans have improved, some could be better so that the staff are provided with clearer information on what they need to do to meet the diverse needs of the people living at Beech Street, especially for those people who have difficulty communicating and who have a dementia type illness. Medication administration procedures must improve, as sometimes people are not getting their prescribed medication. Although there is more for people to do in the home the range of activities needs to improve so that residents are able to go out on day trips or outings into the local community. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 8 Residents need to be able to use the spacious garden areas so that they can enjoy the fresh air and be involved in outdoor activities. The environment could be further improved for people with dementia; for example, grab rails should be painted a different colour to the walls so that they can easily be seen. Bathrooms and WC’s should not be used as storage areas, as by doing so this means that residents cannot safely use these areas. Resident’s personal toiletries should also not be left in bathrooms by staff as other people could mistakenly use them. The quality assurance system needs to develop and this should include asking the residents, relatives and professionals who regularly visit the home how they feel the service could be improved. The manager also needs to regularly check all aspects of the service; for example checking that care plans have been completed properly, checking that the home is clean and safe, checking staff files and training records so that she knows she has all the information she needs in them, and this is to make sure that good standards are maintained. The manger needs to arrange for the staff to attend refresher training on fire safety so they are clear on what they should do in the event of a fire. 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 Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4&6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Each resident has been provided with an adequate written contract / statement of terms and conditions with the home. This helps to ensure that residents and their representatives are clear about what they can expect from the home. However, information is not available on how the home provides for the needs of people with dementia and people with a sensory impairment therefore prospective residents cannot make a fully informed choice as to whether the home can meet their needs. The admissions process ensures that resident’s are adequately assessed prior to care being offered. This helps to ensure that residents are offered the right type of care at the home. However, people have been admitted to the home who do not fall within the home’s current categories of registration. This may mean that the home is not fully able to meet the needs of every one living there. Intermediate care is not provided at Beech Street. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 11 EVIDENCE: There is a Statement of Purpose and Service User Guide. The manager agreed that these need to be up-dated to reflect that the home provides care to a number of people with dementia, people who have a sensory impairment and that the short break service beds are now located throughout the home as opposed to being confined to a separate wing of the building. Originally Beech Street was not registered to provide care to people with dementia. However, a number of residents, as they became older, developed a dementia type illness. In order that they could continue living at Beech Street the manager applied for a variation to the home’s registration. The Commission agreed to this variation on condition that no other people with dementia were admitted to the home without prior consultation with the Commission. However, despite this condition of registration the manager has continued to admit people with dementia. A meeting is to be held with the manager and the Commission to discuss and resolve this. The manager indicated that the majority of recent admissions to the home were made on an emergency basis, for example: where residents have experienced a decline in their health, or their current care support has broken down. For the resident’s whose needs were ‘case tracked’ one was found to have had a comprehensive assessment completed by a member of the home’s management team. Other residents are to have similar assessments undertaken, from which plans of care can be developed. Where admissions are planned, care manager’s assessments are obtained prior to admission. For those people whose admissions to the home are planned the manager said the deputy always visits them prior to their admission so that they can carry out a full assessment of their needs. A standard form of contract has been developed for agreement between the home and the resident. This outlines the key terms and conditions of a resident’s stay in the home, and includes the fees payable. It outlines what the fee covers, and what is not, so that residents are clear about what they can expect during their stay. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, &10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Care plans have improved but further develoment is needed to fully reflect the residents health and care needs so that the staff provide continuity of care. Medication administration and record keeping procedures are unsafe and a potential risk to the resident’s health and well-being. Residents privacy and dignity is upheld. EVIDENCE: A new detailed assessment document, developed by senior management, is currently being introduced and covers a range of issues such as “emotional behaviour”, “mood”, “falling”, “pressure care”, and “oral care”. From these assessments care plans are being developed which guide staff on the action they need to take to meet the residents health and social care needs. It is the responsibility of the keyworker to carry out some of the assessments with the residents once they have been admitted to the home. The manager agreed that it would be beneficial for the residents to sign the completed Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 13 assessment and care plan to confirm their involvement and agreement with them. Some of the care plans viewed for those people chosen to casetrack need further development. For example: discussion with the manager and a resident confirmed that it was important for a commode to be within easy access within their bedroom in order to promote their independence. This information had not been recorded in the care plan. In addition to this needs relating to diet and feeding, anxiety, and communication and how staff are to provide support in these areas where this is an assessed need had not been developed. In order to meet the needs of one resident and enable them to remain within Beech Street, where they have lived for a number of years, a special bed has been provided and a detailed care plan was available to instruct staff of how this should be used. The level of detail recorded in this care plan was of an excellent standard and discussion was held with the manager of the benefits of using this as an example of good practise to help with the development of other care plans. Discussion was held with the manager about cultural diversity in the service. Currently there are no people from an ethnic minority culture, however, in the past the manager said that the staff had knowledge of a Yemen resident’s dietary needs, although these were not strictly observed by them. District nurses and GP’s visited a number of residents during the inspection visits. Two district nurses spoken to said that, compared to other homes, they always enjoyed visiting Beech Street and found the health care needs of the residents always to be met to a good standard. Medication is handled and administered by senior care staff. Medication rounds take place during the morning, at lunch time, teatime and in the evening. A monitored dosage system is used, whereby the dispensing pharmacist supplies a month of each resident’s medication within a “blister pack”. Printed ‘medication administration records’, (MAR), are also supplied by the pharmacist. For those residents whose medication records were examined as part of the case tracking process a number of issues were identified which the manager must address. For example: some medication had been signed for on the MAR yet remained in the blister pack, the audit of the controlled drugs showed there to be a discrepancy and this indicated that some of the staff may not actually count the tablets when they carry out an audit, it was not possible to establish how many paracetamol there should be in stock as it could not be determined from the MAR whether one or two of these tablets had been administered as per the administration instruction and in one instance there was no record available to show that prescribed creams had been administered. Senior staff said that although it was the policy of the home to Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 14 carry out a weekly audit of medication they only have time to do this once a month. The above and further concerns relating to medication administration procedures were discussed with the home’s line manager who agreed to arrange for a full audit of the medication administration procedures to be carried out by a pharmacist and any recommendations made following this to be implemented and monitored by the manager. It was positive to note that the manager had arranged for a GP to visit one resident, who had regularly been refusing their medication, in order to carry out a review. Records also showed that where residents are found to be asleep during the morning medication round, staff return later to make sure that they receive their prescribed medication. No-one currently looks after their own mediaction but there is a policy on self administration of medication and there is a lockable facility in the residents bedrooms in which this can be safely stored. Residents appeared well groomed and staff said that with the improvement in staffing levels this has enabled them to fully meet the residents personal care needs. Instances of privacy were not breached during the inspection visits and staff appeared generally courteous and interacted positively with the residents. All bedrooms are single occupancy and there is a pay phone so that residents can receive calls in private. The manager confirmed that it may take time for a resident to get to the phone and said that usually, rather than the caller having to wait, they ask the caller to phone back in five minutes. The benefits of a mobile phone were discussed with the manager who was receptive to the advise offered. The manager said that female residents are asked if they object to a male carer assisting them with personal care. Their preferences in relation to this should be noted in their care plan. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements to provide activities and occupation have improved since the last inspection, however, the further development of a planned, structured and well delivered activities programme will contribute to a more interesting and stimulating lifestyle for residents. Residents are able to maintain family and other contacts to a good degree should they wish. This can help ensure they do not become socially isolated. Residents are actively encouraged by staff to a good degree in exercising choice and control over their lives. This can help promote their independence. Residents receive a good, varied and well presented, choice based, menu. This can help promote their general health and wellbeing. EVIDENCE: The atmosphere seemed generally relaxed and relatives were observed to come to the home freely. Activities provided by care staff on the day of the inspection included snakes and ladders, and inflatable games such as throwing hoops over a cone and a basket ball game. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 16 Staff spoken to said that with the extra staff they now have more time is available to spend with the residents. They said that each morning a member of staff is given the responsibility for arranging an activity. There is an activities programme, which includes cookery, aromatherapy and crafts but the manager agreed that this needed to be developed to cater for the diverse needs of the people living in the home as well as providing opportunities for people to enjoy outings in the local community and day trips further afield. The home’s line manager said that the Local Authority is soon to appoint an activities co-ordinator who is to work between the four South Tyneside Local Authority care homes. He also said that it is his intention to provide a minibus and developments in these areas are to be encouraged. Religious preferences are recorded in the care plans. The manager said that each Sunday a Lay Preacher visits the home and a monthly coffee morning is held to encourage community contact. Visitors regularly call to the home, and the relatives spoken to said that they were made to feel welcomed in the home and that they could visit their relative in private. One resident staying in the home for a short break was able to continue their preffered daily routine of an early morning visit to South Shields. A risk assessment had been completed in relation to this. Residents are able to bring personal possessions with them to the home. They can look after their own money if they so choose or ask the Local Authority to do this on their behalf. People can choose to have a meal in their room or with others in the communal dining area. Residents were very complimentary about the quality and quantity of the meals. Meals are served in the dining room by the staff to individual’s tastes and preferences. A meal was shared with two residents and the food sampled was of a good quality. During this ocassion it was evident that one person required assistance with their meal due to physical frailty and loss of sight. However, staff support was given by three separate staff, one of whom did not sit down next to them. It was not clear who was giving leadership at the mealtime and advice was offered to the manager that a designated worker would help to improve this activity. The manager confirmed that one person requires a sugar free diet and another person is following a healthy eating plan. Training is to be provided to the catering staff in July 2006 in relation to the nutritional needs of older people. The menus are reviewed twice yearly. The manager said that the catering staff speak with the residents to obtain their feedback and they also obtain the Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 17 views and observations of staff. Hot meals are provided at both lunch and tea time and throughout the winter a soup of the day is provided. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a satisfactory complaints system, however, outcomes from these need to be used to improve the service. Policies and procedures and staff training ensures that residents are protected from abuse. EVIDENCE: Residents and relatives said that they felt able to make a complaint. The complaints procedure is on display in the home and is available in large print on yellow background for people with a visual disability. There is a record of complaint mainatined, however, the action taken by the manager and deputy manager had not always been recorded to show that these had been investigated to the satisfaction of the complainant and whether or not, if the complaint was found to be substantiated, what measures the manager had put in place to prevent a re-occurance. Policies and procedures are available on the prevention of abuse and staff have been provided with training in relation to this. A recommendation made by the Commission in conclusion to a protection meeting held last year,was for the Local Authority to review their procedures for the suspension of staff. The manager confirmed that she still does not have the authority to suspend staff, however, would have no hesitation, if abuse was suspected by a member of staff, to ask that staff member to leave the building in order to ensure the safety of the residents. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,24&26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is clean offering the residents a homely, accessible generally safe well maintained environment in which to live. Some aspects of the environment have recently been enhanced for people with dementia although further improvements are needed to help the people living in the home to remain independent. Resident’s bedrooms are accessible so that people can spend time in private, however, not all of these areas were free from unpleasant odours, which could compromise the dignity of the residents. EVIDENCE: Beech Street consists of four corridors. Along each corridor are a number of bedrooms, a lounge with a small kitchenette in which snacks, tea and coffee Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 20 can be made, bathrooms and WC’s. The design and layout of the home means that the size of the home is broken down from the perspective of people with dementia who live there with small numbers of people occupying each of the lounges, which is good practise in dementia care. WC’s can be easily accessed from communal areas and signs have been placed on these doors which the manager said has helped to improve independence as these areas can now be easily identified. There is one communal dining area and a well equipped reminiscence room where some residents chose to spend their time. The home also benefits from a very pleasant entrance foyer which has been enhanced with a water feature and plants. There are also comfortable seats located in this area. The home is bright and airy and, as the world cup was underway, the communal dining room had been decorated with English flags. There is a very pleasant spacious garden with a green house, however, the manager said that residents cannot independently use this area as it is not secure and level access is not provided throughout. Residents bedrooms viewed had been well personalised with pictures and ornaments and all were found to be clean. However, in one bedroom there was a strong odour and the carpet in this area did not fit flush to the wall. Several bathrooms were inspected and water temperatures checked. The bath temperatures were all found to be in the region of 43 degrees centigrade, the recommended safe temperature. Bathrooms have blinds fitted to ensure the privacy of residents and some have pictures and other decorations to offer a more homely feel. Some bathrooms would benefit from attention as tiles have fallen off, and floor coverings have started to lift. Several bathrooms are also being used to store mobility aids, such as wheelchairs and zimmer frames, and others were found to have a range of toiletries, for example one had four bars of soap, another a plastic box full of toiletry products. Toiletry products should be stored in the residents own room so they are not used communally. The home has level access throughout, hand-rails, adapted bathing facilities and lifting aids have been provided to help meet the needs of physically frail and physically disabled people. One handrail was starting to loosen from the wall, and needs to be more fully secured. Some of the handrails are of a similar colour to the wall and therefore for some people with dementia may not be easily seen. Staff spoken to confirmed they have had training in infection control during their inductuion, however, as a number of staff have been employed by the Local Authority for a number of years the manager agreed that it would be beneficial for refresher training to be provided. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels have improved and this enables resident’s needs to be effectively met. Residents are protected by the home’s recruitment procedures, which are implemented to a good standard. This helps to ensure that unsuitable candidates do not gain employment in the home. Staff training has improved and the way that training is planned highlights where staff require broader and more frequent training opportunities. This will ensure that the resident’s personal and health care needs are fully met. EVIDENCE: Staff confirmed that since the last inspection there has been an increase in staffing levels. They said that as a result of this staff morale had improved and there is now time to sit and talk with the residents. On the day of the inspection visit there were five care staff, one senior and the manager as well as catering and domestic staff on duty, which is above the previously agreed minimum staffing level. The majority of staff have undertaken a course on the needs of people with dementia which they said they found very interesting and that this had helped them to understand the needs of people with this illness. In addition to this the staff confirmed that they had received a range of other training including Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 22 medication, moving and handling, nutrition and communication, as well as 75 of the staff having completed the NVQ level 2 qualification. Some of the staff have also undertaken training in equality and diversity. In addition to the staff training records held in the home the manager confirmed that the training department maintains a record of the health and safety training for all Local Authority care staff and arrangements are automatically made for this training to be up-dated when necessary. All new employees, incluing domestic staff, carry out a 5 day induction, which is paid for by the Local Authority, and includes moving and handling, nutrition, communication, environmental factors and fire safety. There has been very little turnover in staff and the deputy manager said that a relative had written to the home commenting positively about this. Residents, relatives and visiting professionals all said that the staff were friendly and made them feel welcome in the home. Observations confirmed that the staff were knowledgeable of the residents needs. Staff records indicate that an ‘enhanced’ Criminal Records Bureau disclosure is received prior to staff commencing duties. POVA first checks are also being received. Two references are always obtained prior to employment being offered and an interview is carried out to ensure the prospective employees possess the necessary skills and experience. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 23 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): 31,33,35&38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The resident’s welfare is promoted by a well managed home, and robust procedures are in place to safeguard the resident’s finances. Internal quality assurance systems have been developed to an adequate level, but with scope for further improvement. In order to ensure that the home is run in the best interests of all residents, a policy in relation to equality and diversity has been developed. EVIDENCE: The manager has a substantial number of years experience of managing a care home for this client group. She is soon to complete the NVQ level 4 qualification in management and care. In addition to this, in order to up-date her knowledge and skills, she has completed training in relation to equality and diversity as well as dementia and medication. Residents, social workers and Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 24 district nurses all said they found the manager to be approachable and friendly. Appropriate records are maintained of accidents. The manager monitors the occurrence of these for each resident, including details of the time and place, and where necessary advise and support is sought from the falls assessor. Falls risk assessments had been completed by the falls assessor for two residents which indicated that they would benefit from physiotherapy and hip protectors. The manager said that these recommendations have not as yet been implemented and agreed to address this. The manager said that on admision to the home the residents are given a choice of whether they would like to look after their money themselves or if they would prefer the Local Authority to do so on their behalf. For those people who choose the Local Authority to manage their finances the manager confirmed that individual bank accounts are opened for each person and that statements, which are confidential to the resident, are provided. The personal allowance records examined demonstrated that receipts and double signatures are maintained for all transactions. Wherever possible the residents are encouraged to sign the transaction sheet. A brief audit carried out as part of the inspection showed the system to be working effectively. The manager confirmed that she carries out a weekly audit of all money, in addition to this the Local Authority periodically carries out external audits. A corporate buisness plan is now available and this has been individualised to Beech street. It includes a brief “SWOT” ( strengths, weaknesses, opportunities and threats) analysis of the service. There are currently no residents/relatives meetings, however, the home has developed a brief questionnaire which is to be sent to residents and relatives in order to obtain feedback on the service. Indpenedent visitors, recruited by the Local Authority, have carried out visits to the home and provided the home with a report on their findings. There is no internal continuous self-monitoring system in place, however, as previously mentioned the manager does carry an audit of the residents finances and senior staff carry out an audit of the medication. This needs to be expanded to include all aspects of service delivery. There is a detailed fire risk assessment which has been up-dated to include those management strategies in place for those people who smoke in their bedrooms. Recommendations made following a recent fire officer visit to the home have been addressed. Each night, during the handover, the fire procedure to be followed during the night is discussed with the nightstaff and this includes any special needs of the current residents. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 25 The manager has identified that all of the staff need to receive up-dated fire training and this needs to be arranged. Sluicing rooms are located throughout the property and are currently closed, but are not locked. Clinical waste is stored in these areas. Given the needs of some residents living in the home, many of whom have dementia, it is strongly recommended that when not in use these areas remain locked. This was discussed with the manager who agreed to carry out a risk assessment in relation to this issue. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 3 X 2 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 2 Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 27 Yes 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 OP1 Regulation 4(1)(b) Requirement The Statement of Purpose and Service User Guide must be developed to provide information on how the home is suitable and able to meet the needs of people with dementia and people with a sensory impairment. The manager must not admit any further people to the home who have been assessed as having dementia without prior consultation with the Commission. Care plans must continue to be developed to provide staff with detailed guidance on the action they need to take to address the residents assessed needs. A pharmacist must carry out a full audit of the home’s medication administration procedures and records and a copy of the findings forwarded to the Commission. A record must be maintained to show that complaints have been fully investigated. The maintenance issues DS0000037970.V299121.R01.S.doc Timescale for action 30/08/06 2 OP4 12(1)(a) 26/06/06 3 OP7 15(1) 31/10/06 4 OP9 13(2) 31/07/06 6 7 OP16 OP19 22(3) 23(2)(b)& 31/07/06 30/08/06 Page 28 Beech Street Home Version 5.2 OP24 8 9 10 11 12 OP19 OP20 OP21 OP38 OP26 OP26 OP33 16(2)( c) 23(2)(0) 13(4)(a) 13(4)(a) 16(2)(k) 24 discussed in the body of the report must be addressed. Residents must have access to safe outdoor space. Bathrooms must not be used as storage areas. In order to prevent the risk of cross infection toiletries must not be stored in bathrooms. All areas of the home must be free from unpleasant odours. Systems must continue to develop to obtain the views of residents and their relatives as well as the development of an internal self-monitoring system. (Timescale not met 31/03/05) All staff must receive refresher training in fire safety. 31/12/06 26/06/06 26/06/06 31/07/06 30/11/06 13 OP38 23(4) 31/10/06 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 OP18 Good Practice Recommendations The Local Authority procedure for responding to suspicion of abuse should be reviewed to provide the registered manager’s with the authority to suspend staff. Beech Street Home DS0000037970.V299121.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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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