Inspection on 12/07/05 for Beech Tree House

This inspection was carried out on 12th July 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.

Other inspections for this house

Beech Tree House 21/05/07

Beech Tree House 29/06/06

Beech Tree House 25/10/05

Beech Tree House 20/01/05

Beech Tree House 02/09/04

Beech Tree House 24/02/04

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

CARE HOMES FOR OLDER PEOPLE Beech Tree House 240 Boothferry Road Goole East Yorkshire DN14 6AJ Lead Inspector David White Unannounced 12 July 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Beech Tree House Address 240 Boothferry Road, Goole, East Yorkshire, DN14 6AJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01405 720044 01405 763824 Four Seasons Post vacant Care Home 31 Category(ies) of Dementia (31), Old age, not falling within any registration, with number other category (31) of places Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20 January 2005 Brief Description of the Service: Beech Tree House is owned by a large national care organisation and is registered to provide care and accommodation for 31 older people, including those with dementia. The home is situated in the town of Goole in the East Riding of Yorkshire and is close to local amenities. Accommodation is provided in a range of single and shared rooms, some of which have en-suite facilities. Various areas of communal space are available for service users, as well as pleasant outdoor areas. Residents are able to access all areas of the premises and grounds via the provision of a passenger lift and ramps. There is car parking space at the home. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection over 7 hours which involved a check of the records, discussion with four residents, a visitor, two members of the care team, a member of the laundry staff, an handyman and the manager. A tour of the environment was carried out as part of the inspection. What the service does well: What has improved since the last inspection? Residents have access to their records and have opportunities to maintain them. The manager has carried out a risk assessment of the home so that possible hazards to the safety and welfare of the residents are identified and measures are put in place to protect residents. Resident care plans now contain a wider range of risk assessments to safeguard residents from risks to their health and to promote their independence. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 6 Through the use of a survey GPs have been given the opportunity to voice their views about the home. 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 Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 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 standard(s) 3 and 6 Insufficient assessment information is gathered prior to a resident moving into the home and so there can be no assurance that care needs will be met. EVIDENCE: Five residents files were looked at including those of two residents who have recently moved into the home, one for respite care. The quality of the admission assessment information varied. Some of the files had details of preadmission assessments that were usually carried out by the manager or her deputy and information was obtained from other professionals such as care managers and hospital staff. However the records for the two most recent admissions had very basic pre-admission assessment information and did not specify the care needs of the residents. The lack of information within the preadmission assessment could lead to care staff being unaware of the needs of the residents so putting the health and welfare of the residents at risk. The home does not provide intermediate care. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 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 standard(s) 7, 8 and 10 Health care needs are generally being met despite limited progress being made in improving the quality of information within care plans to reflect the care needs of residents. EVIDENCE: The residents looked tidy and well cared for. Personal support is provided in private and the atmosphere in the home is relaxed. Residents spoken to said staff were “helpful and caring” and residents said “staff couldn’t do enough for you”. Residents feel that they are treated with respect and staff could be seen interacting well with the residents. The records of five residents were looked at. Since the previous inspection attempts are being made to improve the quality of the care plan information and risk assessments are in place for each resident to reduce the risk from falling, the prevention of pressure sores, promotion of continence and a nutritional assessment. However a number of risk assessments had not been completed and those in place had not always been reviewed to reflect changing needs. Information within care plans and daily records was often basic and did not always reflect the care being provided and some entries in daily records Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 10 were not been fully signed and dated. One resident is at risk from falling and a risk assessment was in place for this. However the risk assessment was last reviewed in April 2005 since which time the resident has had four more falls and there were no records of any measures that had been taken to address this. One resident said that she had a bath every two weeks but would like one more often. Her care plan stated that she was to have two baths a week but according to the records it had been a month since the resident had last bathed. Residents did say they were able to have a bath whenever they wanted one. There are formal reviews of care for residents and a visitor did say that she was invited for her father’s care plan review. There is a monthly care plan update that gives residents a chance to discuss their care with the staff. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15 Social activities are available and provide stimulation and interest for people living in the home. The meals provided are varied and of good quality. EVIDENCE: Residents have the opportunity to join in a number of activities and some were playing dominoes at the time of my inspection. Residents said they also enjoy the bingo sessions and quizzes One resident said that he enjoys the companionship of the other residents at the home and “the banter between staff and residents”. It was encouraging that one resident who is registered as blind has been able to continue going out with members from the Blind Association since moving into the home. Residents are able to spend time alone in their bedrooms if they choose. A number of people could be seen visiting the home during the inspection and a visitor spoken to said she was able to see her father whenever she wanted. She describes the care as “good” and says that she feels her father’s level of independence has improved since moving to the home. She feels that staff keep her well informed about her father’s care and she is invited to care plan reviews. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 12 Residents said that they carry out their daily routines as they wish. The gardens are accessible for all residents to sit out in and there is a conservatory looking out over the gardens. All of the residents spoken to said that the meals are good. One said there is always “plenty of choice” and another that “plenty of drinks are offered throughout the day”. One resident spoken to has diabetes and was able to confirm that she has a diet which meets her dietary needs. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 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 standard(s) None EVIDENCE: None of the above standards were looked at during the inspection. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The home provides a comfortable and pleasant environment for residents in which to live although further investment is needed in the facilities provided by the home to meet the needs of all the residents. There is one serious matter that puts residents at risk from harm. EVIDENCE: The home is spacious offering plenty of communal space and all parts of the building are accessible to every resident. Three resident rooms were looked at and these were comfortable, clean, tidy and personalised. Those residents capable of and choosing to do so now have their own bedroom key. However the previous requirement that all bedrooms must be equipped for two double electric sockets has not been met and is part of the planned maintenance programme. The premises have not been assessed by an occupational therapist to make sure that the equipment and facilities are suitable for the needs of the residents in the home. During a look around the environment it was noted that not all toilets are clearly labelled which could cause confusion for some of the residents. The hot Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 15 water temperatures from the bath and sink in the ground floor bathroom were in excess of 45 degrees which could have lead to a resident being scalded. The retired handyman who previously worked at the home was called and corrected the water temperatures during the inspection and the temperatures were rechecked and were within safe limits. The registered provider must make sure that this is maintained to ensure residents are kept safe. Since the handyman retired the home has not had a permanent maintenance officer and water temperature monitoring had not taken place. The records show that the last water temperature checks were made in May 2005. A new handyman was due to commence work at the home the week following the inspection and part of his duties will include checking of the water temperatures. The home has one electrical hoist and one manual hoist for 31 residents most of whom need some assistance when bathing. The electric hoist was not working and had been in need of repair for some time so there was only one assisted bath in use for all the residents. Clearly there is a need for more assisted bathing facilities in the home. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 Staffing levels are sufficient to meet the needs of the residents. EVIDENCE: There is in general four care staff on duty for each shift through the day as well as the manager and there are two care staff on duty at night. The duty rotas show that on occasions only three members of care staff were on duty during the day but this is not often and is usually because a member of staff has gone off work through sickness at short notice. Residents feel that the staffing levels are good and said that they were never left waiting to be attended to. Residents looked well dressed, staff carried out their duties unhurriedly and call bell requests are responded to within a short space of time. There is a sufficient amount of domestic, catering and laundry staff on duty for each day of the week. A new member of staff spoken to has received induction training and has worked alongside a senior member of staff until she was competent to carry out the work required. Another member of staff said that she had attended a number of training courses that included NVQ level 2 training, a medication course and some training on dementia care. Staff spoken to had a good knowledge of resident’s personal and health needs. Little progress has been made with NVQ training for the care staff and less than 20 of the care staff are trained to NVQ level 2. The organisation is looking to develop it’s own NVQ training programme. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36 and 38 The manager provides leadership for the home and is respected by residents and staff. There are some shortfalls in the management of the home that do not promote and safeguard the interests of the residents. EVIDENCE: The manager has run the home for over a year and has applied to register as manager of the home with the Commission for Social Care Inspection. The manager is nearing completion of NVQ level 4 in Care and Management. Both residents and staff spoke well of the manager’s abilities. Residents said she was “approachable and helpful” and would feel they could go to her about any problems. Staff feel she is supportive and easy to access if they needed to discuss anything. The manager has tried to introduce ways of seeking views from residents, relatives and others about the home but further work is required. Since the Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 18 previous inspection the manager has carried out a general risk assessment of the home. An Operational Manager for the organisation carried out an audit of the home in November 2004 and the findings from this were available. Residents do now have the opportunity to be able to access their records and help maintain them. A GP survey has been carried out although the results from this were not available. Resident meetings are held but not on a regular basis. Relatives are invited to care plan reviews but more formal systems need to be put in place to find out their views about the home. The home has not got an annual development plan for the coming year. Staff spoken to could confirm that they receive supervision and records of supervision sessions are kept. As detailed under the section of this report dealing with the home’s environment the following are issues of concern and need dealing with to ensure the safety of the residents and staff: • • • Hot water temperatures in areas accessed by residents must be kept within safe limits and arrangements put in place to have hot water temperatures monitored. The electrical hoist needs repairing or replacing as there is only one assisted bath currently in use in the home. More equipment is needed to assist residents with bathing. Since the handyman previously employed by the home has left there have been no systems put in place to make sure that hot water temperatures have been checked. The electric hoist has been out of use for some time and given that there is only one other assisted bath in the home this problem should have been dealt with much sooner. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 3 2 1 x 1 1 3 STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x 1 x x 3 x 1 Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 20 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 3 Timescale for action 14 Accommodation must not be As from provided to residents unless their 12/07/05 needs have been fully assessed. That assessment must be in sufficient detail to enable care staff to meet the residents needs, be kept under review and be revised if there are any change of circumstances. 12, 13, 14 Each resident must have a plan From & 15 of care for daily living that is receipt of this report based on the Care Management assessment and/or the homes own assessment (previous timescale of 20/01/05 not met). 14 & 15 Residents who have respite care From at the home must have a full receipt of this report care plan (previous timescale of 20/01/05 not met) 12, 13, 14 Health care needs highlighted by From & 18 the community care assessment receipt of undertaken by care management this report must be reflected in the homes own care plan which needs to be kept under review to reflect changing needs (previous timescale of 20/01/05 not met) 23 The registered provider shall 31/07/05 having regard to the size of the care home ensure that there are a sufficient number of assisted J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 21 Regulation Requirement 2. 3 3. 7 4. 8 5. 22 Beech Tree House 6. 24 7. 25 8. 33 baths in the home. The electrical hoist in the home also needs repairing or replacing.. 16 & 23 Each bedroom must be equipped with two double electric sockets (previous timescale of 31/12/04 not met). 13 The registered provider must ensure that hot water temperatures in areas where residents have access do not exceed 43 degrees centigrade and have arrangements in place for the monitoring of the hot water temperatures. 14, 15, 17 There must be effective quality & 24 assurance and quality monitoring systems in place which includes consultation with residents, relatives, friemds and other stakeholders about how the home is achieving goals for residents. There must also be an annual development plan in place (previous timescale of 30/04/05 not met) 30/09/05 Immediate requiremen t issued at the inspection. 31/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 21 22 Good Practice Recommendations Daily records in care plans should be fully signed and dated. Toilets for residents should be clearly marked. The registered provider should have the premises assessed by a suitably qualified person such as an occupational therapist to demonstrate that recommended disability equipment and facilities are being provided. Training should continue to make sure that 50 of care staff achieve NVQ level 2 by the end of 2005. Ther home should have a manger in post who has been registered with the Commission for Social Care Inspection and who is qualified to NVQ level 4 in Care and J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 22 4. 5. 28 31 Beech Tree House Management by the end of 2005. 6. Beech Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection York Area Office Unit 4, Triune Court Monks Cross YO32 9GZ 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 Tree House J53_J04_S19646_Beech Tree House_V233739_120705_Stage 4.doc Version 1.30 Page 24 - 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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