Inspection on 13/07/05 for Beech Tree House

This inspection was carried out on 13th July 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beech Tree House 19/08/08

Beech Tree House 31/08/06

Beech Tree House 30/01/06

Beech Tree House 18/01/05

Beech Tree House 03/08/04

Beech Tree House 10/03/04

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

CARE HOMES FOR OLDER PEOPLE Beech Tree House High Street Keinton Mandeville Somerton TA11 6DZ Lead Inspector Sue Burn Announced 13 July, 2005 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 D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Beech Tree House Address High Street, Keinton Mandeville, Somerton, Somerset, TA11 6DZ 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) 01458 223369 Mrs Estelle Louise Josephine Whitehouse Mrs Estelle Louise Josephine Whitehouse Care home only 14 Category(ies) of Old age (14) registration, with number Demential - over 65 (14) of places Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 14 persons in categories OP and DE(E) Date of last inspection 18th January, 2005 Brief Description of the Service: Beech Tree House is a care home, providing personal care, for 14 older people with dementia care needs. The home provides care for service users with low dependency needs. Situated in the village of Keinton Mandeville, the property was built around 100 years ago and extended when it became a care home about 18 years ago. Accommodation is on the ground and first floors. Service users who have rooms on the first floor need to be independently mobile. The home is secure and the old house retains many of its original features, which give the home a domestic and homely feel. The house has a large, well-maintained garden and a mini-bus is available to transport service users. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out as part of the planned annual programme of inspections. One inspector carried out this announced inspection over one day. The inspector was accompanied by a business services administrator from the Commission, who the provider kindly allowed to participate in the inspection process. The last inspection was unannounced and took place on 18 January 2005. A new extension had been completed and was inspected separately during the day to confirm that the 2 additional beds could be registered. Mr and Mrs Whitehouse were both available throughout the inspection. 13 people were living in the home and one person was in hospital. All service users spoken to, and who were able, told inspectors that they were very satisfied with their care, thought the staff were very kind and enjoyed the food. A tour of the premises was made, care in the home observed and a range of records was inspected, including care records. 12 service users, 8 staff and 3 visitors were spoken to. All spoke very highly of the home. What the service does well: Service users benefit from good quality, homely and secure surroundings. The home has thorough pre-admission arrangements that also provide good opportunities for the service user to make a decision about moving in. The home has a robust recruitment and induction procedures that protects service users from the risk of abuse. The home offers a varied menu of home cooked and nutritional meals. Lunch, seen during the inspection, was appetising and plentiful. Planned and unplanned activities and social opportunities are available to all. Service users benefit from an enthusiastic staff team. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 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 D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 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) 1, 2, 3, 4, 5. (6 does not apply). Service users rights are protected by a detailed written agreement with the home. The home has thorough pre-admission arrangements that also provide good opportunities for the service user to make a decision about moving in. EVIDENCE: The home has developed an adequate Statement of Purpose that is made available. The fees charged range from £375-£430 per week, with additional charges for hairdressing and newspapers. The home provides safe and secure surroundings whilst minimising restrictions on service users. All staff receive training in dementia care. The pre-admission assessment for one service user was examined and the process discussed with the manager. The home obtains an assessment from a professional involved with the service user prior to admission to Beech Tree House. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 9 The home assesses service users during a short stay at the home. The service user spends time at the home involved in the daily life and activities. The manager or deputy carries out an unobtrusive assessment. This is then discussed with the service user and family afterwards to help them make a decision about moving in for a trial period. The prospective service user and family member signed the assessment seen. This assessment process also gives service users the opportunity to meet each other and the staff the opportunity to judge how the person’s admission may affect existing service users. This way of assessing a prospective service user is to be commended and allows all affected to be included in the process. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 10 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, 9, 10, 11 The home takes appropriate action to ensure that health care needs of service users are met. There is a systematic care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users’ needs. Medication systems are well managed. The location of medication storage requires monitoring and review. Service users are treated with respect and care is provided in private. The home provides appropriate and sensitive support to service users who are dying. EVIDENCE: 3 service user plans were examined. All the records contained adequate detail to enable staff to meet service users’ needs. The manager was advised to ensure that the staff member signs all entries. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 11 The records evidenced that other professionals are involved with the service user as required and GPs, district nurse and CPN support the home regularly. Action is taken if a person loses weight and appropriate risk assessments are put in place. Pressure relieving equipment is obtained as required. Since the last inspection the keyworkers spend time with each service user every 2 months and review their care with them. This is documented and includes comments made by the service user. During the inspection one person was admitted to hospital, returning later in the day. Inspectors observed a prompt and appropriate response to the person’s needs, all staff were aware of the situation and the person was supported on their return. The inspection was carried out on a very hot day. Staff demonstrated their awareness of the need for fluids and were very attentive to the needs of all service users. All service users were treated sensitively and discreetly during the inspection and visitors spoke very highly of the standard of care provided. The management of medication was inspected. All records examined were satisfactory and all staff who administer medicines have received training and been assessed. The inspector recommended that the manager ensures that any changed prescriptions are re-written on the MAR charts, to avoid the possibility of error, and all medicines prescribed ‘as required’ have an indication for administration. The home is visited regularly by their supplying pharmacist and last visited on 23.2.05. The medication storage in the kitchen was not satisfactory. The medication was stored securely but medicines must be stored below 25C. The location of this storage is unlikely to ensure that this can be maintained. The manager indicated her willingness to comply with all requirements made to improve the storage of medication but had not been aware of this potential problem in the past. The inspector required that the temperature of the storage cupboard be monitored until the CSCI Pharmacy Inspector could arrange a visit. The home has built a sleep-in room, which will be made available to relatives who wish to stay if a service user is ill. One of the care records examined confirmed that care needs are reviewed as a person needs more assistance and that close contact is maintained with the GP when a person is dying. Relatives are accommodated should they wish to stay. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 12 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, 15. The lifestyle afforded to service users is flexible and allows for individuality. Visitors are made welcome at any time. Dietary needs of service users are well catered for with a choice of food available that meets service user preferences. EVIDENCE: The home provides a range of planned and unplanned activities. During the inspection all care staff were engaged in various activities with service users, dependant on their preferences and needs, throughout the day. Staff confirmed that they feel they have enough time to engage socially with service users. There was evidence that service users are supported to continue hobbies and interests, for example, one person has brought their piano into the home and staff encourage him to continue playing. Service users are also able to assist with light household tasks if they wish to. The home has a minibus for the use of service users and staff will accompany people shopping or to events outside the home. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 13 The garden is accessible and all service users could access all areas of the home. Throughout the inspection there was a relaxed atmosphere as service users, who were able, moved around the home and garden freely and bedrooms seen reflected the individual occupant. Staff confirmed that service users are able to get up and retire as they choose and those who have a ‘lie-in’ are offered a cup of tea in bed. All service users spoken to were very satisfied with their lifestyle. Lunch was seen and the cook spoken to. The cook was aware of individual needs and would adjust the menu accordingly. Lunch was appetising and plentiful with home cooked food. Each person was observed being offered the level of assistance they required. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 14 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) 16, 17, 18. Service users are able to exercise their legal rights and make complaints known. The recruitment and training procedures carried out ensure that people are protected from the risk of harm or abuse. EVIDENCE: The home’s complaints procedure is displayed in the home. No complaints have been received since the last inspection. Service users have access to all areas of the home, as appropriate. Records and discussion with staff confirmed that all were offered the opportunity to vote in the last general elections. Post is given to service users unopened. Recruitment records examined confirmed that all pre-employment checks are carried out. The home has appropriate policies for the protection of vulnerable adults. Staff spoken to were aware of what action to take should they suspect abuse and abuse awareness is part of the induction programme. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 15 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, 26. The quality of the furnishings and décor of the home are of a high standard. Service users benefit from accessible and safe gardens. Bedrooms are homely and are personalised according to their preferences. All areas of the home are clean and well maintained. EVIDENCE: A tour of the premises was made and all areas met the required standards. The home was homely, clean and pleasant in all areas. The home is well maintained with pleasant accessible gardens with seating. Service users are encouraged to bring in personal possessions, including items of furniture. There are sufficient and suitable facilities available throughout the home. Service users can choose a bath or shower and all rooms have either an enBeech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 16 suite toilet or are close to a toilet. An additional en-suite toilet has been provided since the last inspection. The home is suitably adapted for the current client group. Those who can manage stairs can only occupy the upstairs rooms. The home is appropriately secure to protect service users. Staff hand washing facilities were discussed during and following the inspection. It has been confirmed with the Health Protection Unit that facilities at the home meet the current service user needs. The manager confirmed that staff have access to hand washing facilities and all carry alcohol gel. Should a service user have higher personal care needs than at present the manager will ensure that staff hand washing facilities are made available in the bedrooms. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 17 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, 29, 30. The home is adequately staffed by suitably experienced staff. There is an enthusiastic workforce with low turnover of staff. The home has clear systems for ensuring that staff receive the training that they require. Recruitment systems are robust and protect service users (see Complaints and Protection) EVIDENCE: Staff rotas were examined and confirmed that sufficient numbers of staff are on duty at all times. The manager is readily accessible 24 hours a day. There is always a senior member of the care staff on duty and the deputy manager has some supernumerary time. Staff are maintained at the previously agreed levels with 2 care staff during the day and 1 waking and 1 sleeping at night. Staff spoken to confirmed that these levels are satisfactory to meet the needs of service users. The home is adequately supported by activities, housekeeping, catering and gardening staff. The provider is responsible for day-to-day maintenance. Staff are supported to undertake NVQ training. 65 of care staff have at least NVQ2 or equivalent. In addition 1 person is undertaking NVQ2 and 2 are undertaking NVQ3. All new staff undertake a TOPSS standard induction programme and records seen confirmed this. The deputy manager has NVQ3 in care. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 18 The manager and deputy have recently been assessed in moving and handling and first aid facilitation and will provide this training regularly for staff ‘inhouse’. All staff have received training in the past year including ‘Attitudes and approach’ in dementia care. The manager has invested in a comprehensive training package that will be implemented and staff updated annually, which will enable them all to receive a minimum of 3 days certificated training annually. Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 19 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, 32, 33, 34, 35, 37, 38. The home is well managed and the manager promotes an accessible and open style of management, including consulting with families. Staff morale is high and all are enthusiastic and committed to the home. Service users’ personal monies are satisfactorily managed. Health and safety arrangements ensure that staff and service users are protected. EVIDENCE: Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 20 The registered manager, Mrs Whitehouse, is an experienced manager. She has completed the NVQ 4 in care and the Registered Manager’s Award. The ethos of the home continues to be open, transparent and supportive to staff and service users. Staff meetings continue to be held about every 6 weeks and each member of staff has a designated role within the home. Staff spoken to felt well supported by the management and were enthusiastic about the standards of care provided by the home. Staff, service users and families were consulted about the new extension, with an option to move into one of the new rooms. Comment cards received before the inspection indicated that service users felt well cared for. The home consults with service users every 2 months on a one-to-one basis and families/representatives twice a year. Visitor questionnaires were seen for the last two surveys, which rated the home good or excellent in the majority areas with some very positive comments made. The January survey received 2 comments asking for more activities. The manager has taken action on this and informed all relatives/service users by letter and through the home’s newsletter. The manager may wish to consider developing quality assurance systems further to enable the home to self-assess the home’s performance against the National Minimum Standards and determine an annual development plan based on both this and the feedback they currently obtain. The home manages personal monies for one service user. Records were examined and found to be satisfactory. The manager was advised to obtain 2 signatures for any expenditure where receipts are not available as an additional check. Discussion was held with the proprietors who confirmed that the home is financially viable and there are finances available for investment. An extension has just been completed. A tour of the premises were made and all areas seen were free from hazards. The manager carries out an annual premises audit and risk assessments. This was last completed on 13.6.05. All staff have received recent fire training and this is held every 6 months. The last fire drill was held on 6.7.05 for staff and service users. Accidents are recorded and audited monthly by the manager and any necessary action taken. A range of records were examined and found to be well maintained and ordered and demonstrated satisfactory checks are carried out, these included; • Electrical testing Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 21 • • • • • Fire equipment and systems Staff risk assessments (as necessary) Hot water temperatures Bath hoists Emergency call systems Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 22 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 4 3 3 3 3 3 3 Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement The temperature of the medication cupboard in the kitchen must be monitored until the CSCI Pharmacy Inspectors planned visit. Timescale for action Immediate 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. Refer to Standard 7 9 Good Practice Recommendations All entries in care records should be dated and signed. The manager should ensure that any changed prescriptions are re-written on the MAR chart and all medicines presribed as required have an indication for administration. Where receipts are not available for personal monies expenditure, two signatures should be obtained for the record. 3. 35 Beech Tree House D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier TA1 4AL 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 D53 - D02 S16082 Beech Tree House V232247 130705 Stage 4.doc Version 1.40 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. 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