Inspection on 25/10/05 for Beech Tree House

This inspection was carried out on 25th October 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 12/07/05

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 Riding Of Yorks DN14 6AJ Lead Inspector Terry Downey Unannounced Inspection 25th October 2005 09:30 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 Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Beech Tree House Address 240 Boothferry Road Goole East Riding Of Yorks DN14 6AJ 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) 01405 720044 01405 763824 County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd ****Post Vacant**** Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (31), of places Physical disability (1) Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Category (PD) applies to one named service user. Date of last inspection 20th January 2005 Brief Description of the Service: Beech Tree House is registered to provide residential personal and social care to 31 people over 65 years of age, some of whom may have dementia, and one named person with physical disabilities. The home is a large detached house set in its own grounds not far from Goole town centre and with good access to the towns services and amenities. Accommodation is provided in a range of single and shared rooms some of which have en suite facilities. There is a lift to provide access between the floors and large well maintained gardens and outdoor areas for the residents to enjoy. The home is owned by a large national care organisation and managed by Ms Margaret Roe who has applied to the Commission to be registered. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the inspection process on 25th October 2005. The manager Ms Margaret Roe was available to assist with the inspection and it was also possible to speak to 7 members of staff, 14 residents and 8 visitors. The inspection also involved a check on the requirements and recommendations from the previous inspection, a tour of the premises, and a check on some of the records. The inspection took 8 hours which includes preparation time. The home was very clean, well decorated and furnished, and there was a pleasant atmosphere. The residents were in the lounges, talking and reading. and the staff were busy in a variety of care duties. There was a constant stream of visitors and they and all the residents spoken to said it was a nice home and that the staff were courteous and helpful. The inspection showed that the administration in the home was not very well organised and that there were some shortfalls which could put residents at risk. Despite this the staff were aware of their duties and the residents and visitors were very happy with the home and the care provided. What the service does well: What has improved since the last inspection? Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 6 The electric hoist has been repaired. Hot water temperatures are being checked and recorded. Toilets have been clearly marked. 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 DS0000019646.V257747.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,6. 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: Information from recently admitted residents files showed that the quality of the pre-admission assessments is very poor and the subsequent care plans therefore contain only minimal information. The assessments were not dated so it is difficult to be able to rely on the information. These problems have been mentioned in previous inspection reports. The lack of information within the pre-admission 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 contract provided to residents is in very legal language and should be put in a format that people can understand. The homes senior managers stated that the format has been approved by the Office of Fair Trading and there are no plans to review it, but residents can ask for clarification should they require it. The home is not registered to provide intermediate care Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. 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 and those spoken to felt that they were well cared for and that the staff were very helpful. None of the residents self medicate. The home’s storage and administration of medication is well organised by a senior member of staff. There was evidence of some institutional practices especially regarding bathing. Residents have a bath once per week and operate on a rota eg Rooms 1-5 one day 6-10 the following day etc. Staff did say that if residents wanted a bath at another time they would fit them in. They also said some residents do get a shower at bedtime. It has to be said that none of the residents complained about the practice. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 10 As mentioned care plans are very basic and records were not always dated or signed. Similarly risk assessments were of poor quality and not reviewed. The relatives spoken to said they were invited to care plan reviews but were not always sure what they should do at a review. They all said they were happy with the home and were always made to feel welcome. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. The residents eat well but the lack of activities means that residents lack stimulation. EVIDENCE: There was little evidence of any activities in the home and some residents expressed concern at the lack of any stimulation. The manager said that she has a very limited budget for activities and this was spent on someone coming into the home once a fortnight. Dominoes and quizzes are organised by the staff but the residents considered they needed more than this. Visitors also said that there seemed to be little for the residents to do especially now it was beginning to get too cold to go out in the gardens, but they said there were always plenty of visitors in the home to talk to. All of the residents spoken to said that the meals were good and that there was sufficient choice. The cook explained that she has regular contact with the residents to discuss the menus and their personal preferences. She also explained that fresh vegetables, fruit, bread and milk are delivered to the home three times per week. The cook has no formal training in the preparation of balanced diets or nutritional assessments and these are not carried out by the home. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The lack of awareness about the Adult Protection Procedure may put the residents at risk. EVIDENCE: The manager was not confident about the adult protection procedure and there was no evidence that staff had had formal training or knowledge of the procedure. This lack of awareness could put the residents at risk. The home’s recruitment procedure is not sufficiently robust to provide the protection it should. Some files indicated that employment history had not been investigated and some of the references were very poor or were not available. The home has a complaints procedure but the residents said that they would speak to the manager if they had any concerns and felt happy that she would help them. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 13 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): 19,20,21,22,23,,23,24,25,26. The home is clean and well decorated and furnished throughout, making it a comfortable place to live. EVIDENCE: There is sufficient communal space to provide for activities or quiet places to sit and talk or read. Overall the standard of furnishings and decorations make the home a pleasant place to live. Residents are encouraged to bring their personal items into the home to make their rooms feel homely. The home was clean and free from unpleasant smells and a good infection control policy was in operation. The person responsible for the laundry explained the procedure which was very efficient and ensured that clothes were cleaned properly at correct temperatures and each resident had their own Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 14 clothes returned. She considered that the facilities and equipment were very good. Since the previous inspection toilets have been clearly labelled which prevents confusion for some of the residents. The hot water temperatures are recorded regularly but there was no evidence of any checks for the storage and distribution of water to prevent the risks from Legionella. The home has one electrical hoist and one manual hoist for 31 residents most of whom need some assistance when bathing. The electric hoist has been repaired since the previous inspection and if the practice of only bathing five residents daily continues this is probably sufficient. 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, but the Company considers that the Care Services Director is suitably qualified to assess the equipment and facilities. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The care staff are aware of their duties and provide good care for the residents but are not well trained. 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. There are also domestic, catering, and laundry staff on duty which allows the care staff to do the caring. Both the staff and the residents considered that there were sufficient staff on duty to meet the needs. The staff work well as a team which makes it a happy place to work. They do work long shifts which they said they preferred because it gives them weekends off, but it is not good practice. The managers consider that the shift system provides the residents with a continuity of care and is the most suitable system for the home. The inspector also considered that some of the care practices eg. bathing, were institutional but the managers consider that the system acts as a prompt to the residents and helps to maintain their orientation. Neither the manager nor the staff were knowledgeable about the National Minimum Standards and the statutory training was not up to date. 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 managers stated that NVQ training is continually offered and accessible to all staff. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 16 The home’s recruitment procedure is not sufficiently robust to provide protection for the residents. Some files indicated that employment history had not been investigated and some of the references were very poor or were not available. The files did not contain all the information required. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 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 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): 31,33,35,36,38. There are some shortfalls in the management of the home that could put the residents at risk. EVIDENCE: The manager has run the home for over a year and has applied to the Commission for registration. She 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 considered they could go to her about any problems. Staff said she was supportive and easy to access if they needed to discuss anything. It is clear from this inspection that the administration of the home is below the standard required and this may have led to previous inspection reports not being acted upon. Few of the requirements and recommendations have been carried out and some go back to January 2005. The manager felt that she Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 18 does not get the support from an area manager. There have been changes and visits have been missed. The manager stated that when visits are made she is notified when the regulations state that these visits must be unannounced. Staff recruitment is not sufficiently robust, staff training is not up to date and records are not well maintained. A quality assurance system has not been introduced and no development plan was available. Staff confirmed that they receive supervision and records of supervision sessions are kept but these are not detailed and the manager has not had training in how to provide formal supervision. Senior managers consider that she has been providing formal supervision for a number of years and is considered proficient and no further training is required. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 3 2 3 3 2 3 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 1 Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation OP14 Requirement Timescale for action 25/10/05 2. 3 and 7 OP15 3. 8 OP12 Accommodation must not be provided to residents unless their 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. ( The previous timescale of 12/07/05 was not met) Each resident, including 25/10/05 residents who have resite care, must have a plan of care for daily living that is based on the Care Management assessment and/or the homes own assessment (previous timescale of 20/01/05 not met). 31/12/05 The routines in the home must be based around the needs of the residents. The health care needs highlighted by the community care assessment undertaken by care management 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) DS0000019646.V257747.R01.S.doc Version 5.0 Beech Tree House Page 21 4 12 OP16 5 18 OP13 6 28, 30 and 38 OP13 7 29 OP19 and sched.3 OP24 8 33 9 38 OP26 Residents must be provided with appropriate programmes of activities both inside and outside the home. The manager and staff must be trained in the adult protection procedure to ensure that residents are safeguarded from abuse. The home must ensure that staff receive the statutory training including adult protection and health and safety to ensure the safety of residents and staff. The home must operate a robust recruitment procedure to ensure that only suitable people are employed. There must be effective quality assurance and quality monitoring systems in place which includes consultation with residents, relatives, friends 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) The regulation 26 visits to the home must be unannounced. 31/12/05 31/12/05 31/12/05 31/12/05 30/01/06 31/12/05 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 Refer to Standard 7 25 Good Practice Recommendations All assessments and records in care plans should be signed and dated. Tests should be made and recorded to check that the hot water is stored at 60oC and distributed at 50oC to prevent the risks from Legionella. DS0000019646.V257747.R01.S.doc Version 5.0 Page 22 Beech Tree House 3 31 The manager needs to be more organised and records better maintained. Beech Tree House DS0000019646.V257747.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York 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 DS0000019646.V257747.R01.S.doc Version 5.0 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. 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