Inspection on 29/06/06 for Beech Tree House

This inspection was carried out on 29th 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 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 21/05/07

Beech Tree House 25/10/05

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 Jo Bell Key Unannounced Inspection 29th June 2006 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.V298992.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 Tree House DS0000019646.V298992.R01.S.doc Version 5.2 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.V298992.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Category (PD) applies to one named service user. Date of last inspection 25th October 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. The fees range from £315-420. 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.V298992.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The first site visit of the year took place on Thursday 29th June 2006. this is part of the key inspection process. One inspector spent 7 hours at the home. The manager was available to assist with the inspection and time was spent touring the premises, checking documentation and speaking with service users and staff. Thirty one service users were residing at the home, both individual and group discussions took place with the service users to ascertain the level of service they receive. The overall quality of care was good, the environment was pleasant and service users commented positively on the food. The manager has applied to the CSCI to become registered, this will be determined shortly. What the service does well: What has improved since the last inspection? Redecoration of the home has being taken place, this was evident at the site visit. This has enhanced the environment for service users. Service users can be confident their needs will be met through improved Care plans, and needs being routinely reviewed and evaluated. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 6 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.V298992.R01.S.doc Version 5.2 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.V298992.R01.S.doc Version 5.2 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): 3&6 Quality in this outcome area is adequate. Service users needs are discussed and recorded through the assessment process. However, attention must be paid to using the correct documentation which should be obtained prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre-admission assessment is undertaken by the manager of the home. Three assessments were checked and these were found to be comprehensive. Details regarding social, physical and psychological care was included. However, the manager was unclear as to exactly which documentation should be used. The ‘admission assessment’ was being used as the pre-admission document and whilst this did not have any detrimental effect on the service users the forms provided through Four Seasons should be used correctly. The home provide intermediate care, one service user was admitted as emergency respite and whilst an assessment had taken place by the home Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 9 once the service user was admitted, it was evident that the Community Care assessment followed a few days later. The manager should obtain this information prior to admission. In discussions with the service user it was evident that rehabilitation was taking place. This person would be resident in the home for 4-6 weeks with the intention of going back home. Physiotherapist services are in place, mobility is being encouraged and staff are aware that this person is in the home for intermediate care. This is reflected in the statement of purpose. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. Service users care needs are met, with health and personal care delivered appropriately. However, the medication procedure needs improving to ensure service users are not put at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The quality of care provided in the home is good. Staff know the service users and can meet their care needs in a professional manner. Three care plans were checked these all contained details relating to social and medical history. Discussions took place with a range of service users, they felt the care was good and staff looked after them well. Information in the care plans included risk assessments for moving and handling, nutrition, prevention of falls and the prevention of pressure sores. Care plans had been reviewed and evaluated on a monthly basis. The home have acted upon the previous requirements regarding the need to improve the care plans. Three service users confirmed that they were aware of their care plan and had been involved in the drawing up of the document. Healthcare professionals are available as needed. The GP Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 11 visits the home, and during the site visit a community staff nurse and community psychiatric nurse were observed visiting. They were both spoken with and were complimentary about the care service users receive. One person who asked to see the inspector very proudly said ‘I love it here’. The service user was happy with every aspect of the care. Access to the infection control or tissue viability nurse is available and the manager is keen to liaise with professionals when the need arises. Privacy and dignity was maintained throughout the site visit, staff were observed treating service users in a polite and friendly manner. Health care professionals provide care in service users own rooms, and there is a telephone available for service users if needed. The medication system was checked. The home have an appropriate procedure in place for administering, storing, recording and disposing of medication. The medication charts are completed correctly and medication including controlled drugs are documented appropriately. Fridge temperatures are taken and staff have received training in using the monitored dosage system of medication. At lunchtime a medication round was observed. On three separate occasions the trolley was left unattended whilst the carer administered medication to a service user. On top of the drugs trolley all the medication to be administered at lunchtime was exposed. This should have been locked away and the trolley should have been kept with the member of staff administering the medication. The manager was alerted to this and acted immediately. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. Service users have a good choice of meals, though attention to detail is needed. There are a range of activities for service users to participate in and service users are encouraged to decide what their daily routine is. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a range of activities for service users, outings to the ‘Courtyard’ opposite the home where school children sing takes place on a regular occasion. This was mentioned in the monthly newsletter which service users receive, and in group discussions service users clearly enjoyed this aspect of the activities. The home has a pleasant garden for service users to enjoy and games including dominoes and cards are offered. The inspector participated in a game of dominoes with four service users and the atmosphere was lively and conservation was interesting. Visitors to the home are encouraged and whilst no relatives were available to speak with this was evident through the entries in the visitors book and in discussions with service users. One service user said a relative comes each week and spends quite a lot of time in the home. Staff said visitors are welcomed at any time and links with the local community are encouraged. One service user said there is a choice in Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 13 what time you get up and go to bed, meal times are flexible and service users can decide what they do during the day. The local clergy visit and religious needs can be catered for as requested. The food provided in the home is good. There is a choice of food which includes a meat dish with fresh and frozen vegetables, home cooked deserts and a range of alternatives if service users prefer something different. Lunchtime was observed and the dining area was light and airy with material table cloths in use. Both large and small tables were available for service users and when the food arrived service users were observed enjoying good sized portions of either liver and onion or Cornish pasty. In the dining room it was evident that plastic beakers were used instead of glasses, no explanation could be given to the rationale for this, and service users had a jug of water on the table to drink. A selection of juices would have been preferable. The dining room whilst generally calm was affected by the kitchen door continually being banged next to one of the tables where three service users were sitting. Comments were overheard regarding this constant interruption. A discussion took place with the chef. Food hygiene training had been completed and the chef was knowledgeable in how to meet nutrition needs. She was aware of how to fortify food, and the range of diets needed. The kitchen generally was clean and tidy. However, it was evident that the sliced bread which had been given to service users was out of date. The stock had not been rotated and it was unclear if the bread was fresh or had been frozen. The chef explained that service users did not have the roast chicken which was on the Sunday menu, this had not been properly defrosted so an alternative was offered. The chef should ensure meals are appropriately planned for to avoid any service users being disappointed. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 Quality in this outcome area is good. Service users feel their concerns will be listened to by the home, and the risk of harm is minimised through robust adult protection procedures which the manager is familiarising herself with. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home have a complaints procedure in place this contains appropriate timescales and service users feel they can discuss any concerns with the staff at any time. No formal complaints have been made. The manager and deputy chat with service users on a regular basis and identify any issues of concern. A record of complaints is available and service users feel that any issues will be dealt with effectively by the home. The home have an adult protection procedure in place. Care staff are familiar with the different types of abuse and know what action to take if an incident occurs. Service users spoken with said staff treated them kindly and they were always handled in a gentle manner. Adult protection training has taken place which was confirmed through checking training records. Whilst the manager has some understanding of the procedure involved she needs to be clear about who the lead agency is. No adult protection issues have occurred and observations showed service users been treated in a respectful and caring manner. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 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 the following standard(s): 19 & 26 Quality in this outcome area is good. Service users live in a pleasant and clean environment which is maintained effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users enjoy living in this environment. The large detached building is set in its own grounds and has two floors for which a passenger lift is available. There is ramped access for wheelchair users and there are a range of communal areas for service users to enjoy. At the site visit redecoration of the hallway was taking place. Service users commented on what an improvement this was and how nice the newly painted area looked. The atmosphere was homely and service users felt comfortable in their environment. The home have infection control procedures in place, the laundry has washing machines and tumble driers and staff have received training in this area. The home throughout smelt clean and fresh. Staff were observed using gloves and aprons where necessary. Two domestic staff were spoken with who were Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 16 clearly committed to their work and they felt a high standard of hygiene is maintained. One service user said ‘my room is always spotless’. The staff have recently completed an infection control questionnaire, this was to highlight the understanding the staff had regarding the infection control procedures of the home. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 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 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. Service users needs are met through adequate staffing levels and suitably trained staff working in the home. Service users are protected through robust recruitment systems. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels in the home are adequate, the manager is supernumerary and the deputy works with three carers during the day. There is always a senior carer on duty. Overnight there are two carers on shift. At the site visit service users needs were met and any calls bells ringing were answered in a prompt manner. Staff were busy during the morning but did some have some time in the afternoon to offer one to one sessions with the service users. Staff are encouraged to completed an NVQ Level 2 or above, currently four staff have obtained an NVQ, whilst a further three are working towards this. Staff are aware that input by the CPN is needed for some service users and they are keen to work with the mental health team to promote a good standard of care for this client group. Induction training is offered and individual training records confirmed new staff follow the induction process which is equivalent to Skills for Care (formerly known as TOPSS). This covers a range of care practices and how to meet social and physical needs of individuals. Staff receive a minimum of three days paid training per year. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 18 The recruitment procedures in the home are robust. Staff complete application forms, interviews take place and both CRB and POVA checks are completed prior to commencement of employment. Three staff files were checked which were found to be complete. Service users spoken with felt staff were skilled and competent in their work. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 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 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 7 38 Quality in this outcome area is adequate. The home is generally run in the best interests of service users, and their views and opinions are sought. The manager needs to be more familiar with the home’s policies and procedures, though health and safety in the home is well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home has applied to the CSCI to become the registered manager she has many years experience working in the care sector and generally manages the home in the best interests of the service users. Service users were aware of who the manager of the home was and staff were all complimentary regarding the effectiveness of the manager. In discussions with the manager it was evident that more familiarity with policies and procedures was necessary, this included adult protection, assessment documentation Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 20 and the quality assurance information. The quality assurance system included Regulation 26 visits by the regional Manager on a monthly basis. A yearly audit was completed in March 2006. For this Four Seasons developed a set of fourteen standards which the home were assessed by. Service users and their relatives have been sent surveys to ascertain their views of the home and residents meetings take place on a regular basis. The home produce a monthly newsletter, this was examined and contained information regarding activities, birthdays and issues affecting the service users. The manager could not locate the annual development plan which Four Seasons need to have in place. Service users finances were discussed, three accounts were checked. Currently service users can deposit small amounts of money for safekeeping, this may be for hairdressing, chiropody, newspapers or toiletries. Receipts are available with these details to confirm the money available. Currently some service users keep their own money in either a wallet or purse, however staff do not know the amounts kept. One service user had a wallet go missing with money in, staff thought it had gone to the laundry and though a search of the home has taken place the wallet or contents have not been found. The manager contacted the police. However, as they felt it was mislaid no further action has been taken. The home needs to review this system as other service users may be carrying large amounts of money which the home is not aware of. Whilst it is up to the service user how they look after their money a more robust system needs to be implemented to safeguard other service users. Health and safety issues are addressed in the home. Records pertaining to gas safety, bathing equipment, emergency lighting, the call bell system and water temperatures were all checked and found to be completed correctly. The health and safety executive visited in April and environmental health visited in June 2006. No serious issues were raised. In the event of a fire the doors automatically close, the home adheres to fire procedures and staff receive mandatory training in fire safety, moving and handling, COSHH, infection control and food hygiene. This was confirmed when examining the training records of three members of staff. Service users and staff spoken with said they felt safe in the home and no concerns were raised during the site visit. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 2 x x 3 Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 22 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 OP3 Regulation 14 Requirement The manager must obtain a copy of the Community Care assessment prior to admission for emergency respite. During administration of medication the drug trolley must not be left unattended with medication exposed. Catering staff must ensure food is not given to service users which has expired. Improved planning of the meals to be served needs to take place to ensure service users are given the food they expect. Service users must be offered glasses to drink out of instead of a plastic beaker, and a choice of drinks other than water should be offered at lunchtime. The door into the kitchen next to where one of the dining table is situated must be adjusted to prevent it from making a loud banging noise every time a member of staff comes in and goes out of this area. Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 23 Timescale for action 29/06/06 2. OP9 13 29/06/06 3. OP15 16 29/06/06 4. OP31 13 The manager must be familiar with the adult protection procedure in the home. 29/07/06 5. OP31 24 An improvement plan will be 29/07/06 forwarded to the CSCI within one month setting out the methods by which the registered person intends to improve the services provided in the care home. 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. 4. Refer to Standard OP3 OP28 OP33 OP35 Good Practice Recommendations The manager must ensure the correct documentation is used when carrying out pre-admission assessments. home. Care staff should achieve an NVQ Level 2 or equivalent The home should have an annual development plan in place The home should review how service users money is dealt with Beech Tree House DS0000019646.V298992.R01.S.doc Version 5.2 Page 24 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.V298992.R01.S.doc Version 5.2 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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