Inspection on 30/01/06 for Beech Tree House

This inspection was carried out on 30th January 2006.

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 13/07/05

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 Somerset TA11 6DZ Lead Inspector Loli Ruiz Unannounced Inspection 30th January 2006 10:00 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 DS0000016082.V281337.R01.S.doc Version 5.1 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 DS0000016082.V281337.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beech Tree House Address High Street Keinton Mandeville Somerton Somerset TA11 6DZ 01458 223369 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) Mr John Whitehouse Mrs Estelle Louise Josephine Whitehouse Mrs Estelle Louise Josephine Whitehouse Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16) of places Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 16 persons in categories OP and DE (E) Date of last inspection 13/07/05 Brief Description of the Service: Beech Tree House is a care home, providing personal care, for 16 older people with dementia care needs. Situated in the village of Keinton Mandeville, the property was built around 100 years ago and extended to accommodate 14 people when it became a care home about 18 years ago. Recently a further extension has provided two additional en-suite rooms that meet modern environmental standards and have been registered with CSCI. Accommodation is on the ground and first floors with the majority of bedrooms on the ground floor. 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 DS0000016082.V281337.R01.S.doc Version 5.1 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. This was an unannounced inspection, carried out by one inspector. The last inspection was announced and took place on the 13th July 2005. Mrs Whitehouse and staff on duty assisted with the inspection. There were 16 persons living in the home and all were at home. The inspector had contact with all service users and those who could provide feedback did so positively, indicating that they liked living in the home and that the staff were kind. A relative also provided positive feedback about the care provided to their relative in the home. A tour of the premises was made, storage of essential items and care practices observed and a range of records were inspected during this visit. What the service does well: Service users benefit from a homely, secure and well maintained home. The home provides a positive experience for those living in it and for those visiting it. Good care staff practices were observed. The home maintains good pre-admission arrangements and provides service users with good opportunities on which to make a decision about moving in. The home has robust recruitment procedures and induction- foundation training that protects service users from the risk of abuse. Service users are provided with daily planned activities. Service users benefit from a stable and well-trained staff team that promote a relaxed atmosphere. More that 50 of staff have NVQ qualifications at levels II and III. There are good links with local social and NHS professionals and with relatives with whom part of the care is shared as appropriate. Relatives are also involved in care reviews. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 6 The arrangements for the storage and administration of medicines, training and supervising staff in this area, protect service users, as observation of practice and inspected medication records evidenced. What has improved since the last inspection? What they could do better: Hot water supply for the two new bedrooms en-suite basins should be made available as a matter of priority. The planned review of the menus should provide freshly cooked substantial mid-day meals to replace those meals now on the menu made up with tinned or processed ingredients. The practice of cooking meat the previous day for serving hot the following day should stop. Storage heaters that get hot during the night and are hot in the mornings should be risk assessed and provided with appropriate protection to minimise identified risks- or their use be replaced by the LSH radiators installed in the home but observed to be cold during the inspection. The manager should ensure that the few staff members that have not had a recent Safe Manual Handling update have one as a matter of priority and that the system is reviewed so that no staff miss such updates in future. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 7 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 DS0000016082.V281337.R01.S.doc Version 5.1 Page 8 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 DS0000016082.V281337.R01.S.doc Version 5.1 Page 9 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, 4, 5 ( Standard 6 does not apply) Standards 1 to 5 were all met in July 2005 The home has thorough pre-admission arrangements that also provide good opportunities for the service user to make a decision about moving in. EVIDENCE: Service user information was observed by the entrance of the home and included the statement of purpose, service users rights and previous inspection reports. These documents were not inspected as the standard had been fully met in July 2005. A visiting relative explained the process followed before making a decision to choosing Beech Tree House. This included prior visiting, trial day, and professional assessments and liaison between all involved with the home. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 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. Standard 11 was met in July 2005. Service users health needs are met by the care practices in the home. Service users benefit from a good care planning system that also assesses and recognises areas of risk and provide appropriate action for staff to follow to meet the identified needs. Service users, however are not invited to sign their agreement to their plan, as they should be. Service users are protected by the medication procedures in the home that include medication training for staff who also have their competencies periodically tested. Service users benefit from a care ethos that respect their dignity and privacy. EVIDENCE: Three care records were selected for inspection. One of these was of a newly admitted service user. Care records seen evidenced good pre-admission and risk assessments, care plans and access to social and health care Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 11 professionals. They also evidenced links with relatives, formal and informal reviews. Relatives were invited to formal reviews and a visitor evidenced being involved with day-to-day care issues. The home’s care plans, assessments and reviews seen lacked the signatures of the service users concerned or that of their relative or advocate. Many service users come from neighbouring counties and all are registered with a local medical practice. Records seen evidenced access to a range of NHS and private health professionals. A relative had taken a service user to the dentist at the home’s request. District nurses came in to assist with health care or skin issues and to assess continence needs. The manager indicated that there are visiting opticians and podiatry services. Mental health professionals are involved and the home has links with Magnolia House in Yeovil. The medication area was found well managed. Areas raised at the last inspection had been improved. The medication trolley is now sited in a cooler Site and the temperature is monitored. “as required” entries in MARs now have explanatory instructions that are signed by two staff members. Staff were observed going about their work and relating with service users in a respectful and kindly manner. They responded to requests from service users and assisted them kindly and promptly. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 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. Service users benefit from the home’s practices that are flexible and allow for The expression of individuality. Service users can receive visitors at any time. Service users benefit from regular meals and frequent beverages. Their diet would be further improved if the tinned and processed ingredients used for 50 of the midday meals were replaced by fresh produce, and freshly cooked meats and fish. EVIDENCE: The home continues to provide daily activities mostly in the afternoons. These are planned, and tasks allocated to staff on duty. During the inspection the two care staff were in frequent contact with service users, not just attending to their care needs but also providing social interaction and gentle music. A number of indoor activities were planned for the afternoon providing choice. The home shares the use of a minibus with its other home in Bridgewater and Mrs Whitehouse indicated that outings are occasionally organised. The home has accessible and well maintained gardens. During the inspection the majority of service users stayed in one of the living rooms but there was also evidence that those who preferred to move about in other areas were free Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 13 to do so. Service users bedrooms were fully personalised. There was a relaxed atmosphere and service users appeared content. Those who could provided a very positive feedback about their experience of living in the home. A visitor spoken with also provided positive feedback. The lunch menu consisted of sausage, baked beans and chips. One person was observed having egg and chips instead. There was a sweet of fruit crumble. Copies of the 4 week menus were provided. Menus are well laid out and evidence that regular meals and beverages are served. This was also observed during the morning. Some 50 of midday meals were made up with tinned or processed ingredients. Mrs Whitehouse indicated that menus are at present under review and agreed to redraw the ingredients used at midday. The meat for roast meals was cooked the previous day and re-heated the next day. Alternative strategies should be worked out so that this practice stops- both for safety reasons, as meat is a high risk item, and also for quality reasons. The meal was served in a very pleasant dining room and service users had the assistance that they needed during the meal. There continued a relaxed and homely atmosphere in the home throughout the meal. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 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. Standard 17 was fully met in July 2005. Service users benefit from the home’s complains procedure. Service users are protected from abuse by the home’s recruitment and training procedures. EVIDENCE: There had been a recent complaint, the first one since Mrs Whitehouse took over the ownership of the home. That was appropriately investigated by the manager and promptly responded to both complainant and CSCI. The file of a new staff member was inspected evidencing that all appropriate checks are carried out and that induction training and necessary supervision are in place. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 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): 19,20,21,22,23,24,25,26 Service users benefit from a home that is well maintained, comfortable and also furnished and decorated to a high standard. Service users can access safe and attractively maintained gardens. Service users enjoy en-suite facilities in the majority of bedrooms and have sufficient communal bathrooms and WCs, however, their choice would be enhanced if the shower room was adapted as such, so that they could use it. Service users benefit from comfortable and attractive bedrooms that reflect their individual styles, however two bedrooms had not hot water supply to their basins. Some bedrooms and public areas had hot, unprotected storage heaters that the manager agreed to risk assess and to take appropriate action to minimise risks. Service users benefit from a clean home. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 16 EVIDENCE: A tour of the home was undertaken and all areas seen were attractive, comfortable, clean and, generally well maintained. The home has one double room and all bedrooms except two, have en-suite facilities. They were all personalised and attractive. There are large gardens that are accessible from the living areas, attractively maintained and safe. There are three bathrooms, two of them downstairs. The upstairs bathroom is not adapted and not used. The shower is in a bathroom that has small sized bath. There is a bath chair in it but this bath in not in use either, possibly because of its size. The manager agreed to consider converting this room to a walk-in shower that would provide genuine choice for service users. One of the bathrooms downstairs is well adapted and of a good size. There are three WCs near the communal areas and bedrooms have WCs. The temperature of hot water outlets is checked and recorded. The manager agreed to maintain a record showing that the shower and taps not in use are run at least weekly to prevent legionela bacteria in the system. The two new bedrooms have no hot water supply and have not had it for some time. This should be resolved as a matter of priority. The home has dual heating systems: Oil fuelled system with cool surface radiators and a number of electric storage heaters. On the day of the inspection a number of storage heaters in public and private areas were observed too hot to the touch and unprotected. The heaters got cold by the early afternoon. The oil fuelled heating was off during the morning (radiators were cold). Mrs Whitehouse agreed to risk assess the storage heaters and take appropriate action to minimise identified risks, and whenever possible use the LSH radiators instead as they are safer. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 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. Service users benefit from adequate staff numbers and a stable and capable staff team. Service users benefit from the systems in the home that ensure that staff have good foundation training and that staff are developed in their roles. Service users are protected from the home’s robust recruitment practices (see complaints and protection). EVIDENCE: Staff confirmed that staffing levels have been maintained since the last inspection. On duty were two care staff, one of them was a designated senior carer and took charge of the shift, a domestic assistant and a cook that worked from 11 a.m. to 2 p.m. (Mrs Whitehouse may wish to review the cook’s hours in connection with cooking roast dinners- see standard 15). Day staff overlap with night staff for one hour to assist service users at a busy time. At night there is one awake staff member and a sleep-in staff on call. Mrs Whitehouse was off duty but came to the home to assist with the inspection. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 18 Staff on duty were able to provide service users with the support and assistance that they required and to do so in an unhurried manner. There was a very pleasant, relaxed and homely atmosphere in the home and staff were observed socialising and chatting with service users. Training records confirmed that the home has maintained a ratio of above 50 of staff that are NVQ qualified at levels II and III. There is also a good record of mandatory and specialist training. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 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): 31,32,34,35,36,37,38. (Standard 33 was fully met in July 2005). Service users benefit from a well-run home, and from a qualified and experienced manager who promotes openness in communications with those involved with the home. Service users benefit from a home that has financial viability and is appropriately insured. Service users benefit from a stable, capable and enthusiastic staff team, that promote a relaxed and homely atmosphere, and also from hands-on managerial staff. Service users are protected by the health and safety arrangements in the home, and also by its policies and procedures. Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 20 EVIDENCE: The registered manager, Mrs Whitehouse, has owned the home for 20 years. She has completed the Registered Managers Award. Staff have clear designated areas of responsibility. Staff are closely supervised informally and also have formal supervision with frequent supportive meetings. Staff spoken with confirmed that they were well supported in their roles and demonstrated being able to provide a homely, caring and relaxed environment for service users. The home had valid insurance cover and Mrs Whitehouse confirmed that it was viable and able to invest capital in maintaining it to the present high standard and also to invest in training for staff. The home only manages the cash of one service user for whom appropriate records are maintained, receipts are obtained and records include are appropriately signed. Service users have lockable space and lockable rooms. A number of records were inspected and, unless already mentioned under previous standards, found to be well maintained and up-to-date. Records inspected included the new induction package, training charts, staff recruitment, fire logbook and maintenance, servicing of mobile equipment, of water temperature readings, menus, Rights charter and required documentation displayed by the entrance of the home, activities charts, care and medication records. The mandatory training records showed that staff had received all essential training, and also specialist training, but also that a few staff had not received the annual update in Safe Manual Handling as they should do. Mrs Whitehouse confirmed that the staff had received the training but had failed to document this. A tour of the premises evidenced a well maintained and a generally safe home. Areas that needed further risk assessment, action, or new ways of evidencing checks, were agreed with the manager (see standard 25). Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 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 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 2 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 3 3 x 3 3 3 3 3 Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 15 Good Practice Recommendations The use of tinned and processed ingredients for the midday meal should be reviewed in favour of more fresh and unprocessed ingredients cooked in the home. Meat for roast dinners should be freshly cooked on the day. It is strongly recommended that hot water supply be installed in the two new bedrooms’ basins. The manager should risk assess storage heaters in service users areas and take appropriate action to minimise risks. 2. 3. 25 25 Beech Tree House DS0000016082.V281337.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton 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 DS0000016082.V281337.R01.S.doc Version 5.1 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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