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Inspection on 28/02/07 for Beechbrook Residential Home

Also see our care home review for Beechbrook Residential Home for more information

This inspection was carried out on 28th February 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users are assessed prior to admission and are given the opportunity to visit the home before moving in. Service users were observed to be well groomed and smartly dressed. Service users confirmed that their right to privacy is respected. Staff were observed to communicate with service users in a respectful and appropriate manner. The majority of staff have worked in the home for a number of years and have developed a good rapport with service users and relatives. The home provides a safe, comfortable and spacious accommodation for service users. Communal rooms are attractively furnished and decorated. All bedrooms are personalised and have private bathrooms, with appropriate aids as necessary. Currently all double bedrooms are used for single occupancy. Several bedrooms have a separate sitting room.

What has improved since the last inspection?

Since the last inspection one bathroom has been upgraded and several bedrooms have been redecorated. At the last inspection a good practice recommendation was made that training in moving and handling and fire training is updated on a regular basis. The provider/manager confirmed that all staff had received this training since the last inspection.

What the care home could do better:

Care plans need to contain sufficient information to demonstrate that the needs of service users are identified are being met. Appropriate risk assessments must be undertaken. needs of service users are identified are being met. Appropriate risk assessments must be undertaken. Records of prescribed medication administered to service users must be accurately maintained at all times and that risk assessments are completed for service users who are responsible for their own medication administration. The home`s policies and procedures on prevention of abuse and whistle blowing need to be developed, to ensure that staff are familiar and confident with procedures for reporting concerns or allegations made. Staffing levels must be reviewed to ensure that there is always a minimum of two care staff on duty during day time hours, to meet the needs of the service users. This must be in addition to catering and domestic staff. A review of the night staffing arrangements must be undertaken and include a review of the on call arrangements provided by senior staff, off site. Lone working risk assessments must be undertaken to ensure the health and safety of the staff member on duty alone. Action must be taken to ensure that recruitment practices are robust, to protect service users from potential harm. In addition to mandatory training, staff must be provided with appropriate specialist training in order to meet the needs of the service users.Procedures need to be put into place to ensure that the care provided to service users and the day to day management of the home is monitored effectively by the provider and that staff communication systems in the home are robust. That all care staff receive formal, planned supervision at least six times per year. All other staff receive supervision as part of the normal management process on a continuous basis. The home`s policies and procedures need to be reviewed and developed, as some documents are only brief statements. Records of accidents must be maintained to ensure the confidentiality of the information provided and a record of all visitors to the care home, including the name of the visitor. The Commission should be notified about deaths, illness and other events in the home. Records relating to safety information in the form of safety data sheets or COSHH assessments in relation to chemicals used in the home must be maintained.

CARE HOMES FOR OLDER PEOPLE Beechbrook Residential Home The Holt Hare Hatch Wargrave Berkshire RG10 9TA Lead Inspector Marie Carvell Unannounced Inspection 28th February 2007 10.55 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 Beechbrook Residential Home DS0000011400.V324673.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. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechbrook Residential Home Address The Holt Hare Hatch Wargrave Berkshire RG10 9TA 0118 940 3987 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) Mrs Catherine Seagrim Mr Michael Paul Seagrim Mrs Catherine Seagrim Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 2006 Brief Description of the Service: Beechbrook provides accommodation and care for up to fifteen service users over the age of sixty five years, who have care needs associated with old age. The home is not registered to provide care to people with needs associated with dementia or require full time nursing care; this would require additional registration categories. Accommodation is available on the ground and first floors of the home, with access to the first floor by staircase or passenger lift. All bedrooms have private bathrooms. One bedroom is separate to the main building. The current scale of charges as at February 2007 are between £675.00 and £1050.00 per week. There are additional charges for chiropody, physiotherapy, newspapers, hairdressing and toiletries. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 10.55 am and was in the service until 6.10pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s provider/manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. Four service users, four General Practitioners, one relative,one district nurse, a visiting hairdresser and visiting chiropodist responded to questionaires sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. A brief tour of the premises was carried out and a sample of records required to be kept in the home were examined, including case tracking of three service user’s files. At the last inspection carried out in January 2006, two requirements were made, these were that the provider/manager reviews the arrangements of the Grange Suite and considers its registration to ensure that there is no breach of registration and that full and satisfactory information is available on file for each employee and is available for inspection. These requirements had not been complied with, within the timescale given. In addition three good practice recommendations were also made, these were that the format used for care planning be reviewed to ensure that the care needs of service users are fully documented, training in moving and handling and fire training is updated on a regular basis and that advice is sought on testing the home’s water system. The first recommendation has been partly addressed and the second and third recommendation fully addressed. Feedback was given to the provider/manager throughout the inspection. What the service does well: Service users are assessed prior to admission and are given the opportunity to visit the home before moving in. Service users were observed to be well groomed and smartly dressed. Service users confirmed that their right to privacy is respected. Staff were observed to communicate with service users in a respectful and appropriate manner. The Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 6 majority of staff have worked in the home for a number of years and have developed a good rapport with service users and relatives. The home provides a safe, comfortable and spacious accommodation for service users. Communal rooms are attractively furnished and decorated. All bedrooms are personalised and have private bathrooms, with appropriate aids as necessary. Currently all double bedrooms are used for single occupancy. Several bedrooms have a separate sitting room. What has improved since the last inspection? What they could do better: Care plans need to contain sufficient information to demonstrate that the needs of service users are identified are being met. Appropriate risk assessments must be undertaken. needs of service users are identified are being met. Appropriate risk assessments must be undertaken. Records of prescribed medication administered to service users must be accurately maintained at all times and that risk assessments are completed for service users who are responsible for their own medication administration. The home’s policies and procedures on prevention of abuse and whistle blowing need to be developed, to ensure that staff are familiar and confident with procedures for reporting concerns or allegations made. Staffing levels must be reviewed to ensure that there is always a minimum of two care staff on duty during day time hours, to meet the needs of the service users. This must be in addition to catering and domestic staff. A review of the night staffing arrangements must be undertaken and include a review of the on call arrangements provided by senior staff, off site. Lone working risk assessments must be undertaken to ensure the health and safety of the staff member on duty alone. Action must be taken to ensure that recruitment practices are robust, to protect service users from potential harm. In addition to mandatory training, staff must be provided with appropriate specialist training in order to meet the needs of the service users. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 7 Procedures need to be put into place to ensure that the care provided to service users and the day to day management of the home is monitored effectively by the provider and that staff communication systems in the home are robust. That all care staff receive formal, planned supervision at least six times per year. All other staff receive supervision as part of the normal management process on a continuous basis. The home’s policies and procedures need to be reviewed and developed, as some documents are only brief statements. Records of accidents must be maintained to ensure the confidentiality of the information provided and a record of all visitors to the care home, including the name of the visitor. The Commission should be notified about deaths, illness and other events in the home. Records relating to safety information in the form of safety data sheets or COSHH assessments in relation to chemicals used in the home must be maintained. 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. The summary of this inspection report can be made available in other formats on request. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 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 Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 and 4. Standard 4 was subject to requirement at the last inspection. Quality in this outcome area is good. Service users are assessed prior to admission and are given the opportunity to visit the home before moving in. The provider/manager has agreed to develop the home’s Service User Guide, Statement of Purpose and service user contracts. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider/manager has agreed to review the home’s Statement of Purpose, Service User Guide and service user contracts, as they currently, incorrectly refer to the home being registered with Wokingham District Council. The Commission should be notified when the changes have been made. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 10 The provider/manager or deputy manager undertakes a pre-assessment of all prospective service users to ensure that the home is able to meet their needs. The assessment covers health, welfare and social circumstances. Prospective service users are encouraged to visit the home and move in on a trial period. Since the last inspection two service users have moved into the home. Service user questionnaires returned to the Commission confirmed that sufficient information was received in order to decide whether the home was the right place to live. During this visit time was spent with one service user who was spending four weeks in the home, before making a decision as to whether the home was able to meet her needs. Time was spent with two relatives of a prospective service user visiting the home. In discussion with relatives, several said that they were unaware of inspection reports being available to the general public or a copy given to prospective service users. The provider/manager agreed to provide this information with copies of the Statement of Purpose and Service User Guide and display in the home, copies of the most recent inspection report. From discussion with the provider/manager, the inspector considers that the home is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. At the last inspection, the inspector was made aware that a flat at the rear of the care home was occupied by a tenant. This accommodation is not registered with the Commission and therefore should not be providing personal care to the individual living there. A requirement was made that the provider/manager must review its arrangements and consider registering this accommodation to ensure that there was no breach of registration. Following clarification with the Commission it was agreed that registration was not required as the provider/manager confirmed that the tenant was not receiving personal care. At the time of this inspection the tenant’s needs had changed and it was evident from discussion with the tenant and staff on duty that their understanding was that the tenant was a service user. This was supported by written evidence. Following the inspection the provider/manager has written to the Commission to confirm that the personal care needs of the tenant will now be met by an external domiciliary care provider. The care home will continue to provide catering, cleaning and laundry services only. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Standard 7 was subject to a good practice recommendation. Quality in this outcome area is poor. Care plans need to contain sufficient information to demonstrate that the needs of service users are being met. Medication administration records need to be accurately maintained. Service users were observed to be treated with respect and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records of three service users were case tracked. Since the last inspection the provider/manager has changed the care planning documentation. However, there was no evidence that the service users are involved in the care planning process. No care plans seen were signed or dated. No evidence was available that care plans are updated or contained sufficient detail to ensure that all staff are familiar with the specific care needs of each service user, when care is to be provided or how. Some care provided is dependent on staff being available. For example, service users who require assistant with bathing are unable to Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 12 have a bath in the evening, due to only one member of staff being on duty. The provider/manager confirmed that three service users have mental health care needs. Care plans make no reference to psychological health, nutritional screening or end of life care. One service user had requested three baths each week; this was not recorded on the care plan. Daily records do not validate information recorded on care plans. Another care plan stated “No night time checks”, this was not supported by any other information, such as guidelines or a risk assessment despite the service users being referred to as “forgetful”. Daily records for this service user implied that some attention had been provided during the night as entries referred to the service user as “Slept well” In discussion with service users and comments recorded on questionnaires it was clear that service users’ considered that their care needs were being met. Comments received included “All the staff are very, very kind and caring and always willing to help in any way”, “ Excellent nursing when I suffered a temporary setback” and “That is why I like it here.” Healthcare needs are provided by several GP practices and records evidenced that healthcare professionals are involved as necessary. Service user questionnaires confirmed that medical support was always available. Comments received from questionnaires completed by healthcare professional included “ We have always found the home and its staff very amenable to us and our service”, “Beechbrook is always a pleasant home to visit. The staff consistently behave in a calm, professional and caring manner” and “ In my view Beechbrook is the best home of its kind in the area”. Comments made by two GP about requesting visits to the home in the afternoon, were passed to the provider/manager. Medication administration records were not signed to evidence that service users had received their medication on the morning of this inspection. The controlled drug book also evidenced that the previous night only one care assistant had signed for medication given. The provider/manager said that this was her fault, as the one care assistant on duty did not administer medication. It was not evident that risk assessments have been completed for those service users who are responsible for their own medication. Service users were observed to be well groomed and smartly dressed. Service users confirmed that their right to privacy is respected. Staff were observed to communicate with service users in a respectful and appropriate manner. The majority of staff have worked in the home for a number of years and have developed a good rapport with service users and relatives. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. Activities provided to service users are dependent on staff time and are limited. Service users who require minimal staff assistance are able to make choices about routines of daily living. Choices and preferences are not recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Many service users confirmed that the home meets their expectations and preferences well. For the independent service users the routines of daily living are flexible and varied to meet their needs and wishes. Choices and preferences are not recorded in care plans or daily records. Service users are encouraged to take part in a variety of activities both within the home and in the local community. Comments made on service user questionnaires included “Very few residents attend the activities, so they cannot always take place”, ”Activities are limited because of my bad eyesight”,” I do everything that I want to do” and “There are not many activities, because not sufficient residents wish to take part or are unable to do Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 14 so”. In discussion with service users many said that they spent time in the afternoons in their rooms. One service user showed the inspector a selection of knitted teddy bears made by a small group of service users, to benefit a children’s charity. Facilities available to service users include croquet, tennis, mini golf and a heated swimming pool. None of the current service users use these facilities. During the afternoon of this inspection the provider/manager held a word game with some service users, several left the game commenting that it was too difficult for them. It was not evident leisure or social activities are organised for those service users with sensory impairment or mental frailty. The one to one activities to be arranged with service users did not take place, as the two care staff on duty were preparing the evening meal. Service user meetings take place every six months, the last one being held in November 2006. Meetings are well attended. The majority of service users have friends and family who are able to visit the home on a regular basis. Service users are encouraged to maintain contact with the local community by attending functions, visits to local attractions, meals out and attendance at places of worship. All service users are encouraged to manage their own money. If this is not possible then relatives or friends assist as necessary. Copies of menus sent to the Commission showed that there is always a choice at lunchtimes of three dishes and the evening meals a choice of two dishes. Menus showed that a well balanced, varied diet is offered to service users. On the day of the inspection the day’s menu was displayed in the lounge. Comments made on service users questionnaires included “An alternative is always available”. One service user “always” liked the meals in the home and two service users “usually” liked the meals provided. In discussion with service users, several said that they were unaware of the food to be provided for lunch that day, that the menu was not always displayed and no choice was offered, although several service users commented that if they asked for an alternative then this would be provided, but they would need to ask as an alternate would not be offered. One service user said that they “Seemed to have a lot of pork dishes”. There is a cook employed to work 8.30am until 2.30pm for five days per week. When the cook is off duty or on leave, as she was at the time of this inspection, then food is cooked by the care staff. It is not evident that care staff who are involved in food preparation have received training in food legislation. Meals are plated up before being served to service users; service users are able to eat in their own rooms if they wish. No facilities are available for service users to prepare a drink or snack. Some service users have a fridge in their room/suite, where they can store fresh fruit, cold drinks or snacks. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. Service users are confident that their concerns and complaints will be taken seriously and acted upon. The home’s complaints procedure and recording of complaints needs to be developed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure and complaints book in the home, the provider/manager has agreed to review and updated the procedure and how complaints are recorded. Two complaints were recorded, one being a general complaint from service users and the second about a flowerbed needing weeding. The provider/manager said that she wouldn’t necessary record complaints received, as she tried to deal with them informally. Service user questionnaires commented that the four service users know how to make a complaint. In discussion with service users, most were clear about who they would speak to if unhappy or had a complaint, but none of the service users were aware of the home’s complaints procedure. The provider/manager has agreed to consider displaying the home’s complaints procedure in a prominent position in the home. The provider/manager confirmed that all staff have received training in safeguarding adults from abuse, and the home has a copy of the local authorities safeguarding adult procedures. The homes whistle blowing policy Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 16 and policy and procedure on abuse needs to be developed, as these are only brief statements. No information concerning complaints about the service has been received by CSCI since the last inspection. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24, 25 and 26. Quality in this outcome area is good. The home is maintained to a high standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a safe, comfortable and spacious accommodation for service users. Communal rooms are attractively furnished and decorated. During a tour of the premises, it was noted that a fire door was being wedged open, for ease of access to the kitchen and a fire exit through a service users bedroom was obstructed with furniture. The provider/manager has agreed to contact the Fire Authority for advice on how to address these issues. In addition it was noted that visitors were able to wander into the home and in some cases upstairs, without staff on duty being made aware. The provider/manager has agreed to address this immediately. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 18 All bedrooms are personalised and have private bathrooms, with appropriate aids as necessary. Since the last inspection one bathroom has been upgraded and several bedrooms have been redecorated. Currently all double bedrooms are used for single occupancy. Several bedrooms have a separate sitting room. The premises were seen to be clean and free from unpleasant smells. It was evident that the staff team work hard to keep the home clean, pleasant and hygienic. The gardens are extensive and enjoyed by service users and visitors in the warmer weather. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27, 28, 29 and 30. Standard 29 was subject to requirement at the last inspection and standard 30 was subject to a good practice recommendation. Quality in this outcome area is poor. Staffing levels are stretched at times to meet the needs of the service users. Recruitment procedures need to be more robust to protect service users from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a staff team of eight care assistants and a deputy manager in post who are contracted to work for 256 per week, in addition there is a part time cook, three part time domestic assistants and a part time administrator. The home currently has vacancy for a part time cook. From observation, examination of duty rosters and discussion with staff, staffing levels are at times inadequate to meet the needs of the service users. At the time of this inspection, the duty roster showed that the night care assistant had been on duty until 7.30am from 8pm the previous night, one care assistant was working from 7am until 2pm and the provider/manager working from 7.30am until 2pm, with a domestic assistant working 9am until 3pm. The care assistant was working alone, as the provider/manager had “popped out”. The care assistant said that the cook was on leave and in Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 20 addition to providing care to the fourteen service users, had prepared and served breakfast and was also cooking the midday meal. The care assistant on duty was unable to name two service users sat in the lounge and confirmed that she didn’t administer medication to service users. At 12pm an additional care assistant came on duty earlier than rostered to assist with serving lunch, as the provider/manager had a pre arranged appointment with relatives of a prospective service user to look around the home. A second care assistant came on duty at 2pm. Both care assistants were rostered to work until 8pm. The provider/manager arrived back at the home at 11.30am. Duty rosters over a four week period showed that on occasions there is no cook or cleaning staff on duty, that the contracted care hours only allow two care staff per shift, this includes the deputy manager, who provides “hands on care “as well as managing the home in the absence of the provider/manager. From 8pm until 7.30am, there is only one member on staff on duty in the home, with the provider/manager or deputy manager providing on call support from their own homes. Then provider/manager was unable to evidence that lone working risk assessments have been undertaken. In discussion with service users and from records seen, the night care assistant, on occasions is required to leave the main building to attend to service users, accommodated in the grounds. Duty rosters also evidenced that on occasions, when care staff are not available, then the administrator and domestic staff are covering these shifts. Care staff felt that two care staff on duty are able “to manage” if additional ancillary staff were on duty. Staff on duty were seen carrying out their duties with patience and a sense of humour, this was observed in their interactions with service users with mental frailty. Seven of the eight care assistants have achieved NVQ at level II or III. The deputy manager has achieved NVQ level IV in management and the Registered Managers Award. At the last inspection a requirement was made that full and satisfactory information is available on file for each employee and is available for inspection. Since the last inspection two members of staff have been recruited to non care posts, however, as already commented are covering duty rosters, when care staff are not available. The personnel files of the last two members of staff recruited were examined. One file contained an application form, without a full employment history being recorded, two references were on file and a letter offering the applicant a position dated the same day as she commenced working in the home. The letter stated “You will be employed under strict supervision until we have received satisfactory references, POVA (protection of vulnerable adults list of individuals unsuitable to work with vulnerable adults) and CRB (criminal records check for convictions or police cautions) checks. The member of staff was in post for two months before a fast track POVA check was carried out, putting service users under potential risk of harm. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 21 The second staff file contained a CV, but this did not contain full details of employment or explanations about gaps in employment history. Although this member of staff commenced her current position in the home in January 2007, the references were dated 2002, with a job description for an unconnected post. A POVA first check was undertaken in November 2005 and a CRB in January 2006. It was not evidenced what level the CRB was checked. A preemployment medical questionnaire was dated October 2005. At the last inspection a good practice recommendation was made that training in moving and handling and fire training is updated on a regular basis. The provider/manager confirmed that all staff had received this training since the last inspection. The provider/manager confirmed that the home has a staff training and development programme and a copy of this document was sent to the Commission after the inspection. Unfortunately this document only records a list of training courses, only refers to “all staff” or “care staff” and states the provider as “to be decided”. The document needs be developed to include individual training, a development assessments and profiles for each staff member. There is a need for staff to receive training in Infection Control, food hygiene and First Aid. In addition to mandatory training, staff should receive appropriate specialist training, for example training to meet the specific care needs of service users with mental health care needs. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38. Standard 38 were subject to good practice recommendations at the last inspection. Quality in this outcome area is poor. It is not evidenced that the home is effectively managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider/manager is a qualified nurse and has completed NVQ level IV and the Registered Managers Award. The provider/manager is rostered to be on duty full time, however this is not necessary in the home as the provider/manager’s office is external to the building. A part time administrator supports the provider/manager. The daily routines and management of care is delegated to the deputy manager. It is not clear how the provider/manager monitors the care provided or staffing issues in the home. The Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 23 provider/manager was unsure of where some records were stored and appeared to be unaware of the contents of some records. The provider/manager commented that she preferred inspections to be undertaken by appointment to ensure that the administrator and deputy manager were present. Service users benefit from an experienced, stable staff team who have worked in the home for many years. It is not clear how information is cascaded in the home as staff meetings are held infrequently and are poorly attended by care staff. Staff handovers take place at the end of each shift; staff confirmed that this is dependent on staff coming on duty earlier than rostered or staying later. The provider/manager is currently working on an annual development plan for the home. The home’s business and financial plan was not available at the time of the inspection and was sent to the Commission after the inspection. Unfortunately this business plan was unrelated to the care home. No monies are held in safekeeping on behalf of service users. Staff do not receive formal supervision at least six times per year. This was confirmed by the provider/manager. The home’s policies and procedures need to be reviewed and developed, as some documents are little more than a brief statement. Not all records are in good order. Accident records are not being maintained to ensure that the confidentiality of the information is protected. The provider/manager was unaware of the need to inform the Commission of all deaths of service users. A sample of records relating to fire and health and safety were up to date and well maintained. Safety information in the form of “ safety data sheets” or COSHH assessments in relation to chemicals used in the home were not available for examination by the inspector. Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 24 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 2 2 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 1 3 1 1 2 Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 Requirement Care plans must be in sufficient detail to ensure that all staff are familiar with the specific care needs of each service user, when care is to be provided and how. Service users’ psychological health needs and nutritional screening are monitored on a regular basis to ensure that the care needs of service users are being met. Records of prescribed medication administered to service users must be accurately maintained at all times and that risk assessments are completed for service users who are responsible for their own medication administration. The home’s policies and procedures on prevention of abuse and whistle blowing need to be developed, to ensure that staff are familiar and confident with procedures for reporting concerns or allegations made. Staffing levels must be reviewed to ensure that there is always a minimum of two care staff on DS0000011400.V324673.R01.S.doc Timescale for action 28/04/07 2. OP8 13 28/04/07 3 OP9 13 28/04/07 4 OP18 13 28/05/07 5 OP27 18 28/04/07 Beechbrook Residential Home Version 5.2 Page 26 6 OP27 18 7 OP29 19 8 OP29 17 9 OP30 18 10 OP31 10 11 OP34 25 12 OP36 18 duty during day time hours, to meet the needs of the service users. This must be in addition to catering and domestic staff. A review of the night staffing arrangements must be undertaken and include review of the on call arrangements provided by senior staff, off site. Lone working risk assessments must be undertaken to ensure the health and safety of the staff member on duty alone. Action must be taken to ensure that recruitment practices are robust, to protect service users from potential harm. Full and satisfactory information must be available on file for each employee. The previous timescale of 30/03/06 has not been complied with. A staff training and development programme must be completed and include individual staff training, a development assessments and profile for each member of staff. In addition to mandatory training, staff must be provided with appropriate specialist training in order to meet the needs of the service users. Procedures need to be put into place to ensure that the care provided to service users and the day to day management of the home is monitored effectively by the provider and that staff communication systems in the home are robust. A copy of the home’s business and financial plan must be sent to the Commission, to demonstrate the effective and efficient management of the business. That are care staff receive DS0000011400.V324673.R01.S.doc 28/04/07 28/04/07 28/04/07 28/04/07 28/04/07 28/04/07 28/05/07 Page 27 Beechbrook Residential Home Version 5.2 13 OP37 17 14 OP37 17 15 OP38 13 formal, planned supervision at least six times per year. All other staff receive supervision as part of the normal management process on a continuous basis. The home’s policies and 28/05/07 procedures need to be reviewed and developed, as some documents are only brief statements. The Commission is to be notified 28/04/07 retrospectively, in writing of the two service users who have died since the last inspection. Records of accidents must be maintained to ensure the confidentiality of the information provided and a record of all visitors to the care home, including the name of the visitor. Records relating to safety 28/04/07 information in the form of safety data sheets or COSHH assessments in relation to chemicals used in the home must be maintained. 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 OP12 Good Practice Recommendations Leisure and social activities are developed for service users with sensory impairment and/or mental frailty and form part of the individuals care plan. Menus accurately reflect food choices and any alternates offered. Vegetables and gravy served separately instead of being plated up and consideration given to the provision of facilities for service users to prepare a drink or snack. 2. OP15 Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Beechbrook Residential Home DS0000011400.V324673.R01.S.doc Version 5.2 Page 29 - 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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