Inspection on 02/09/08 for Beechcare Care Centre

This inspection was carried out on 2nd September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beechcare Care Centre 04/09/07

Beechcare Care Centre 05/02/07

Beechcare Care Centre 02/05/06

Beechcare Care Centre 21/11/05

Beechcare Care Centre 13/04/05

Beechcare Care Centre 07/09/04

Beechcare Care Centre 01/06/04

Beechcare Care Centre 20/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

Thorndene

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beechcare Care Centre Darenth Road South Darenth Dartford Kent DA2 7QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hall     Date: 0 2 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Beechcare Care Centre Darenth Road South Darenth Dartford Kent DA2 7QT 01322628000 01322628001 beechcare@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Beechcare Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Name of registered manager (if applicable) Karen Elizabeth Kempson Type of registration: Number of places registered: care home 74 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Beechcare Care Centre consists of two large, detached single storey buildings, which are closely adjacent to each other. Beechcare is a forty-eight bed unit for older people with nursing care, and the second building is the Peter Gidney Unit. This provides care for twenty-six younger adults with physical disability and nursing needs - particularly including neurodisability. The home is owned by Four Seasons Healthcare, who have a number of care homes across England and Scotland. It is situated in its own extensive grounds in a rural setting, but close to the town of Dartford, with all the usual town amenities and shopping areas. The surrounding gardens are attractively maintained, Care Homes for Older People Page 4 of 32 Over 65 48 0 0 26 Brief description of the care home and overlook the countryside. The home can easily be reached via the M20, M25 and M26 motorways. Most bedrooms are for single use, and all bedrooms in Beechcare (and some in the Peter Gidney Unit) have en-suite toilet facilities. There are spacious communal areas in both buildings. Fee levels are set according to the individually assessed needs of each resident. There are additional charges for items such as hairdressing, chiropody and newspapers. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This home has been assessed as having a rating of good, 2 stars. The fee levels currently range from 560.29 - 1000.00 per week, depending on the assessed needs of each individual resident, and the room being used. This was a key inspection, which includes all information gained about the home since the last inspection, as well as a visit to the home. CSCI survey forms were sent out to residents, health professionals and staff, and nine were received back. These contained mostly positive information, indicating that residents are happy with the care they receive, and are confident that their views are listened to and are taken into account. Comments included: of course I am well Care Homes for Older People Page 6 of 32 looked after! and I am happy with the way the home is run. The inspection visit was carried out by one inspector and lasted for nine hours. During this time, we (i.e. CSCI) chatted with nine residents, six relatives, one health professional, and nine staff, as well as the manager, who was present throughout the day. The companys area manager was also present in the home, and feedback was given to the manager and area manager together. The home is divided into two units: Beechcare - for the care of older people with nursing needs; and the Peter Gidney Unit - for the care of younger adults with physical disability and nursing needs. Both buildings were inspected, and medication and care plans were inspected in both units. Both buildings were clean and well presented, and there was a relaxed and homely atmosphere. Staff are friendly and approachable, and provide good standards of care. CSCI has not received any complaints about the home since the previous inspection, and there have been no referrals to the Social Services Safeguarding Adults team. What the care home does well: What has improved since the last inspection? What they could do better: The medication room in Peter Gidney is too small for its purpose. There is insufficient space for effective storage and administration of medicines. The room temperature is borderline. The complaints procedure on display does not include timescales for a response to complainants. Care Homes for Older People Page 8 of 32 There is a general lack of storage space in Peter Gidney unit, so that there is no specified area for hoist and wheelchair storage, linen trolleys and other equipment. Beechcare bathing facilities do not include a dedicated shower room (wet room), and it would be advantageous to residents to have additional choice in regards to bathing/showering facilities. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides very clear and detailed information to enable prospective residents to make a choice. A comprehensive needs assessments is carried out prior to arranging admission. Evidence: The statement of purpose and the service user guides have been amended since the last inspection visit. These have been produced in separate folders for each of the two units for the main house of Beechcare, and for the Peter Gidney Unit. The documents are very well presented in printed folders, and include colour brochures with photographs showing both units, and the facilities available. The statement of purpose states that the homes purpose is to maintain the highest standards of care on an individualised basis. The service user guides include relevant details for prospective residents with Care Homes for Older People Page 11 of 32 Evidence: information included about numbers of staff, and how to recognise their uniforms; mealtimes, snacks and drinks; visiting; bringing in personal effects; laundry management; and activities and outings. They also include a residents charter, and information about the company Four Seasons. They operate in England, Scotland and Northern Ireland, and are a large independent care provider with approximately 300 care homes. This includes a subsidiary called the Huntercombe group, who oversee the management of specialist services. The Peter Gidney Unit which provides specific neurodisability care for younger adults is included as part of the Huntercombe Group. The guides include data about the different communal areas and bedrooms available in both units. There is a profile about the manager; details regarding the complaints procedure, and a copy of the terms and conditions. These are provided separately for self funded clients, and for those who are funded by the Local Authority or by NHS continuing care. The terms and conditions form the contractual documents, and both parties sign these. There are clear details about the fees, showing the breakdown of fees, and how the RNCC contributions are deducted. There are also details about vacating rooms, and in the event of either party giving notice. Pre-admission assessments are usually carried out by the manager for Beechcare, who may also take a member of the nursing staff, so that they can discuss any complex nursing management with the resident, and relatives or hospital staff. Pre-admission assessments for the Peter Gidney Unit would usually be carried out by the unit manager. This post is currently vacant, so these assessments are being carried out by the manager, with a member of the nursing staff allocated to the Peter Gidney Unit. Pre-admission assessment formats have recently been altered into a new format by the company, and are being piloted. Three pre-admission assessments were viewed for Beechcare, and two for Peter Gidney. They are extremely detailed documents, and include all aspects of care and daily living. The pre-admission assessments have been completed very well. However, the documentation is very lengthy, and may need to be made a bit more user friendly for the staff who are completing them. Any equipment needed, (for example, specialised beds or mattresses) is put in place prior to admission. Residents and relatives (or representatives) are invited to view the home, and can view all areas and meet some of the staff. Care Homes for Older People Page 12 of 32 Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal and healthcare needs are met by a team of competent staff, with relevant referral to additional health professionals. Evidence: Residents have detailed assessments on admission to the home, following up the data which has already been accessed prior to admission. These assessments form the basis for the care planning. Care plans are stored in individual folders, and these are indexed for easy access of information. The manager and nursing staff have worked very hard over the last six to nine months to improve the care plans, and these are now in good order, and contain detailed information. We (i.e. CSCI) viewed three care plans from Beechcare, and two from Peter Gidney, and were impressed by the changes that have been made, and the hard work to improve these to such a good standard. Assessments and care plans follow the Ropers activities of daily living, and include all aspects of care such as personal hygiene care, moving and handling needs, skin integrity and care of pressure areas, nutrition, medication, social activities, Care Homes for Older People Page 14 of 32 Evidence: communication, sleeping, continence care and pain management. All assessments and care plans are reviewed monthly. Wound care is well managed, as care plans clearly state the type of dressing to be applied, and how often the dressing is to be changed. The documentation includes an account of each dressing change, showing the size and state of the wound, and with each wound documented separately. Accompanying photographs are taken (with the consent of the resident), showing the progress of healing. Moving and handling care plans specify if a hoist is to be used, and identify the type of hoist and sling, and how many staff are needed for transfers. Nutrition care plans show if residents need assistance with eating and drinking and the type of diet; and have very informative details for residents with PEG feeds, for which there are usually a significant number on the Peter Gidney unit. Risk assessments are well managed and include use of bed rails, falls assessments, use of lap belt in wheelchairs, and use of wheelchairs without footplates. This is specifically for residents who can propel themselves using their feet, but cannot manage other forms of self-propelling wheelchairs. Many of the residents on both units have complex nursing needs, and the care plans show that there is attention to detail, ensuring that residents can be confident that their health needs will be met. Referrals are made to other health care professionals as needed, and these include good ongoing input from GPs, speech and language therapist, dietician, and the Primary Care Trust tissue viability nurse. The Peter Gidney unit has a contract with a physiotherapist who visits two to three times per week, and the home employs a physio assistant who works alongside the physiotherapist. They ensure that nursing and care staff are kept informed about any changes, and how to carry out passive exercises; and work together to improve or retain residents mobility and dexterity. The physiotherapist also works with the occupational therapist and wheelchair services to provide residents with the best equipment to meet their needs. There is input available from a consultant psychiatrist and community psychiatric nurses for any residents suffering with anxiety, depression, or mental health difficulties as a result of their illnesses or injuries. Medication is managed separately in each unit, and was inspected in both. In Beechcare, the clinical room is a reasonable size, but in Peter Gidney, the clinical room is far too small for effective storage and administration of medication. The manager has already raised this as a concern with the estates management. There is a requirement to provide a clinical room with sufficient space. The room temperature is satisfactory in Beechcare, but is borderline (i.e. often 25 degrees) in Peter Gidney Unit, Care Homes for Older People Page 15 of 32 Evidence: and this is an additional cause for concern. Medication is administered via the Boots monitored dosage system as far as possible, with as necessary medication stored separately. There is evidence of good stock rotation, and external medication is stored separately from internal. Bottles of medication are dated on opening. One homely remedy was out of date. Both units have good management for the storage and recording of controlled drugs, and for the disposal of waste medication. Many residents on Peter Gidney Unit have medication administered via PEG tubes. The unit has a sensible system of two nurses to administer medications, with one for PEG tubes and one for all other medication. This is because it takes additional time to administer via PEG tubes. Residents are treated with respect, and privacy is maintained when personal care is attended to. Residents said that they are very well looked after; and chats with residents, and survey forms, indicate that residents are confident in the standards of care. One survey form stated that staff sometimes have to rush to complete care, and that residents sometimes have to wait too long before the call bell is answered. Chats with staff and residents indicated that this is mostly on Beechcare in the afternoon and evenings, and the manager is already looking at increasing the number of care staff hours at this time of day. The staff are committed to carrying out end of life care with sensitivity, and to meet the individual wishes of residents. The objectives are to keep residents comfortable and pain free, and to support them with visits from family when possible, or with staff providing company. Discussions are held with residents and/or their next of kin as appropriate, in regards to end of life care, resuscitation in the event of emergency, and with reference to the best interests of residents who can no longer make their own decisions. This is in accordance with the Mental Capacity Act 2005, and there is an ongoing staff training programme in respect of this. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has made great improvements in providing relevant activities and increased opportunities for outings. Food is well managed in the home. Evidence: The home has employed a second activities assistant recently, and both activities assistants work together to arrange entertainment and activities for both units. Residents often like to mix together from both units, and it has been found that they benefit from each others company for items such as film shows, bingo, outside entertainers, and coffee mornings, fetes etc. The activities assistants keep a record of activities each day, and provide an ongoing programme which is displayed on notice boards in both units. They also write an account in individual care plans, showing when residents have taken part, and if they have enjoyed the specific activity that day. Residents who do not wish to join in, or who prefer to stay in their own rooms, are visited by the activities assistants for one to one time, just chatting, doing crosswords, reading etc. Group activities have recently included flower arranging, cardmaking for events, games, film afternoons, strawberries and cream tea, cheese and wine afternoon, and cooking (for the Peter Gidney residents). A resident in Beechcare said Care Homes for Older People Page 17 of 32 Evidence: she would like to do cooking again as well, so this was passed on to the manager for consideration by the activities assistants. The home has their own minibus, and the manager has brought about an increase in the numbers of drivers available. They may also use an additional minibus on loan. There are frequent trips out to the seaside (Herne Bay, Hastings, Brighton recently); shopping to Bluewater, or local Dartford shops; and other places of interest. There is a nearby pub which residents said they enjoy visiting for drinks or meals. The home also includes evening events such as an evening quiz night (with buffet and prizes); and an Elvis impersonator, who is very popular. The Peter Gidney unit has a gym/recreation area, which has a large screen for film evenings, and the younger adults and older people take it in turns to choose which movie to watch. This area is also used for physiotherapy, or for beauty and pampering sessions. A hairdresser visits the home every week, and nail care is provided at different times. Residents can join in with a church service in the home each month; or are enabled to visit their own churches in the vicinity if they wish to do so. Relatives are invited to join in with activities and entertainment if visiting, and are welcomed at any time and are offered drinks. They can also stay for meals. There is a families and residents committee, and many relatives take part in the life of the home, and help with outings, gardening etc. The home had a lovely atmosphere on the day of the visit, with many residents joining in to listen to a visiting trio of singers and musicians. Later in the afternoon, a staff member took a few minutes out to play the piano, and started an impromptu singing time in the spacious reception lounge area. Relatives were sitting together with residents chatting and drinking tea together, and it was a very homely and relaxed atmosphere. The home fosters other links with the local community such as arranging for local schoolchildren to come in and sing. Residents can bring in their own possessions to personalise their rooms, and have their own pictures, duvet covers etc. if they wish to do so. A property list is completed on admission. Food is well managed in the home by two cooks/chefs. The head cook was on leave, but the home has an arrangement with a catering agency, which can usually provide a chef who knows the home and residents, when needed. The homes regular chefs spend time with the residents, and get to know their likes and dislikes well. The food was seen to be well prepared and presented. Residents said that there is a good choice, and they can always ask for an alternative to the two main courses on the Care Homes for Older People Page 18 of 32 Evidence: menu at lunch times. Cooked breakfasts are available, and a hot meal is provided at teatime. Snacks and drinks are always available, and are actively offered in the evenings with drinks. Home made cakes are offered, and crisps, biscuits, yoghourts and fresh fruit are always available. Times of meals are flexible, with breakfast from 7.00am, and lunch times staggered to fit in with residents who are going out. Staff were observed assisting residents with eating and drinking, and were doing this in a calm and unhurried manner. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously, and are properly investigated. Appropriate action is taken to address these. Residents are protected from abuse. Evidence: The complaints policy and procedure is included in the service users guides, and is also displayed in the reception area. The policy includes details of the complaints process and details of timescales, but the procedure does not include timescales, and there is a recommendation to amend this. The company aim to investigate and respond to any complaints within nine working days. The complaints log showed that all complaints are taken seriously, and the manager usually writes to complainants within one to two days to acknowledge complaints, and to outline the action being taken. Each complaint is filed separately, and this protects confidentiality. The records show that the manager carries out thorough investigations, and keeps complainants informed as to what is happening. There is a monthly audits process for complaints, so that the Head Office and Regional Manager are kept informed about any issues. Small day to day concerns are recorded by the nurses in a notebook in each unit; the manager checks these to see if there are any ongoing patterns of concerns which can be addressed, or to investigate any necessary incidents. Care Homes for Older People Page 20 of 32 Evidence: All staff are trained during the induction programme, and with yearly updates, in the recognition and prevention of adult abuse. A copy of the Kent and Medway procedures for safeguarding adults are kept in the home and available to staff. There have been no complaints made directly to CSCI during the past year, and no referrals to the Social Services Safeguarding Adults team. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a pleasant and comfortable environment for the residents. Evidence: The home is purpose built, and is suitable for its purpose, with wide corridors, lots of communal space and en-suite toilet facilities. It has been refurbished in many areas since the previous inspection. This includes corridors and communal areas, and many of the bedrooms. However, there is still some work to be completed, such as repairs to bedroom doors which have been damaged by wheelchairs, and refurbishment of the bathrooms. The home had been without a maintenance man for several months, and a new maintenance man had just commenced employment. Staff and residents have been frustrated with delays for some repairs, so the appointment of a new maintenance man should be an advantage. The Peter Gidney Unit lacks necessary storage space for items such as hoists, linen skips and wheelchairs, and many other pieces of equipment needed for residents with highly complex nursing needs. This needs to be addressed. The buildings are closely adjacent to one another, with a few metres separating them. The doors between the two buildings have become worn and damaged with use, and the estates management have agreed to improve these doorways. Wider, sliding Care Homes for Older People Page 22 of 32 Evidence: doorways will be fitted, with sensors operating as people approach them. This will make it much easier for staff with equipment, and wheelchair users, to go from one building to the other. The plans include additional fencing and locks for security. Communal areas have been well designed, and include two large lounge areas and a smaller quiet lounge in Beechcare, plus a separate dining room; and a large lounge, dining room and gym/recreation area in the Peter Gidney unit. There is also a designated smoking room in Beechcare, which has patio doors and automatic air extraction/exchange. The quiet lounge includes a small kitchenette area which can be used by relatives and friends to make drinks and snacks. The building is set in extensive grounds, and these are very well maintained and provide a relaxing and attractive outlook from all areas of the home. The front of Beechcare overlooks gardens and fields, and the M25 motorway is visible, but is not a distraction, and cannot be heard from inside the building. The home has a variety of different garden and patio areas, a summer house and a potting shed, and some newly purchased garden furniture. The bedrooms are a reasonable size and many have been redecorated. Residents are able to help choose the decor for their rooms. The bedrooms in the Peter Gidney Unit are larger than those of Beechcare, and this is appropriate for the amount and type of equipment needed for residents in this unit. Rooms are personalised according to residents wishes. Both units have toilet facilities near to the lounges. These need refurbishing, and are included in the homes maintenance plan for the coming year. All of the bedrooms in Beechcare have en-suite shower facilities, and there are two shared bathrooms, which have baths with integral hoisting facilities. Some residents would prefer a shower, but do not find it easy to sit for long, and it would be an advantage to have a bathroom with shower trolley for these residents (i.e. a wet room). The manager said that this was currently under discussion with the estates management. Some bedrooms on the Peter Gidney Unit have en-suite shower facilities, and there are additional bathrooms and shower rooms with a shower trolley. These rooms are in need of refurbishment, as they are generally run down. One bathroom has tiles broken and missing. Many new nursing beds have been purchased this year, and the manager stated that when additional equipment is needed for any resident, that the estates management ensure that items for nursing care are purchased. Additional pressure relieving mattresses have also been purchased. There are a sufficient number of hoisting facilities, and the manager is currently discussing the purchase of another hoist for the Peter Gidney Unit. Other equipment such as raised toilet seats and grab rails are Care Homes for Older People Page 23 of 32 Evidence: provided as needed. New beds have integral bed rails for when they are needed. All radiators have been fitted with covers, but a wooden one in the front entrance hall was broken. This is in a very busy area, and gets damaged by wheelchairs knocking into it. The manager is looking at the purchase of a more suitable metal cover. The kitchen for both buildings is situated in Beechcare, and this was seen to be in good order and well equipped. The laundry for both buildings is situated in the basement of the Peter Gidney Unit. This has a laundry chute leading down from the ground floor into the dirty area. There are two commercial sized washing machines, and two tumble dryers. One of these was broken and waiting to be repaired. This makes it very difficult for laundry staff to keep up to date with drying laundry. Bed linen and soft furnishings are of good quality and replaced as needed. The home usually has two domestic cleaning staff for each building, and both buildings were seen to be generally well maintained and clean in all areas. Carpets are cleaned as needed. Care Homes for Older People Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager liaises with other staff to ensure that staffing levels remain effective to meet the dependency needs of residents. Staff recruitment and training are well managed. Evidence: Residents dependency levels are worked out using a reliable scoring system, and the dependency levels form the basis for the numbers of nursing and care staff on duty. Both buildings have two nurses on duty throughout the day shifts, and this is essential for managing the high levels of nursing care required. The nursing staff lead the way in carrying out all aspects of care, as well as acting in a supervisory capacity, carrying out nursing duties, and overseeing documentation. The manager has implemented some supernumerary hours for senior staff in both buildings, to enable them to have time to spend on updating and auditing care plans, medication etc. Beechcare usually has seven care staff in the mornings, and four in the afternoons and evenings. Staff and residents both commented that this can sometimes be a difficult time to keep up with the level of care needs, and the manager has already contacted senior management to request an additional carer for this shift. Times of shifts are staggered to start at 7am or 8am, and at 1pm or 2pm, giving overlaps of staff. Night staff shifts are from 7pm to 7am. There is one nurse and three carers on night duty. Care Homes for Older People Page 25 of 32 Evidence: The Peter Gidney Unit has two nurses and seven care staff in the mornings (if all beds are filled), three care staff in the afternoons, and one twilight shift to help cover the busy evening times. There is one nurse and two care staff at night. The home currently has a low percentage of care staff who have completed NVQ 2 or 3 training, but another six care staff are studying for this. The level has risen from 16 last year to approximately 25 this year, so progress is being made. The target is for a minimum of 50 , and the senior staff are dedicated to encouraging care staff into this training. Recruitment practices are well managed. Four staff files were viewed, and contained all required information, except for one file, which had already been recognised as being incomplete in one area. Staff who are recruited from abroad have a police check from their own country as well as a Criminal Record Bureau check in the UK. The home has a detailed induction programme for all levels of staff. The manager has been updating the staff training matrix, and has also implemented individual staff training files. These are colour coded for different units. The matrix confirms that all statutory training is being undertaken. This was up to date except for infection control training, and basic food hygiene. The manager has already arranged these training subjects, and CSCI are confident that training is being carried out effectively. Staff were receiving an update in medication training on the afternoon of the inspection visit. Additional training is carried out for subjects such as applying the Mental Capacity Act; nutrition - with the dietician and speech and language therapist; and wound care, with training from wound care representatives. Nursing staff are enabled to carry out training to keep their skills and competencies up to date. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from living in a home which is effectively managed. They are confident that their views are listened to and are taken into account. Evidence: The manager is a level one nurse, and has a wide knowledge, and a variety of experience, in caring for older and younger people. She is in the process of studying for the Registered Managers Award, which will complement her previous management training and experience. She has an open door policy, and is known by the residents and relatives. Staff were seen to interact well with the residents and with each other. There is a good sense of team work, and staff said that they have good working relationships as a team. Residents said that they can easily talk with the staff and the manager, and can raise Care Homes for Older People Page 27 of 32 Evidence: any ideas or concerns. Satisfaction survey forms are used each year to ask residents their views on how the home is running. These include shorter surveys for particular items, such as the food. The manager is supported by liaison with other home managers, and also by the companys regional manager who carries out monthly visits and audits. There is a families and residents committee, and meetings are held every one to two months. This provides an additional opportunity to talk together, and raise ideas as to how to develop the life and activities in the home further. The manager holds these meetings alternately in afternoons and evenings, to enable different groups of relatives to attend. Some residents have small amounts of pocket money kept by the home. This includes some money in a dedicated bank account, and small amounts of cash stored safely in the home for everyday items. The administrator records each transaction in individual accounts, and there are two signatures for any withdrawals. If the resident is unable to sign personally, the second signature will be the manager or a senior staff member. There are detailed weekly and monthly checks for these accounts, carried out by the home and by the head office. All receipts are retained, and all monies are randomly audited by the head office. Residents (or their representative) receive a statement after each transaction. All staff receive one to one formal supervision approximately every eight weeks. This is delegated to the heads of different departments, who have received the necessary training to enable them to identify strengths and weaknesses, and to help staff with their personal role development. Policies and procedures are amended by the head office as needed, and any changes are highlighted to the manager, who ensures that staff are made aware of the changes. The documentation did not show clear evidence that the company reviews all policies and procedures each year. The company has their own training officers for statutory training, including health and safety. Some maintenance records were viewed, and these show that there are ongoing checks for equipment such as fire alarms, water temperatures, wheelchair checks and nurse call alarms. Water temperatures, and the nurse call system, are checked monthly for all rooms. Portable appliance testing is carried out yearly, and visual checks on electrical equipment are carried out for residents own electrical items. The home has detailed risk assessments in place for all areas of the home, such as kitchen, laundry, and nurses station; and the assessments are filed in these areas for easy access by the staff concerned. Care Homes for Older People Page 28 of 32 Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 To provide a clinical room in the Peter Gidney Unit which is of sufficient size for effective management and storage of medication. In order to comply with Regulation 13 in regards to safe storage of medication. 30/11/2008 2 19 23 To ensure that sufficient 31/12/2008 storage space is provided for the Peter Gidney Unit. So that suitable provision is made for storage for the purposes of the care home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 16 To ensure that the complaints procedure on display is amended, so that it shows timescales for when complainants will receive a response. To alter a bathroom in Beechcare into a shower room, providing additional choice for residents. 2 21 Care Homes for Older People Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!