Inspection on 04/12/09 for Beechcliffe Residential Home

This inspection was carried out on 4th December 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beechcliffe Residential Home 25/02/10

Beechcliffe Residential Home 08/12/08

Beechcliffe Residential Home 10/12/07

Beechcliffe Residential Home 13/02/07

Beechcliffe Residential Home 25/10/05

Beechcliffe Residential Home 03/05/05

Beechcliffe Residential Home 11/01/05

Beechcliffe Residential Home 06/07/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Beechcliffe Residential Home 16 Park Drive Heaton Bradford West Yorkshire BD9 4DR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Stephen Marsh     Date: 0 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Beechcliffe Residential Home 16 Park Drive Heaton Bradford West Yorkshire BD9 4DR 01274487207 01274497352 satnam@pcslimited.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Jarnail Singh Bassan care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 25 Dementia Code DE, aged 55 years and above on admission, maximum number of places 25 Date of last inspection Brief description of the care home Beechcliffe Residential Home is a large detached Victorian building standing in its own grounds in the Heaton area of Bradford. The home provides accommodate for twentyfive people in a mixture of single and double rooms. The home does not provide nursing care. There is good disabled access into the premises and a large garden available for people to enjoy during the summer months. Car parking is available to the front of the building. The home is fairly close to a number of amenities within the Care Homes for Older People Page 4 of 32 Over 65 0 25 25 0 Brief description of the care home local area including shops, public houses and a large park. The weekly fees range from GBP380.00 to GBP420.00 and do not include costs for hairdressing, chiropody, toiletries and personal transport. 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: zero star poor 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: The last inspection of this service was the 8 December 2008. Since then we have improved our practice when making requirements to improve national consistency. Some requirements from previous inspections may have been deleted or carried forward as recommendations, but only when it is considered that people that use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Following this inspection visit we wrote to the registered provider regarding the serious concerns we had about some aspects of the service. These related to staff recruitment, staffing levels, care plans, the safe handling of medication and the environment. We asked for a response from the provider by the 18/12/2009 but received no correspondence by that date. We did receive a letter from the general manager on the 12 January 2010 indicating that some of the requirements made in this report have now been met. However, we will check to make sure that all requirements have been Care Homes for Older People Page 6 of 32 fully met within the timescales set, at our next inspection visit. The inspection process included looking at information we have received about the service since the last key inspection, as well as this unannounced visit to the home, which was carried out by one inspector between 10:00 and 17:00 hrs. The methods we used during this inspection included looking at records, observing staff at work, talking to people living at the home and visitors, talking to the manager and staff and looking around the property. Before the visit we had provided some people living at the home,staff and other health care professionals with survey questionnaires so that they could share their views of the service with us. We received five questionnaires back from people living at the home, six from staff and one from a health care professional. The information provided by people living at the home and staff has been used as evidence in the body of the report. The home had also completed and returned their Annual Quality Assurance Assessment (AQAA) form and the information provided has also been used as evidence in the body of the report. The AQAA is a self assessment form that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The purpose of the visit was to assess what progress the home had made in meeting the requirements made in the last inspection report and the impact of any changes in the quality of life experienced by people living at the home. Feedback was given to the manager at the end of the visit. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The admission procedure must be more thorough so that people can be confident that once admitted to the home the staff have the skills and experience necessary to meet their needs. Care plans and supporting documentation must be maintained in good order and give clear guidance to staff on how peoples needs are to be met. This will make sure that people receive the level of care and support they require. Only care staff that have received appropriate accredited medication training must administer medication. This will make sure that people living at the home are only given medication by staff who are trained and competent to carry out this task. A new controlled drug cabinet must also be installed so that controlled drugs can be stored safely and in line with current legislation. More should be done to provide people with the opportunity to participate in appropriate social and leisure activities both within the home and the wider community. Work is also still outstanding to comply with the enforcement notice served by the Fire Service. This work must be carried out to avoid further action being taken and to make sure that the health and safety of people living at the home is not compromised. The staff recruitment and selection procedure must be thorough so that the home is clearly able to evidence that it is employing staff that are suitable to work in the caring profession. Staff must also receive the support and supervision they need to carry out their roles effectively so that people can be confident the home is run in their best interest. Action must be taken to make sure that the minimum night staffing level of two waking night staff and one staff sleeping on the premises is maintained every night. There must also be a senior care assistant on duty at all times and staffing levels must be Care Homes for Older People Page 8 of 32 sufficient to meet the needs of people living at the home. The domestic hours must be increased to make sure there are sufficient domestic assistants employed to keep the home clean, tidy and free from offensive odours. Clear lines of communication and accountability both within the home and external management need to be established so that the home is managed effectively and in the best interest of people living there. Action must be taken to address the five requirements outstanding from the last inspection visit made on the 8 December 2008. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is admitting people without carrying out a thorough pre-admission assessment and therefore are unable to evidence that staff have the skills and experience to meet their needs. Evidence: The home has produced a service user guide which provides people with the information they need to be able to decide if the home can meet their needs. At the current time the information is only available in English but the manager confirmed that it would be made available in different languages and formats on request. The manager confirmed that people are invited to visit the home before admission to see at first hand the facilities provided, meet the staff and other people living there and stay for a meal if they wish to do so. People are also able to move in to the home on a trial period if they are still undecided. Care Homes for Older People Page 11 of 32 Evidence: However, we looked at the pre-admission information for the last three admissions had found that in two instances people had been admitted from another home owned by the provider without a new assessment of their needs being carried. There was also little evidence that either person had been offered alternatives or choices in relation to moving to another care home or that they had visited the home before admission. There was however an entry in the daily notes completed for one person indicating that they had requested to be admitted to Beechcliffe as they felt that the home was better equipped to meet their physical needs. Information obtained by the home for one person on admission showed that they had a diagnosis of schizophrenia, manic depression and was in the early stages of dementia. The manager appeared unaware of this diagnosis and recent information provided by another healthcare professional stated that this person had learning disabilities but made no mention of the previous diagnosis. Had a comprehensive assessment been carried out before admission this matter would have been highlighted sooner, which would have helped the home decide whether or not staff could meet their needs. The manager confirmed that the home will admit people on an emergency basis, however, wherever possible the Social Services assessment of need is obtained either before or on admission. Care Homes for Older People Page 12 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care records do not always provide accurate and up to date information, which means that some people might not receive the level of support and care they require to meet their health, personal and social care needs. Evidence: Care plans are in place for all people living at the home and are initially generated from the information provided by the Social Service Care Management Team or the assessment of needs completed by the manager. The manager confirmed that wherever possible care plans are drawn up with the involvement of the person using the service and/or their relatives and form the basis for the care to be provided. We looked at three care plans and found that in two instances they had not been reviewed since June 2009. In addition we found that there was no care plan or risk assessment in place for one person who had exhibited behavioural problems and been both verbally and physically aggressive to other people living at the home and staff, resulting in the police being called on one occasion. Staff had therefore no clear guidance on how to manage their behaviour and reports clearly showed that they had Care Homes for Older People Page 13 of 32 Evidence: struggled to do so. This is unsafe practice which might put other people living at the home and staff at risk of injury. All people living at the home are registered with a general practitioner and are supported in having access to the full range of NHS services. The input of other healthcare professionals is clearly recorded in the documentation available. This shows that staff are seeking advice if they have concerns about peoples health. We received a survey questionnaire back from one healthcare professional, which showed that they consider people are cared for and look well kept. However, they did comment that staff required moving and handling training as part of their induction as at times they can move people poorly. This matter was discussed with the manager who confirmed that moving and handling training is done by staff as part of their induction process, but she would make sure that all staff had updated their training in line with good practice guidelines. Survey questionnaires returned by people show that they are happy with the care and support they received and said that staff always treated them with respect. Comments included the staff look after me well and I enjoy living at Beechcliffe and have always found the staff to be kind and caring. We had the opportunity to speak to one visitor on the day of the inspection and they told us that they had always found the standard of care to be good and they were always kept informed of any significant changes in their relatives general health. We reviewed the medication system in place and found that in some instances when no senior staff had been on duty to administer medication, staff from another home owned by the provider have administered medication. We also found that a care assistant had been designated on the staff rota to administer medication on two occasions in December 2009 even though they had not received accredited medication training and did not feel confident to do so. This is unsafe practice which increases the risk of medication errors occurring and puts staff under undue pressure. A new controlled drug cabinet also requires installing so that controlled drugs can be stored safely and in line with current legislation. This requirement is outstanding from the last inspection report. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home could provide more opportunities for people to participate in a wider range of appropriate social and leisure activities both within the home and the wider community. Evidence: The manager confirmed that people are encouraged to make choices and decisions about how they spend their time whilst living at the home. Peoples personal interests are recorded in their care plan and wherever possible they are supported by staff to follow their own daily routines. The home does not employ an activities co-ordinator therefore in house activities and trips out are organised by the care staff. For people that dont like to join in group activities time is made to engage with them on a one-to one basis. Survey questionnaires returned by people indicate that while some activities and outings take place at the home it depends on staffing levels and what other duties they have to undertake . Comments included I would like to go out more but there is not always staff available to assist me. Care Homes for Older People Page 15 of 32 Evidence: The manager confirmed that people are encouraged to continue to attend their place of worship if they wished to do and Holy Communion is held at the home every two weeks. People spoken with said that they were able to see visitors in their own rooms if they wished to do so and family and friends were always made to feel welcome and offered light refreshments when they visited. During the visit we had the opportunity to have lunch at the home and the meal served was tasty, well cooked and well presented. Staff were observed to help people if they required assistance to eat their meal, the meal was unhurried and there was good interaction between staff and people living at the home. Survey questionnaires returned show that people feel that the food is always good and their preferences are taken in to account when menus are planned. Comments included there is always a good choice at meal time and I have no complaints at all about the standard of meals provided - I enjoy all my meals. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable systems in place to make sure that complaints are dealt with appropriately and people are protected from any form of abuse. However, safeguarding procedures are not always being followed, which might put people living at the home at risk. Evidence: There is a clear complaints procedure in place and information provided in the self assessment form shows that no complaints have been received by the home in the last twelve months. Feedback from relatives clearly indicates that they are aware of the complaints procedure and would have no problem at all in approaching the manager or registered provider if they had any concerns about the standard of care being provided. Adult protection (safeguarding) policies and procedures are in place and the manager said that all staff receive training in the recognition and reporting of allegations of abuse. Feedback from staff indicates that they are aware of the homes policy on whistle blowing and knew what to do if they suspected that people were being abused or working practices at the home were not in the best interest of the people living there. However, we were concerned that the manager had failed to inform us of recent Care Homes for Older People Page 17 of 32 Evidence: incidents of physical and verbal abuse toward people living at the home and staff by a person exhibiting behavioural problems although she had discussed the matter with Social Services Safeguarding Team. The manager was reminded that under regulation 37 of the Care Standards Regulations 2001 she must inform us of any event which adversely affects the well-being or safety of any person living at the home. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ongoing programme of refurbishment must be continued to make sure that standards are improved and people are able to live in a safe, pleasant and comfortable environment. Evidence: Some parts of the home are still in need or upgrading and the manager confirmed there is an ongoing programme of refurbishment in place. We have asked the provider to provide us with an updated copy of the refurbishment programme. Work is also still outstanding to comply with the enforcement notice served by the Fire Service. The provider must make sure that this work is carried out to avoid further action being taken and to make sure that the health and safety of people living at the home is not compromised. All the communal areas including lounges and the dining room are situated on the ground floor of the home, conveniently close to toilet facilities. The standard of decor and furnishings in these areas is satisfactory and they generally make comfortable places for people to relax and eat their meals. Bedrooms are situated on three floors of the building and there is a passenger lift available to enable people with mobility problems reach the accommodation on the Care Homes for Older People Page 19 of 32 Evidence: upper floors. The rooms we looked at were decorated and furnished to a satisfactory standard although some rooms would benefit from decorating and old tired furniture replacing. In three bedrooms, which are occupied, we found that there was no water coming out of the hot water tap. Staff told us this happened frequently and they had to carry hot water from the bathrooms to enable people to wash and maintain their personal hygiene. Bathroom and toilet facilities are located throughout the home. We found the bathroom and toilets on the ground floor are in urgent need of refurbishing to bring them up to an acceptable standard. This matter was highlighted in the last inspection report and therefore it is disappointing that no action has been taken to provide people with bathroom and toilet facilities that are clean and fit for purpose. On the day of the visit there were no cleaning staff on duty and some areas of the home including bathrooms and toilets were dirty and needed a thorough clean. This matter was discussed with the manager and the findings can be found in the staffing section of this report. Care Homes for Older People Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment policies and procedures are not being followed and there are not always sufficient staff on duty to meet peoples personal and social care needs. Evidence: The home has a thorough staff recruitment and selection procedure, which includes obtaining at least two written references and a Criminal Record Bureau (CRB) before new staff start work unsupervised. However, we looked at the employment files for four recently appointed staff and found the procedure had not been as thorough as it should have been. For example in two instances we could find no written references on file and in one instance references had not been received before the person had started work. There was also a lack of interview notes and evidence to show that the manager is not always seeking references from peoples last employer. This matter was discussed with the manager who said that she had initially thought staff could be employed once a satisfactory POVA First and CRB had been received but had recently been informed by senior management that this was not the case. She said that references had been sought but not always obtained before a person started work. This is unsafe practice which might result in the home employing staff unsuitable to work in the caring profession. Care Homes for Older People Page 21 of 32 Evidence: The staff rota showed that the home is running on minimum staff levels during the day and at times there is no senior care assistant on duty. We spoke to one recently appointed staff member who had no previous experience in care work and they confirmed that they had at times worked a shift with only one other care assistant.This is unsafe practice which might compromise the health and safety of people living at the home. The rota also showed that the home currently only employs one domestic assistant and at the time of the visit she was on two weeks annual leave. This means that in addition to their other duties the care staff have also to undertake cleaning tasks, which is putting more pressure on an already over stretched staff team. Steps must therefore be taken to employ more domestic assistants so that care staff are able to carry out their roles effectively and in the best interest of people living at the home. The staffing arrangement during the night should be two wakeful staff on duty and one staff member sleeping on the premises. The reason for this is because of the size of the building and the fact that the home has failed to carry out essential fire safety work. However, the rota clearly showed that some weeks there has been only two wakeful staff in the building on Friday nights as the manager has been unable to find a member of staff willing to sleep-in on the premises. This is unsafe practice which could put people living at the home and staff at risk. On discussing this matter with the manager she said that the home had recently experienced staffing difficulties due to longterm sickness and maternity leave and was finding it difficult to recruit new staff. However, she confirmed that staff recruitment was now a priority and every effort would be made to make sure that sufficient trained and experienced staff were on duty at all times and the recruitment process was thorough. All new staff receive induction training in line with the Skills for Care Common Induction Standards. These are nationally agreed induction standards designed to help new staff get the skills and knowledge they need to care for people. Following induction there is an expectation that staff will study for a National Vocational Qualification (NVQ) at level two or three above depending on the post they hold. Feedback from staff varied and while some were generally happy with the level and standard of training provided others felt that due to staffing problems there had been few opportunities to attend training courses in the last year. Staff training records are held in their individual personnel files. We have therefore asked the manager to provide us with a training matrix and a training programme for 2010 so that we can Care Homes for Older People Page 22 of 32 Evidence: clearly see the training and development opportunities made available to staff both on an individual and team basis. Care Homes for Older People Page 23 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are no clear lines of communication or accountability either within the home or with external management, which means that the home is not being managed effectively and in the best interest of people living there. Evidence: A new manager was appointed about one year ago although she has still to complete the registration process. The manager is a qualified nurse, has a positive attitude to the inspection process and during the course of the inspection showed a willingness to work with us to maintain and improve standards at the home. The manager confirmed that one-to-one formal supervision with individual staff does not take place as often as required but as Beechcliffe is a relatively small home and she works with the staff on a daily basis she is always available if they have any concerns. Feedback from staff show that they feel generally well supported by the manager although two staff were concerned that she did not always realise the pressure they were under when short staffed. Comments included the manager is Care Homes for Older People Page 24 of 32 Evidence: approachable and genuinely cares about the people living at Beechcliffe and we have a good manager but she sometimes fails to understand the problems we have or keep us informed of events. There are some recognised quality assurance monitoring systems in place although they need to be developed further so that concerns highlighted in the body of the report are identified sooner and not brought to the attention of the provider through the inspection process. As part of the quality assurance monitoring process the general manager employed by the company visits the home on a monthly basis and completes a written report on the conduct of the service as required under Regulation 26 of the Care Standards Act 2001. However, the reports we looked at showed little evidence to suggest that the concerns we had raised with the manager had been picked up during these visits. We have therefore asked the provider to in future forward us copies of the monthly reports so that we can be confident that shortfalls in the service are being addressed quickly and in the best interest of people living at the home. The manager also confirmed that an important part of the quality assurance process is sending out survey questionnaires to people living at the home, their relatives and other healthcare professionals on an annual basis to assess how well the home is meeting stated aims and objectives. We have asked the manager to forward us the results of the next survey so that we can be sure that any concerns raised by people are dealt with appropriately. The home holds money in safekeeping for a number of people. Only senior staff deal with peoples personal finances and receipts are obtained for any items purchased on their behalf. We checked the system in place and no concerns were raised. We did however recommend that two people always sign the record sheets following any transaction. Information provided in the self assessment form shows that all equipment in use at the home including the passenger lift and hoists are serviced in line with the manufacturers guidelines, which means that people can be sure they are in good working order. Care Homes for Older People Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 Care plans must give clear guidance to staff on how peoples needs are to be met. 31/01/2009 So that they receive the level of care and support they require. 2 9 13(2) A new controlled drugs 28/02/2009 cabinet must be installed so that controlled drugs can be stored safely and in line with current legislation. The home must provide us with an updated programme of planned refurbishment so that so we can be sure people are living in a safe and comfortable environment. 28/02/2009 3 19 23 4 29 19 Staff recruitment and 31/01/2009 selection procedures must be followed at all times. So that people can be confident that they are being cared for by staff that are suitable to work in the caring profession. Care Homes for Older People Page 26 of 32 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 5 33 24 Effective quality assurance monitoring systems must be put in place. 31/01/2009 So that shortfalls in the service are identified sooner and people can be confident that the home is run in their best interest. Care Homes for Older People Page 27 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 3 14 A thorough pre-admission assessment must be carried out before people are admitted to the home. This will make sure that staff have the skills, experience and training to meet their needs. 31/01/2010 2 7 15 Care plans and supporting 31/01/2010 documentation must give clear guidance to staff on how to meet peoples needs. This will make sure that people receive the care and support they require and enable staff to use the care plans as working documents. 3 9 13 Only care staff that have received appropriate accredited medication training must administer medication. This will make sure that 31/01/2010 Care Homes for Older People Page 28 of 32 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 people living at the home receive their medication from staff who are trained and competent to carry out this task. 4 9 13 A new controlled drug cabinet must be installed. So that controlled drugs can be stored safely and in line with current legislation. 5 19 23 The home must provide us 28/02/2010 with an updated programme of planned refurbishment. So that we can be sure people are living in a safe and comfortable environment. 6 24 23 Hot water must be made available at all wash-hand basins. 31/01/2010 26/02/2010 This will make sure that people can access hot water to maintain their personal hygiene. 7 27 18 Domestic hours must be increased. To make sure there are sufficient domestic assistants employed to keep the home clean, tidy and free from offensive odours. 31/01/2010 Care Homes for Older People Page 29 of 32 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 8 27 18 Action must be taken to 31/01/2010 make sure that the minimum night staffing level of two waking night staff and one staff sleeping in the home is maintained every night. There must also be a senior care assistant on duty at all times and staffing levels must be sufficient to meet the needs of people living at the home. This will make sure that people are cared for appropriately and their needs are met in line with their agreed care plan. 9 29 19 Recruitment and selection 31/01/2010 procedures must be followed at all times. So that people can be confident that they are being cared for by staff that are suitable to work in the caring profession. 10 33 26 Monthly reports required under Regulation 26 of the Care Standards Act 2001 must be forwarded to us. So that we can be confident that the home is being run in the best interest of people living there. 31/01/2010 Care Homes for Older People Page 30 of 32 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 11 33 24 Effective quality assurance 31/01/2010 monitoring systems must be put in place. So that shortfalls in the service are identified sooner and people can be confident that the home is run in their best interest. 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 12 More should be done to provide people with the opportunity to participate in appropriate social and leisure activities both within the home and the wider community. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC 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!