Inspection on 26/03/07 for Beechcroft House

This inspection was carried out on 26th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beechcroft House 02/09/09

Beechcroft House 19/02/09

Beechcroft House 28/08/07

Beechcroft House 22/08/07

Beechcroft House 09/05/06

Beechcroft House 14/11/05

Beechcroft House 23/05/05

Beechcroft House 15/03/05

Beechcroft House 14/12/04

Beechcroft House 21/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beechcroft House St Johns Road Rowley Park Stafford Staffordshire ST17 9BA Lead Inspector Sue Jordan Unannounced Inspection 26th March 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechcroft House Address St Johns Road Rowley Park Stafford Staffordshire ST17 9BA 01785 251973 01785 212652 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Beachcroft Homes Limited Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability over 65 years of age (6) of places Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. PD(E) - REGISTERED FOR 6, 2 OF WHOM MAY BE 50 ON ADMISSION Date of last inspection Brief Description of the Service: Beechcroft House is an extended Victorian town house close to local services and shops with the railway station being one mile away, close to the town centre. Beechcroft offers 24-hour residential care, for up to 25 adults. All places are available to older people, and six places are available for persons with physical disabilities. The Home is well maintained and there is a continuous programme of redecoration. The Home charges from £325 to £395 per week. The Home is presently without a manager and actively recruiting a replacement. On the day of the inspection there were 20 people resident in the Home. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours with two inspectors. This was a ‘key inspection’ and the core standards were assessed. The methodologies used were discussions with a number of the residents, and some staff. Observations were made of staff and service user interaction and non-personal care tasks. The medication systems were examined and a tour of the environment undertaken. Two residents’ care records were checked and the records for four new staff employed since the last inspection, including recruitment and training documents. Since the last inspection on 09/05/06, the Commission for Social Care Inspection has been closely monitoring this service and eight additional visits took place between the end of June and November 2006. There have been five meetings with the proprietors and one with the manager. Three complaints have been made about this service since the last inspection and the Commission for Social Care Inspection and the Local Authority have been involved in making enquiries. The complaints centred on management practices and in March 2007, the registered manager resigned. The proprietors and staff are actively taking action to recruit a new manager and address any areas of concern. What the service does well: The residents’ health care needs are monitored. Access to medical health professionals is obtained as required. The proprietors keep the Commission for Social Care Inspection informed of any significant events or changes in the Home. Residents said, “The girls are lovely, anything we need, we get”. Beechcroft House is nicely situated in its own private grounds. It provides a well-maintained and comfortable environment for its residents, which is continually redecorated and refurbished. All of the residents spoken to said that they enjoy the meals and alternatives to the menus are available. The Home is able to cater for people with diabetes and those who require a soft diet. They have sought advice from the hospital dietician. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 6 The staffing ratios are maintained at a satisfactory level. The Home has a fairly consistent staff team, some of whom have worked there for many years. They are dedicated to the residents. What has improved since the last inspection? What they could do better: Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 7 Some additional work is required to bring the care plans up to date and ensure that current, accurate information regarding each resident is available to staff. This will ensure that they know exactly what they need to do to meet each resident’s needs. This includes risk management. The staff would benefit from some additional guidance as to how to identify risks and develop sensible management plans. The Home must ensure that they seek professional advice when deciding that a resident needs a particular piece of equipment. They also must ensure that all equipment is used safely. The proprietors were asked to re-examine their infection control practices and ensure that measures are in place, which eliminate the possibility of cross infection. The storage of cleaning products needs to comply with the Control of Substances Hazardous to Health legislation. Staff recruitment is more organised and generally more robust, however one member of staff has been employed before any references have been obtained. The Home must ensure that the appropriate checks are carried out for all staff members, so that they can be confident that the staff they employ are suitable to care for the residents. A new medication system, which includes training for staff has been implemented. Improvements were noted and the staff confirmed that they found the new system more straightforward. However, a number of requirements have been carried over into this report and further work is required to fully safeguard the residents. A recommendation is made that new staff receive manual handling training before working with the residents. A new manager must be employed with the qualifications, skills and experience necessary for managing the care home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New service users are not admitted into Beechcroft without prior assessment. This assists the management to make decisions as to whether they can meet the needs of the prospective resident and affords them and their family confidence in their move into the Home. EVIDENCE: Five new residents have been admitted into the Home since the last inspection. In the case of Local Authority referrals, assessments have been received from the social worker. In the absence of a manager, the most senior care worker has completed preadmission assessments for those people purchasing their own care. She has Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 10 received some instruction from one of the proprietors and is planning to undertake National Vocational Qualification level 3 in care. The information gathered covers all of the required areas and gives a indication of the individual’s needs, however this is not always carried forward into the Home’s care plans meaning that the staff do not have all of the information required to meet people’s needs. Beechcroft House does not provide intermediate care. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and well being of the residents is monitored and appropriate professional support obtained. Care planning and medication systems have improved, although further work is required to fully safeguard the residents and ensure that the staff know what support is required and any risks involved. EVIDENCE: Care planning has been an on-going issue in this Home resulting in a number of requirements over a number of inspections. The care plans have been re-organised and new formats introduced. The senior care workers and care staff have worked hard in the last few weeks to complete them. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 12 Three care staff were interviewed and all said that they thought that the care plans were better and easier to work with. Inspection of the care plans showed obvious improvements although more work is required to avoid confusion and confliction. Two sets of care records were thoroughly checked. The improvements needed include: Better recording of personal care activity. The identification of risks and how they are to be managed. The completion of all areas of the care plan, including the wishes of an individual and/or their family regarding death and dying and an inventory of the resident’s property. Following the instructions given in the assessment. For example, regular weighing of the residents and how to manage pressure sores. Ensuring that the information received at the assessment stage is carried forward into the care plans properly and subsequently reviewed monthly. In some instances, the care records have not been completed in their entirety, including the nutritional assessment, the social interaction assessment and the safe handling of people assessment. Some of the records are not dated or signed, including the personal handling plan and the social interaction form. There is no evidence that the residents have been involved in planning their care. There is some positive recording taking place, including the residents’ preferred daily routines, a record of visits and appointments with medical health professionals and daily records kept for each resident at the end of every shift. The staff were reminded that they should not leave gaps in the daily records. Bed guards are being used in the Home, although the senior care worker reported that they do not have covers for them and that they use duvets wrapped around them. The proprietor agreed to access professional support and guidance regarding this issue, to purchase proper covers and to complete individual risk assessments. A relative expressed concerns that the Home is insisting that footplates be used for all transfers as per the Commission for Social Care Inspection reports. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 13 It was explained that the Home needs professional medical advice regarding this issue. Mrs Gould said that she would contact the PCT, (Primary Care Trust) to ask for physiotherapist input. Two of the residents were spoken to at length. Both of them had recently moved into the Home. Both spoke highly of the staff and one said, “Anything we ask for, we get”, the other said that the “girls are lovely”. Staff were observed sitting with the residents, enjoying their lunch together. This meant that they could assist the residents in a ‘low key’ manner without drawing any undue attention to them. The Pharmacist Inspector also formed part of the inspection team and was asked to assess what progress the home had made in meeting the requirements following the pharmacy inspection carried out on the 30th November 2006. Medication Policy: The updated policy and procedures document for the safe handling of medicines within the home has been updated and a copy sent to the inspector. The document has been greatly improved but some minor details still need to be amended. Record Keeping: The record keeping of the medication received into the home has greatly improved. The record keeping was to such a standard during this inspection that all medication, with the exception of two entries, sampled for the audit process could be accounted for. Compared to the last inspection the scale of the recording on the medication administration charts has also improved. However there are still a number of issues that have not been addressed effectively. Administration: A number of the residents are administering part of their prescribed medication. The Home has not carried out any risk assessments to determine whether the residents have the ability to administer their medication as prescribed. The Home does not have an effective monitoring program in place to ensure that the self-administering residents administer their medication as prescribed. The lunchtime medication round was observed and was found to have significantly improved in procedure. The only issue identified was the fact that a Salbutamol inhaler was being shared between two residents because the Salbutamol inhaler for the one resident had run out. The Home must have enough stock within the home to make sure that the home does not have to share medicines to meet the residents’ needs. A brief observation of the Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 14 teatime medication round highlighted the fact that not all of the staff are performing to the standard seen at the lunchtime round and further evidence the need for competency monitoring of the staff. Training: A representative from the pharmacy has conducted a training course on how to use the new medication system. Not all of the staff were able to attend, so some of the staff are using the system without the knowledge of whether their practices were right or wrong. The Home must ensure that all members of staff involved in the administration of medication have received the training on how to use the system properly. Although the staff have received training on the safe handling of medication, the Home has also decided to arrange for the staff to attend the foundation course run by the pharmacy. The Home needs to introduce a consistent programme of monitoring to ensure that the staff are competent to handle and administer medication to the residents in the correct manner. One of the residents is now administering their own insulin after being assessed by the District Nurses. The staff are supporting the resident, however the information is not contained in the residents care plan and the staff have not received any training or assessments for competency for these procedures. Controlled Drugs: The Home still does not have a Controlled Drugs cabinet. It was again recommended that, in order to comply with the National Minimum Standards, the home obtain a Controlled Drugs cabinet and locate it on a solid wall using rag bolts. A number of failings were identified with the Controlled Drugs register. Storage: With the introduction of a mobile drugs trolley and the new system the organisation and storage of the residents’ medication has greatly improved. The proprietors were informed that they must secure the mobile drug trolley to the wall and keep the door of the fridge locked. The Home must ensure that those residents self administering their medication keep it secure when not in use. The Home has also obtained a fridge for the purpose of storing medicines, which required cold storage conditions. The staff are not obtaining the temperatures from the fridge display correctly and need to reset the thermometer after obtaining the readings. The proprietors were advised to obtain a simpler maximum and minimum thermometer to measure the Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 15 maximum and minimum temperatures more accurately. A number of medicines were being inappropriately stored in the fridge. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to be flexible and attempts to provide a service that is as individual as possible using its staff and resources effectively. More emphasis is needed to ensure that the people using the service have more opportunities to take part in a variety of activities both within the home and in the community. The people living in the home receive a well-balanced and varied diet, which caters for individual needs and preferences. EVIDENCE: Previous inspections and information gathered in service users and relatives’ surveys highlighted the need for more structured activities. One of the staff members interviewed said that she thought there should be more activities and would like to be able to take residents out into the community, if only for a walk. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 17 Some attention has been given to this area. One member of staff has been organising craft sessions and additional staff have been recruited, which should allow more time for activities and trips into the community. Some outside entertainers have been booked. It was noted during this inspection that the majority of the residents sit in either of the two lounges, both of which have the television on. There was little evidence of any additional stimulus or activities being provided. One of the proprietors said that there had been high levels of staff sickness, which has impacted on the activities programme. The staff did say however that the atmosphere has improved in the Home, which has had a positive effect on the residents and observations during the inspection confirmed this. One staff member said that they were no longer prevented from spending quality time with the residents and that they could sit and have a chat or maybe read the newspaper. Families are encouraged to visit their relatives living in the Home. One of the residents said that he went to bed at 10:30pm and got up at about 07:00am. He said that he was happy with this. The residents’ choices for their ‘typical day’ are recorded in the care plans. Beechcroft has employed a new cook. A four weekly menu is in place although it was suggested that this be changed on a seasonal basis. The Home has had an environmental health officer visit in 2007 and have complied with the recommendations made. There is a plentiful supply of fresh fruit and vegetables and food storage is satisfactory. Both of the residents spoken to said that they enjoyed the food. An alternative to the menu is available if required. The Home is able to cater for people with diabetes and those who require a ‘soft’ diet. There are sufficient staff available to assist those residents requiring help to eat their meals. Drinks and snacks are provided throughout the day. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Action is being taken to create a more open culture, which allows people to express their concerns and complaints. Procedures and practices in the Home have been strengthened, which safeguard the residents from potential abuse and the staff from wrongful allegation. EVIDENCE: There have been three complaints since the last Key Inspection on 10/05/06. One was made direct to the proprietors and two to the Commission for Social Care Inspection. The complaints all concerned the manager and the management practices in the Home. One of the proprietors initially investigated the first complaint, but this was not carried out to the satisfaction of the Commission for Social Care Inspection. As a result, the Commission for Social Care Inspection made their own enquiries and also for the subsequent two complaints received. Two of the complaints were anonymous. A number of visits were made to Beechcroft in which many of the staff were interviewed. The Local Authority became involved due to the serious nature of one of the complaints and all of the residents were reviewed and asked for their opinions about the Home. Letters were sent to the families asking for their views. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 19 Following these enquiries one of the complainants and the proprietors were notified of the findings and outcome and requirements and recommendations made under the Care Homes legislation. One area of criticism noted by the Commission for Social Care Inspection when making enquiries was the response of one of the proprietors to people expressing concerns and complaints and the ‘closed’ culture in the Home, which inhibited people, including staff from making their views known. The proprietors have been pro-active in addressing the areas of concern. Staff report that they are now more able to speak openly to the proprietors about any concerns they may have. The proprietors were advised at this inspection to implement a ‘grumbles’ book, in which they can demonstrate how they respond to more minor concerns. This will provide an indicator that they take all areas of concern seriously and respond appropriately. The management made a referral to the Local Authority in June 2006, because they were concerned about the vulnerability of one of the residents. Following a meeting with the relevant parties, a satisfactory conclusion was found, which would keep the resident safe. This situation highlighted the deficiencies noted at that time in the management of the Home, including assessments, care plans and how to make an appropriate Vulnerable Adults referral. These areas of concern are presently being addressed. Staff are being trained to understand adult abuse and what to do to prevent it, or how to report it, if identified. The proprietors were able to provide evidence that Protection of Vulnerable Adults and Criminal Records Bureau checks are now being carried out for all prospective staff. This will safeguard the residents and afford them the confidence that trustworthy staff support them. The record keeping for all financial procedures has been strengthened. All transactions are being signed for by two witnesses and receipts given. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live there. The home is comfortable, and has a programme to improve the decoration, fixtures and fittings. EVIDENCE: On 06/12/07 the fire safety officer attended Beechcroft to check their procedures and to update the proprietor on the changes to legislation. Since that visit the Home has used the services of an external company to undertake a full fire risk assessment of the Home, which highlighted a number of issues. Action is being taken to address these issues. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 21 Individual fire risk assessments for the residents still need to be completed, so that their individual needs, in particular mobility, are taken into account and ensure their safe evacuation. A tour of the Home was undertaken. It provides a well-maintained and clean environment for the residents. There is a programme of regular maintenance, redecoration and refurbishment. Equipment is available for those residents with mobility needs, which is serviced regularly. The environmental health officer visited the Home and inspected the kitchen at the beginning of 2007. Their recommendations have been actioned. To assist the prevention of cross contamination and the spread of infectious diseases some of the Home’s practices need to be improved. The hand-washing sink in the laundry should be accessible to staff and it was also recommended that disposable gloves be available in the laundry. The staff have appropriate hand washing facilities in their own toilet area and gloves and aprons are available for personal care tasks. Where possible liquid soap and paper towels should be available in the communal bathrooms and toilets, unless adequately assessed as being problematic. The proprietors were asked to risk assess the unguarded pipe work in one of the upstairs toilets. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home has a consistent staff team dedicated to the residents. Training provision has started to improve, with more regular courses being planned and attended, ensuring that the staff have the knowledge and skills required to care for the residents. A safe recruitment system must be maintained for all staff being employed so that the residents can be fully confident in the people that support them. EVIDENCE: There are presently four staff vacancies, including the manager’s post, however the staffing ratios are maintained at a satisfactory level. Five new staff, including a cook have been employed since the last Inspection and they have been undertaking induction training. Staff are given a handbook at the start of their employment, which tells them what they can and can’t do and what is expected of them Four staff files were checked during this visit. Recruitment procedures have generally improved and there is evidence of a more efficient approach. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 23 Protection of Vulnerable Adults and Criminal Records Bureau checks are undertaken for all prospective staff and staff do not work in the Home until their Protection of Vulnerable Adults check has been received. However, the proprietors had not received references for one of the staff and therefore the previous requirement has been carried over. It is vital that references be received for all prospective staff so that the proprietors can fully satisfy themselves that they are employing the right people to care for the residents. Start dates need to be clearer on the staff files. The proprietors were recommended to devise a protocol for Criminal Records Bureau checks and convictions. For example, the procedure to be followed if convictions are recorded on the disclosure and how to ensure that staff are still free of any convictions. One of the staff interviewed said, “The staff are here for the residents”. Even though there have been difficulties and problems at Beechcroft House in the last twelve months, the staff have remained loyal and dedicated with a determination to improve the standards in the Home. Discussions with the proprietor and the staff confirm that training is more regular and being planned on an on-going basis. Most of the staff have now had manual handling training and they have recently attended food and hygiene and fire safety courses. Some of the staff have received infection control training. Many of the staff have attended an awareness session regarding the care of the people with dementia care needs. The proprietor confirmed that she is yet to arrange more comprehensive training. The Home has recently changed its pharmacist and some training has been provided to the staff administering medication. A second day is yet to be planned. Some of the staff have completed the Safe Handling of Medicines training, although the results of a previous inspection of the medication systems did not evidence that this had been put into practice. Improvements however were noted at this visit. One of the proprietors is trained to train manual handling techniques and procedures and she assesses the new staff, however records are not kept of these assessments. External training is then arranged for the staff, but there may be delays in staff receiving this training. It is recommended that new staff receive documented manual handling training during their induction period and before assisting the residents. Six staff have registered to do National Vocational Qualification 2 in care and two to do National Vocational Qualification 3. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 24 Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is without a manager, however systems are in place to ensure that the residents are kept safe in the interim period. EVIDENCE: During the last two years the management systems in the Home have not supported the overall care being given to the residents by the care staff. The registered manager resigned on 12/03/07. The proprietors have started to advertise for a new manager. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 26 In the interim period, the three proprietors and the senior care workers have been given specific roles and responsibilities. One of the senior care workers has been given more managerial responsibilities, particularly regarding assessment and care planning for the residents. She also oversees the staff in the absence of the proprietors. Since the last inspection and as the result of the feedback given following the complaints’ enquiries, two of the proprietors have become more actively involved in the running of the Home. Major improvements are noted, although they are aware that there is a lot of work still required. Their presence in the Home and the work of the senior care worker has had a positive effect. Three staff were interviewed and all commented on the improved atmosphere in the Home. Regular staff meetings are being held, which keep staff informed and the staff report that the proprietors are approachable and willing to listen to their suggestions and ideas. They also confirm that the proprietors and senior are available in the event of emergencies. Individual staff supervision sessions have commenced. The Commission for Social Care Inspection is being appropriately notified of important events. As the result of one of the complaints, the financial records and procedures were checked on 30/10/06. There was no evidence of any financial discrepancies, however the proprietors were strongly advised to strengthen their recording systems. This has now been implemented. The proprietors have shown a willingness to co-operate with the Commission for Social Care Inspection to meet previous requirements and improve standards at Beechcroft House. They have attended regular meetings with the Commission and have developed an action plan following each inspection. Together with the staff in the home, they have started to improve many of the systems in the Home. This work will be enhanced and improved by the employment of an experienced and effective registered manager. It is hoped that the recruitment of a new manager will afford the staff and the residents with a period of sustainability, which builds on and maintains the improvements made in the last few months. The Home is well maintained and mobility equipment used by the residents regularly serviced. The proprietors have responded positively to recent visits by the fire safety officer and the environmental health officer. Action is being taken to meet their requirements and recommendations. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 27 Control of Substances Hazardous to Health measures need to be improved. Although products are safely locked away, some are being decanted into smaller bottles without information labels. The proprietor agreed to pursue this issue. It was also recommended that data sheets be available in the kitchen. More emphasis is required in the area of risk management, particularly for the residents. The staff would benefit from further instruction as to how to identify risks and this includes individual needs and the use of equipment, for example bed guards. Any limitation placed on a resident should also be carefully assessed and adequately justified. At present the proprietors and are concentrating their efforts on addressing previous areas of concern and as a result any formal Quality Assurance systems were not checked during this inspection. The proprietors have been more closely monitoring the practices in the Home and actively involved in making improvements. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X 3 3 X 2 Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Further work is required to ensure that care-planning information is current, accurate and covers all the assessed needs. This will ensure that staff have the information required to meet individual resident’s needs safely. More emphasis is needed to ensure that the people using the service have more opportunities to take part in a variety of activities both within the home and in the community. The management must monitor practices in the Home to ensure that suitable arrangements are in place to prevent infection and the spread of infection. Recruitment procedures must be further strengthened to fully protect the safety of service users. Previous Requirement from 23/08/06 Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 30 Timescale for action 31/05/07 2 OP12 OP13 16 (2m n) 31/05/07 3 OP26 13 (3) 31/05/07 4 OP29 19 Schedule 2 31/05/07 5 OP31 8 (1a) A manager must be employed with the qualifications, skills and experience necessary for managing the care home. The advice of an occupational therapist or relevant health professional must be sought to ensure the necessity of bed guards for the relevant service users and their safe usage. Risk assessments must also be completed. Previous Requirement from 31/10/06 More emphasis is required in the area of risk management, particularly for the residents. Control of Substances Hazardous to Health and Infection Control procedures and measures must be improved, in order that they comply with the relevant legislation and keep the residents and staff safe. The prescriber’s directions must be adhered to without fail. If it appears that the directions are not appropriate for the circumstances of the resident then the GP must be consulted. Previous Requirement 30/06/07 6 OP38 13 (1b, 4c) 31/05/07 7 OP38 13 (4a, b, c) 13 (4a, b, c) 31/05/07 8 OP38 31/05/07 9 OP9 13(2) 10/05/07 10 OP9 13(2) A written criterion for the administration of prescribed as required medication in respect of individual residents must be available and based on documented medical advice. Previous Requirement 10/05/07 11 OP9 13(2) Where possible the home must ensure that the residents GP DS0000004916.V334676.R01.S.doc 10/05/07 Page 31 Beechcroft House Version 5.2 confirms any changes to the residents’ medication in writing. Previous Requirement 12 OP9 13(2) Detailed risk assessments must 10/05/07 be carried out for those residents wishing to self medicate and the information recorded must be able to support the home’s decision to allow/refuse the residents’ wishes. The home must also establish a monitoring programme to ensure that these residents act in accordance with the prescribers’ directions. Previous Requirement 13 OP9 13(2) All as directed doses must be confirmed in writing by the prescriber and the MAR sheets must be amended accordingly. Previous Requirement 14 OP9 13(2) The home must ensure that all staff involved in the administration of medication to the residents has received appropriate training. Previous Requirement 15 OP9 13(2) The home must develop an effective programme to assess and monitor the care staffs’ competency in handling and administering medication to the residents. Previous Requirement 16 OP9 13(2) It must be ensured that all medication is stored in accordance with the manufacturers storage requirements. DS0000004916.V334676.R01.S.doc 10/05/07 10/05/07 10/05/07 10/05/07 Beechcroft House Version 5.2 Page 32 Previous Requirement 17 OP9 13(2) All medication must be securely stored so that unauthorised personnel do not have access to it. Previous Requirement 18 OP9 13(2) The temperature of the medication fridge must be maintained at between 2 and 8(C through daily monitoring of the maximum and minimum temperatures using a maximum and minimum thermometer. Previous Requirement 10/05/07 10/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP16 OP30 OP9 Good Practice Recommendations It is recommended that a ‘grumbles’ book be implemented, which provides evidence that all concerns are taken seriously. It is recommended that new staff receive documented manual handling training prior to working with the residents, ensuring a safe system of work. It is recommended that the home obtain a Controlled Drugs cabinet and attach it to a solid wall using rag bolts. Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beechcroft House DS0000004916.V334676.R01.S.doc Version 5.2 Page 34 - 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!