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Inspection on 01/06/05 for Beechcroft Nursing & Residential Home

Also see our care home review for Beechcroft Nursing & Residential Home for more information

This inspection was carried out on 1st June 2005.

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.

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

What the care home does well

Residents feel care for by the staff and are enabled to maintain their privacy and dignity. There is a robust complaints procedure in place. There is a good investment in staff training.

What has improved since the last inspection?

Residents are offered more choice at mealtimes and an additional person has been appointed to provide activities two afternoons a week. Further refurbishment has been carried out and the lounge, dining room and corridors in Ash House providing a particularly nice environment for the residents. Fifteen staff had received training in the care and management of residents with dementia and eight more staff had obtained an NVQ Level 2 in Care, enabling them to give a better standard of care to residents. Progress had also been made in improving levels of staff supervision. .

What the care home could do better:

There needs to be consultation with residents about their preferred choice of activities and a programme drawn up to provide more stimulation for the residents. There needs to be investment in increasing the assisted bathing facilities in Oak House and the provision of more moving and handling equipment to ensure that service users do not have to wait for a bath or to use the toilet. Agreed staffing levels on Oak House must be maintained to ensure that all residents needs can be met and enhanced Criminal Records Bureau checks must be carried out for all care staff to improve protection for residents.

CARE HOMES FOR OLDER PEOPLE Beechcroft Lapwing Grove Palacefields Runcorn WA7 2TP Lead Inspector Gill Matthewson Announced 1 June 2005 09:30 st 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 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. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Beechcroft Nursing & Residential Home Address Lapwing Grove Palacefields Runcorn WA7 2TP 01928 718141 01928 714573 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Care Homes No. 3 Limited Care Home (CRH) 67 Category(ies) of DE(E) Dementia - over 65 (12) registration, with number OP Old age - (67) of places LD Disability - (1) PD Physical disability - (1) F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 67 service users including: *Up to 67 service users in the category of OP (old age not falling within any other category) *Up to 12 service users may be in the category of DE(E) (old age with dementia) and in receipt of personal care only * Up to 1 service user may be in the category of LD (learning disability) 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 16 November 2004 Brief Description of the Service: Beechcroft is a care home providing both nursing and personal care for 67 older people.The home is located in the Palacefields area of Runcorn, in a quiet cul-de-sac, close to churches, a pub and local shops.The home was opened in 1989 and consists of two single storey purpose built units. Ash House has 26 beds allocated for nursing care and Oak House has 41 beds allocated for personal care.All bedrooms apart from one are single and six have en-suite facilities. The grounds are landscaped and well appointed, with good access for persons with a disability, both within and outside the building. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection the registered manager had retired and there was an acting manager in post. Also, the company registered in respect of Beechcroft had merged with another care home provider. At the previous two inspections concerns had been raised about the home’s ability to care for residents with dementia. A meeting was held with the new operations director for the home and agreement reached that the home would cease to provide care for residents with specialist mental health needs in the future. This inspection was carried out by two inspectors of the Commission. The lead inspector spent two hours planning the inspection by reviewing previous inspection reports and the service history over the last twelve months. The inspection took place over seven hours and included a tour of the building, inspection of records and discussion with twelve residents, four relatives and eight staff. Feedback was given to the acting manager at the end of the inspection. What the service does well: What has improved since the last inspection? Residents are offered more choice at mealtimes and an additional person has been appointed to provide activities two afternoons a week. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 6 Further refurbishment has been carried out and the lounge, dining room and corridors in Ash House providing a particularly nice environment for the residents. Fifteen staff had received training in the care and management of residents with dementia and eight more staff had obtained an NVQ Level 2 in Care, enabling them to give a better standard of care to residents. Progress had also been made in improving levels of staff supervision. . What they could do better: 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. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 With one minor exception, prospective service users are provided with the information they need to make an informed choice about where to live. EVIDENCE: The home had recently reviewed its statement of purpose. This contained the information required by Schedule 1 of the Care Homes Regulations except the details of the accommodation provided were incorrect in that it stated there were no double rooms and the details of bathroom facilities were incorrect. See Requirement 1. The acting manager said that that this information was provided to prospective residents when they made enquiries about the home. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 9&10 The home has satisfactory systems and procedures for the safe handling, storage and administration of medication and staff are trained to ensure that residents receive the medicines prescribed by their general practitioners. Residents considered that their right to privacy and dignity was respected by staff. EVIDENCE: In Ash House all medicines are administered by qualified nurses and in Oak House by senior care assistants who have undertaken appropriate training in this area. The home uses computer generated Medicine Administration Record (MAR) sheets, which are supplied by it’s contracted pharmacy. MAR sheets were viewed in both Ash House and Oak House and these showed that medicines were being recorded appropriately at the time of administration. A photograph of each resident preceded their respective MAR sheet. Records of medicines supplied each month were pre-printed on the MAR sheets. In Ash House, quantities of any medicines which were being carried over from the previous month were being clearly shown. In Oak House, however, medicines carried over from the previous month were not being shown on the MAR sheets. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 10 Receipt, administration and disposal of controlled drugs was recorded in a controlled drugs register. Medicines, in both Ash House and Oak House were being appropriately stored in locked cabinets in locked rooms and a separate lockable cabinet was being used for controlled drugs. There were separate fridges on both units for medicines requiring refrigeration, and temperatures were being monitored. Records of medicines returned to the pharmacy were being maintained in both units. These contained the names and quantities of medicines being returned and were signed by a pharmacy representative. In Oak House one recent record of medicines returned was not readable (due to insufficient pressure being used on the carbonised paper) and a number of sheets did not clearly show the date on which the medicines had been returned. See Requirement 2. Residents felt that staff showed respect towards them and confirmed that staff members always knock on their bedroom doors and await permission before entering. A staff member who was spoken with gave examples of the ways in which she and her colleagues try to respect residents’ privacy and dignity; these included: using a towel to cover residents before lowering them into the bath; making sure bathroom/toilet doors are closed when providing personal care such as toileting or bathing; ensuring that bedroom curtains are drawn at night; knocking on bedroom doors and awaiting permission before entering. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 &15. The limited number of activities does not provide adequate stimulation and interest for people living in the home. However, the home has made progress in providing residents with greater choice at mealtimes. EVIDENCE: Whilst a planned activity (visiting musical entertainer) was taking place on the afternoon of the inspection, a number of service users said that not enough activities were provided by the home. One individual said “there are not many activities but we have been promised more”. The home’s acting manager acknowledged that this was an area where improvements were needed. She said that the home currently employs an activities co-ordinator for 21 hours each week and that a care assistant was now working two afternoons each week to provide additional activities for residents. See Requirement 3. Residents considered that the food provided by the home was improving. Care and catering staff said that residents’ meals were now served individually (rather than ready plated) according to their own preferences and that this offers greater choice in terms of the quantities of food they are given. Whilst one resident said that she can have a cooked breakfast (bacon and eggs) if she wishes, there was uncertainty – which was confirmed by some staff members – as to whether the option of a full cooked breakfast was available to all F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 12 service users on a daily basis . Indeed, menus seen did not make any reference to the availability of cooked breakfasts. See Recommendation 1. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints system that is accessible to residents and relatives. EVIDENCE: The home had a written complaints procedure which included contact details for the Commission for Social Care Inspection (CSCI). This was included in the resident guide and on display in the foyer. Residents confirmed that they knew who to contact if they wished to make a complaint. There had been no complaints since the last inspection. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21,22&26. Recent investment has significantly improved the appearance of this home creating a comfortable environment for those living there. Residents would benefit from some further investment in additional assisted bathing facilities and moving and handling equipment. EVIDENCE: Adequate bathroom and shared toilet facilities were provided in Ash House and it was noted that a new ‘Aquanova’ bath had been installed in one of the bathrooms and that this was proving popular with both residents and staff. In Oak House, however, the only bath with a fixed hoist had not been operational since the beginning of April 2005 due to a fault with the hoist. This had resulted in residents having to have a shower or use the bathing facilities in Ash House. As there is currently only one bathroom in Oak House with an assisted bathing facility, inspectors considered that it was now necessary to provide an additional bathroom with such a facility. See Requirement 4. It was observed that one resident in Ash house had to wait at least ten minutes to use the toilet because the hoist she required was in use. This was F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 15 discussed with the deputy manager who said that some residents would be capable of using a standaid hoist but were moved using a full body hoist because there was no standaid hoist available. See Requirement 5. The home had undergone an extensive programme of refurbishment in the previous year and provided a good standard of accommodation. All areas were clean and free from any offensive odours. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29&30 The home’s investment in staff training ensures that staff are competent to do their jobs but the staffing levels are not always sufficient to meet residents’ needs and recruitment procedures do not afford adequate protection to residents. EVIDENCE: One resident (who had lived at the home for 8 years) and a relative (not related) referred to there being a lot of staff changes at the home. Two other relatives commented that staff did not have time to sit and talk to residents or make a cup of tea in between the usual drinks rounds. Staff rotas demonstrated that staffing levels on Ash House were sufficient to meet the needs of residents, but not on Oak House. There were two night vacancies and existing staff were usually working extra hours to meet the shortfall. There had been five nights in March when there were only two staff on duty to care for all the residents on Oak House (up to 41 residents). CSCI had not been notified of this. See Requirement 6. A senior care assistant said that all care staff undertake induction training, which is recorded, and that this included adult protection. Approximately 30 of staff had achieved at least an NVQ Level 2 in Care and another 30 had enrolled to start their NVQ training. Other training provided since the last inspection had included continence promotion, catheter care and dementia care. Future planned training included loss and bereavement. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 17 Staff records were reviewed. Two written references, including one from the previous employer, were obtained prior to employment and a Criminal Records Bureau disclosure was obtained. In most cases, this was an enhanced disclosure, but there were eight members of care staff for whom only a standard disclosure had been obtained. See Requirement 7. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33&38. The acting manager is supported well by the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The registered manager, who had managed the home for many years, had recently retired. There was an acting manager in post, who was a registered nurse within the general and mental health fields of nursing, and also held an honours degree in health care and a certificate in nurse management. A permanent manager had been appointed and was due to start at the end of the month. A consumer survey had been sent out to residents, relatives, GPs and social workers. Some responses had been received. Health and social care professionals seemed satisfied with the standard of care provided within the home. Responses were to be collated at the end of the month. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 19 There was a system in place for staff supervision and 12 staff had received formal, documented one to one sessions with the manager in the previous two months. There was a health and safety training programme in place to ensure that staff received training in fire safety, moving and handling, infection control, first aid and food hygiene. Six fire drills had been held in the previous year, but only one of these had been for night staff. See Requirement 8. All equipment had been service at the required intervals. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 4 x 2 2 x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x 3 x x x x 2 F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 4 Sch.1 Requirement The registered person must amend the statement of purpose to include accurate details of the accommodation provided. The registered person must ensure that clear records are maintained in Oak house of the number of tablets carried forward from the previous month and any medication returned to the pharmacy. The registered person must consult with residents about their recreational intersts and provide a programme of activities. (timescale of 16.02.05 not met) The registered person must provide an additional assisted bathing facility in Oak House. The registered person must provide a standaid hoist. The registered person must provide at least three members of staff on duty in Oak House at night and notify the Commission of any shortfalls. The registered person must obtain enhanced Criminal Records Bureau disclosures for all care staff prior to Timescale for action 1.08.05 2. OP9 13(2) 01.08.05 3. OP12 16(2) (m&n) 01.09.05 4. 5. 6. OP21 OP22 OP27 & OP37 23(2)(n) 23(2)(n) 18(1)(a) 37(1)(e) 01.12.05 01.09.05 01.08.05 7. OP29 19 01.06.05 F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 22 employment. 8. OP38 23(4)(e) The registered person must ensure that night staff attend a least two fire drills per year. 01.09.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations The registered person should amend the menus and ensure that all residents and staff are aware that a cooked breakfast is available on request. F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI F51 F01 S5171 Beechcroft V222988 010605 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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