Inspection on 10/04/08 for Beechcroft Nursing & Residential Home

This inspection was carried out on 10th April 2008.

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

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

Other inspections for this house

Beechcroft Nursing & Residential... 15/10/08

Beechcroft Nursing & Residential... 26/06/07

Beechcroft Nursing & Residential... 03/10/06

Beechcroft Nursing & Residential... 12/01/06

Beechcroft Nursing & Residential... 01/06/05

Beechcroft Nursing & Residential... 16/11/04

Beechcroft Nursing & Residential... 22/07/04

Beechcroft Nursing & Residential... 16/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Beechcroft Nursing & Residential Home Lapwing Grove Palacefields Runcorn Cheshire WA7 2TP Lead Inspector Helena Dennett Unannounced Inspection 10 April 2008 16:00 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 Nursing & Residential Home DS0000005171.V361757.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 Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechcroft Nursing & Residential Home Address Lapwing Grove Palacefields Runcorn Cheshire WA7 2TP 01928 718141 01928 714573 beechcroft@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Homes No 3 Limited 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) Ruth Welsby Care Home 67 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (67), of places Physical disability (2) Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 67 service users to include:* * * * Up to 67 service users in the category of OP (Old age, not falling within any other category) Up to 2 named service users in the category DE(E) (Dementia over 65 years of age) in receipt of personal care only Up to 2 service users in the category PD (Physical disability) Up to 26 service users may be in receipt of nursing care 17th January 2008 Date of last inspection Brief Description of the Service: Beechcroft is a care home that provides nursing and personal care for 67 older people. The home is 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 people with a disability. Fees range from £334.33 to £675.00 per week, depending on the level of care required. There are additional charges for hairdressing, toiletries, newspapers and outside social activities, for example cost of transport and theatre tickets. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 0 stars. This means that the people who use the service experience poor quality outcomes. This visit took place on 10 and 11 April 2008 and took 12 hours. inspectors made this visit to the service. Two The visit was just one part of the inspection. The home was not informed of the date the visit was to take place, but a few weeks before this visit, the manager was asked to complete a questionnaire to provide us with some information about the service. The manager was also asked to distribute questionnaires to residents, relatives and health and social care professionals to help the inspector find out what they think of the home. No responses were received back before the visit. During the visit we spoke with the manager, staff, people living in the home and visitors. We toured the home and looked at various records. Information about our findings was given to the manager at the end of our visit. A number of concerns were raised with us before the visit. As a result we did a random inspection in January 2008 and focused on choice of food, care staffing and management. Some requirements were made at that time. The manager wrote back to us informing us that they had met those requirements. What the service does well: Residents are assessed before they move in to make sure their needs can be met at the home. People living in Ash House (unit providing nursing care) are generally happy and are cared for well. Some staff were seen to treat people living in the home with respect and ensure that their privacy is maintained when carrying out care duties. Fire safety checks and fire drills are carried out at different times so that staff are aware of what to do in the event of a fire. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Care planning practices need to improve. Staff do not always plans when a persons needs change. Risk assessments are completed accurately and some people did not have care plans wound care or pressure area care. This means that people living are at risk of their needs not being met. update care not always in place for in the home Care practices in particular on Oak unit (unit providing personal care only) need to improve. Staff must make sure that they provide the care identified in the care plan and that records are completed accurately so people living in the home can be confident they are getting the most appropriate care to meet their needs. Call bells must be answered within an acceptable timeframe. We saw staff use poor moving and handling techniques and using wheelchairs without footrests so putting people living in the home at risk of harm or injury. Staff must make sure they accurately record on medicine administration sheets if a medicine has been given to show that people living in the home are given their medicines as prescribed. Controlled drugs must be stored correctly. Medicines must be stored at a lower temperature to ensure they are still in good condition when given to people living in the home. A system should be in place to ensure that all meals are kept hot until the person is ready to eat. Staff must make sure that they report immediately in accordance with Southern Cross Care Home policy, any poor practice or allegation of abuse so people living in the home are kept free from harm. Recruitment practices need to improve to ensure that at least two written references (one from the last employer) are obtained so the manager can be confident the person is suitable to be employed in care. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 7 The system for supervising carers needs to be reviewed so that any poor practice is identified and appropriate action taken. Annual appraisals should be carried out for all staff. We the the not should be notified about any incident/occurrence that may adversely affect wellbeing of anyone living in the home so everybody can be confident that correct action has been taken to make sure that people in the home are at risk. The maintenance of wheelchairs needs to be improved to ensure that this equipment is safe for people to use. 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 Nursing & Residential Home DS0000005171.V361757.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 Nursing & Residential Home DS0000005171.V361757.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): 1&3 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Prospective residents’ have an assessment of needs before moving into the home to ensure there are the right resources available at the home to meet their needs. EVIDENCE: The records of two people recently admitted to the home were looked at. These contained an assessment of needs completed before the person came into the home. This means that the person can be confident that staff at the home can meet their needs. Information about the home and the services it provides is available in all of the bedrooms. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 10 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 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. People’s health, personal and social care needs are not always set out in their plan of care. This, together with poor recording and some poor care practices means that people who live in the home are at risk of not having their care needs met. EVIDENCE: The records of five people living in the home were looked at during the visit. All of these contained an assessment of needs, which formed the basis of the individual plan of care. When we visited in January 2008 we found that some care plans had not been updated following changes to the person’s condition. This means that there was a risk that their needs may not be met. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 11 During this visit we found again that some care plans had not been updated and some records were not completed accurately. For example: the care plans we looked at for two people were written in 2006. Although these had been reviewed monthly, the care plans had not been changed when the person’s needs had changed. In one of the care plans, it stated that staff were to give the person supplementary drinks. We spoke to care staff who told us that the person did not require supplementary drinks and these had not been prescribed by the doctor. This issue was also highlighted in another care plan of a person who moved into the home in January 2008. Care staff told us that person also did not have or need supplementary drinks. Although the person had started to lose weight, there was no evidence that supplementary drinks had been prescribed by the doctor even though the care plan stated that staff should give the person these drinks. Some of the risk assessments completed in the files contained inaccurate information, which could affect the overall risk score. We noticed that some of the people in Oak House had dressings on their legs. One person’s bandage appeared marked and stained during the evening visit. It was evident that this had not been changed when we visited the following morning as the same bandage was in place up to the time we left the following afternoon. We looked at that person’s care file. A risk assessment was in place for the bandages on her legs, stating that when her legs breakdown, daily bandage changes should occur. However this assessment was last reviewed in January 2008 and it stated that her legs were intact. A care plan for the care of her wound was not in place. Another person was seen walking around the unit with a support bandage in place at 0800hrs. The bandage had slipped, causing the person’s leg to swell around the bandage. At 10:30 the carer told the lady that she would change the bandage. This had not been attended to by 12:00. We saw poor practice in Oak House. This included staff using poor moving and handling techniques to transfer individuals and using wheelchairs without footplates to assist people to move around the unit. This puts people living in the home at risk of injury or harm. We also noticed that staff did not change one person’s clothes after assisting her to the toilet even though it was evident that these needed to be changed. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 12 We checked some of the charts for people living in the home. It had been written that one person required assistance to go to the toilet every two hours. Staff had recorded that on the 09/04/08 the person was attended to at 3.10pm and the next record was on 11/04/08 at 7.10am. According to the records, therefore, the person was not assisted to the toilet for over 36 hours. Also we observed that from 6pm – 9.30pm on 10/04/08, the same person was not taken to the toilet and the following day from 8am – 11.30 again she was not attended to. People spoken with gave mixed opinions about the care provided at Beechcroft Care Home. People living in Ash House said that staff were good and attended to their needs. All said they were very happy in the home. People in Oak House were not as complimentary about staff. One person felt that agency staff are not given enough information about their needs so do not always provide the right type of care. One person expressed concerns that some staff do not always assist them to have a thorough wash but that they just wash their face and hands in a morning, although this was not true of all staff. Two people said that there is a delay (up to one hour) in answering the call bells particularly when they are sat in the lounge. The arrangements for ordering and disposing of medication are satisfactory. A discrepancy was found on one of the medicine administration record sheets. Staff had written the person’s blood pressure in the box that should be signed to indicate whether the medicines had been given or not so it was difficult to judge when the person had their tablets. Instructions had been left for staff not to give a particular tablet if the person’s blood pressure dropped below a certain level. However there was no care plan in place to identify this or the action to be taken if the person’s blood pressure dropped very low. Several prescribed creams had not been signed for so it was difficult to know whether these had been given. One person was prescribed Lactulose solution regularly. This had not been given and a code ‘n’ ( not required ) used with no explanation why it wasn’t required or whether the GP had been informed. We found that a box of Fentanyl patches on Ash House was stored incorrectly. This is a controlled drug and should be stored in accordance with regulations. Eye drops were found stored in a box in the trolley. These should be stored between 2 – 8°C. A community pharmacist visited recently and judged that the temperature of the room where medicines are stored in Ash House is too hot and recommended that an alternative be found. The manager told us that plans are in place to address this. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 13 During the random inspection earlier this year, we were told that some medicines were given out earlier than prescribed at nighttime. A requirement was made at that time to make sure that this practice would not adversely affect the people receiving the medicines. The manager has since told us that this practice has stopped and people are receiving their medicines at the correct time. Some people living in the home told us that staff maintain their privacy and dignity. One lady told us that she sometimes feels embarrassed using the toilets as it is difficult to use the locks and so anyone could walk in. One gentleman told us that he thinks there are times when the ladies are attended to first even though the men may have rang the call bell for attention before the ladies. We observed this during the visit when a gentleman had to wait quite a while for attention whilst the ladies were attended to more quickly. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 14 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 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. There are enough activities provided so that people can take part in a variety of different things to do. Some of the food provided is not kept warm enough so there is a risk that some people may not eat their meal. EVIDENCE: During the random inspection, which took place in January 2008 it was found that there were not enough activities going on in the home to meet the needs of the people living there. Since then the manager told us that there is a seven-day activity programme in place with care staff carrying out activities regularly. The activity coordinator works three days per week; the manager said that an advertisement has been placed to cover additional hours. People living in the home confirmed that there is a range of activities now taking place. However, two people said they would like to have a more varied programme so that their interests could be included. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 15 On the afternoon of the inspection visit a singer was seen entertaining people in the lounge area. People living in the home said that they could in general suit themselves regarding the time they get up and go to bed. One person on Oak House said it could be late before they go to bed, as there is only three staff working at night. Visitors can visit the home at any reasonable time. The home has links with the local churches and schools. Religious ministers visit regularly. Most people spoken with thought the food was good or OK although one said they didn’t like the food very much. The chef writes the menu on the white board in the dining room every day so people living in the home know what’s on offer. One person suggested this board should be lowered so people in wheelchairs can read them. We saw breakfast, lunch and tea being served during the visit. A member of staff visits everyone in the morning to tell them what food choices are available that day. People’s choices are then written down. During teatime one person was seen asking for some soup and sandwiches. The member of care staff said this person had chosen one of the alternative meals so that had been served to her. The chef said that extra portions are provided so people who change their mind can have another choice. There is a hostess employed to look after people in the dining room during breakfast and lunchtime. This is good practice as it means that carers can have time to help people to eat and drink. One member of staff was seen assisting a person to eat and this was done in a sensitive way. During the mealtimes the only drink that appeared to be available was tea or squash even though on some people’s care plans it stated their preferred drinks were orange juice, milk, water or coffee. During breakfast, the porridge was ready on the serving table in a large bowl, and it was served to people from this. However breakfast is served from 08:00 to 11:00hrs and there was no system to keep the porridge warm. One person told us that at times the pureed food was left to stand whilst staff assisted people to eat, so it became cold. The chef told us that the food is covered with cling film and put back in the hot trolley to keep warm on Oak House but a carer working in Ash House confirmed that the pureed food is left on the person’s table until a carer is free to help them to eat. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 16 One relative expressed concern that a jug of water was not always left in bedrooms for people to use. We saw a jug of squash with several glasses placed in the lounge area; however no one was seen using this throughout the morning. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 17 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 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People living in the home have access to a good complaints procedure which means their concerns should be listened to and acted on. Lack of staff action in reporting events means that people living in the home could be placed at risk. EVIDENCE: There is a complaints policy for the home which sets out what to do if someone has a concern or complaint. People living in the home said they would know who to complain to if they had any concerns We have received a number of complaints since the last inspection. These were referred back to the provider to investigate using their complaints procedure. The manager keeps a log of complaints received, the action they have taken and the outcome of any investigation that has taken place. A number of safeguarding adults referrals have been made since the last key inspection. In some instances staff have not referred these on within an acceptable timeframe and in accordance with the home’s policy and procedures. This means that people living in the home are not always protected. However the managers of the home have acted appropriately once they received the allegations. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 18 The manager told us that all staff at the home have had up to date safeguarding adults training and the training files we checked confirmed this. There is a whistle blowing policy in place. Staff spoken with knew about the policy. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 19 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, 20 & 26 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Although the environment is generally well maintained, some areas of the home were not very clean and poor staff practices in relation to infection control could leave residents at risk. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home provides an adequate standard of accommodation throughout. Gardens are attractive and accessible to wheelchair users. However there are signs of wear and tear throughout the building. Some maintenance issues were noted on Oak House. The door to the staff locker room had been removed and a mattress was stored in there. A door handle to one of the toilets was broken and in need of repair. The handrails on the corridors were chipped with paint peeling off. Bedrooms are personalised with personal mementoes, small pieces of furniture and photographs are in place. Although the main lighting is satisfactory two people spoken with said they found the lighting poor and this prevented them from reading. Energy saving bulbs are used around the building. There is a designated area set out for people who smoke. This is situated outside and is not totally enclosed. There is a step to negotiate in order to get to this area. People living in the home were seen using this shelter and told us this is the only place they could smoke. This is not acceptable as some of the people are elderly, frail and in poor health. A suitable place should be provided inside the home to meet the needs of those people. Infection control and cleanliness issues were also noted during the site visit. One of the shower rooms was used to store a number of items, some of which obstructed the sink. This means that people using the toilet would not be able to wash their hands. In another bathroom several toiletries were found under the sink. People’s toiletries should be returned to their rooms after use. A jug was also placed under the sink. There was nothing on the jug to indicate what it is used for, as some may be used to rinse people’s hair whilst others may be used to measure urine output. This jug should be disposed of. The bin in the bathroom was dirty and in need of cleaning. A commode in one person’s room was also noted to be marked, stained and in need of cleaning. The floor in the small kitchenette in Oak House was marked, stained and in need of replacement. The walls were marked and the insides of the cupboards were dirty. The small fridge had a bad smell and was dirty inside. A large fridge in the dining room had an assortment of foodstuffs, which were not marked or dated. The fridge required cleaning. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 21 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 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Some staff practice is poor so people living in the home are at risk of harm. EVIDENCE: There were enough care staff working in the home during the time we spent there. Agency staff are asked to cover any unauthorised absences. One member of agency staff spoken with said she had received a full induction when she first started working at the home. She had completed several shifts so felt she knew the people living in the home well. One person living in the home said that some agency staff are not given enough information on the needs of the people living there. They said that the staff work individually and at times the residents have had to tell the member of staff what to do. Poor staff practices were noted. These are identified under standard 8 and mean that people living in the home might be placed at risk. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 22 Less than 50 of care staff hold a National Vocational Qualification Level 2 in care. More needs to be done to make sure that at least 50 of care staff hold this qualification to ensure that people living in the home are in safe hands at all times. A sample of recruitment records was looked at. There was evidence that a Criminal Record Bureau disclosure had been carried out so protecting people living in the home. In one person’s file we noted that only verbal references had been obtained no written references had been obtained. This is not considered good practice. In another person’s file two references had been sought; however one of these had been obtained from the partner of a relative of this member of staff. More impartial references should be obtained to ensure that the person is suitable to work in care. Information received before the site visit states that all staff will be regularly supervised every 6-8 weeks. The manager told us this is already in place. The way this is carried out should be revised so that poor practice can be identified and action taken as necessary. Annual appraisals are not carried out. Members of staff told us that they are supported in their training. There is evidence that a range of training is available including moving and handling, adult protection, medicines, fire training, food safety and infection control. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 23 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, 33, 35, 36, 37 & 38 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. The health, safety and welfare of people living in the home is not always promoted and protected and so people may be at risk of injury and harm. EVIDENCE: The manager is a qualified nurse and is experienced in managing a care home. She has worked at the home for over 2 years and previously held senior positions within the nursing/care industry. Members of staff told us that they felt supported by the manager of the home. They said they could approach her if they had any problems or concerns. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 24 People living in the home said they knew the manager and that she visited the units regularly. There is a quality assurance system in place. However there was little evidence to suggest the quality of care being delivered to people is monitored closely. People living in the home told us that they have been sent some satisfaction questionnaires to fill in recently. These had been distributed by the local authority. The manager told us that relatives’ meetings are held regularly. Only the minutes from the last relatives’ meeting were available. Staff meetings are also held. The minutes from the last staff meeting were available. We looked at accident/incident records for Oak House. The accident book was seen and was noted that it was started on 21/02/08. Since then 35 incidents/accidents had occurred, of which 9 resulted in injuries. These should be audited to find out whether there is a trend and so reduce the number of accidents/incidents on the unit. All of the entries were kept in a general book, which means they do not comply with the Data Protection Act. This is also contrary to Southern Cross Care Home procedures. We have not always been informed of some incidents that have happened in the home that have affected the people living there. This is a breach of the regulations. A system for managing people’s money is in place. Computer records are held and records of all transactions are kept. A ‘pool’ of money is held in the home so that people living there can get access to some money at short notice if they wish. We identified issues relating to maintaining accurate records under standard 7 and 8 as this had an impact on the care provided for people living in the home. We checked the wheelchairs during the visit. One was found to have faulty brakes and some had no footrests in place. One person living in the home said he had been waiting three weeks to have his wheelchair attended to and in the interim was using one that was not suitable. The manager told us that this had been reported to the company responsible for maintenance of the wheelchairs and that they were waiting for them to visit. Some people on Oak Unit were seen trying to get around by using their feet to propel the wheelchair. This could cause them injury or harm. Suitable equipment must be provided. We spoke to the maintenance man who explained the system he uses to make sure equipment etc is kept in good order. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 25 Information we received before the inspection indicated that equipment is maintained regularly. We checked a sample of records to confirm this. The electrical wiring certificate was not available. The manager told us that she did not have a copy of current certificate. However the electricians were checking the system during the inspection visit and a new certificate would be available soon. The records showed that fire safety checks are done regularly and staff have taken part in fire drills. As stated above, some poor practices were seen which could compromise the health and safety of people living in the home. These need to be addressed. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 26 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 2 x x x x x 1 STAFFING Standard No Score 27 2 28 1 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 2 2 Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 27 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 Requirement A care plan must be developed when a need is identified e.g. when a person has a wound, so that all staff know what care is to be provided. Care plans must be updated when residents’ needs change so that the person living in the home and staff know the care required to meet their particular needs. (Previous timescale 31/03/08 not met.) All the care identified as needed in the care plan must be provided so that people’s needs will be met. Adequate care, including assisting people to have a full wash/bath/shower and assisting them to change their clothes when necessary must be provided so that people’s personal care needs are met. Steps must be taken to ensure that medicines are stored below 25 degrees Celsius to maintain their shelf life. This will ensure that they are in a good condition when administered to residents. DS0000005171.V361757.R01.S.doc Timescale for action 10/05/08 15 (1) 2 OP7 15 (2) (c) (d) 10/05/08 3 OP8 12 (2) 10/05/08 4 OP8 12 (2) 10/05/08 5 OP9 13 (2) 10/05/08 Beechcroft Nursing & Residential Home Version 5.2 Page 28 6 OP18 13 (6) 7 OP20 23 (2) (e) 8 OP26 16 (2) (j) (k) 9 OP29 19 (1) (b) Schedule 2. 10 OP36 18 (2) (a) (Timescale 17/01/08 not met) All medicines must be correctly recorded and stored so that they continue to be effective and there is evidence that they have been given as prescribed. Any witnessed events or allegations of abuse or misconduct must be reported without delay in accordance with the home’s policies and procedures to promote the safety of the people living in the home. Steps must be taken to provide a more suitable smoking area for people who live in the home who smoke so they do not have to go out into an area which may present risks to them. The cleanliness of the home must be maintained to an acceptable standard to ensure the environment is pleasant place for people to live in. Infection control issues identified in the report must be addressed so people living in the home are not placed at risk. Two written references must be received including, where applicable, a reference from the person’s last place of employment that involved children or vulnerable adults. Written verification must also be sought on why the person left that post. This means that people living in the home can be confident that anyone employed is suitable to work in care. Staff at the home must be appropriately supervised to ensure that an adequate standard of care is provided to people living in the home. 10/05/08 10/06/08 10/05/08 10/05/08 10/05/08 Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 29 11 OP37 37 12 OP37 13 OP38 17 (1) (a) Schedule 3 13 (6) CSCI must be informed of any adverse events that may affect the health and well being of people living in the home in accordance with Regulation 37. Records completed by staff must be accurate and up to date at all times. 10/05/08 10/05/08 14 OP38 23 (2) (c) Safe working practices must be 10/05/08 used by all staff at all times so people living in the home are not at risk of harm or injury. This includes moving and handling techniques and use of wheelchairs. Suitable equipment must be 10/05/08 provided for people living in the home and all equipment used must be kept in good working order, in particular wheelchairs so people who live at the home can use the equipment without being at risk of injury. 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 OP10 OP10 OP12 Good Practice Recommendations Privacy signs for the bathroom and toilet areas should be provided so people living in the home who cannot use the locks can maintain their privacy. Everyone living in the home should be treated equally especially when they require assistance. The views of people who live in the home should be obtained regarding the type of activities they would like to have provided in the home so their interests can be catered for. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 30 4 5 OP15 OP37 All meals should be served at an acceptable temperature to people living in the home. Varied drinks should be offered in accordance with people’s preferences. Records kept in the home should comply with the Data Protection Act to ensure that information about people is kept confidential. Beechcroft Nursing & Residential Home DS0000005171.V361757.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston, PR2 2YQ 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. 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