Inspection on 12/01/06 for Beechcroft Nursing & Residential Home

This inspection was carried out on 12th January 2006.

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 Nursing & Residential... 15/10/08

Beechcroft Nursing & Residential... 10/04/08

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

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

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 Beechcroft Nursing & Residential Home Lapwing Grove Palacefields Runcorn Cheshire WA7 2TP Lead Inspector A Gillian Matthewson Unannounced Inspection 12th January 2006 09:30 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.V274263.R01.S.doc Version 5.1 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.V274263.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beechcroft Nursing & Residential Home Address Beechcroft Nursing & Residential Home Lapwing Grove Palacefields Runcorn Cheshire WA7 2TP 01928 718141 01928 714573 beechcroft@highfield-care.com 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) Southern Cross Care Homes No 3 Limited Mrs Kathleen Ann Ridings Care Home 67 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (67), of places Physical disability (1) Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 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 OP (Old age, not falling within any other category) * Up to 3 named service users in the category DE(E) (Dementia over 65 years of age) in receipt of personal care only * Up to 1 service user in the category PD (Physical disability) * Up to 26 service users may be in receipt of nursing care The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 1st June 2005 2. 3. Date of last inspection 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. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection a new manager had been appointed and registered by the Commission. 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 six hours and included a tour of the building, inspection of records and discussion with eight residents, four relatives and eight staff. Residents and visitors were very positive about the care provided. One relative whose mother had lived at the home for four years said “ We are very happy with Mother’s care”. Feedback was given to the registered manager at the end of the inspection. What the service does well: Residents are assessed prior to admission to ensure that the home will be able to meet their needs. Senior staff, in consultation with residents and their representatives, complete detailed care plans to ensure that all staff have access to detailed instructions on how to meet those needs. Residents feel cared for by the staff and are enabled to maintain their privacy and dignity. They can exercise choice and control over their lives and retain links with family, friends and the local community. Recruitment procedures, staff training and staff supervision ensure that residents are protected from harm. Residents’ financial interests are also safeguarded. The home is clean and comfortable. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 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.V274263.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 With one minor exception, prospective service users are provided with the information they need to make an informed choice about where to live. They also have a full assessment of need prior to admission to ensure that the home has the resources to meet their needs. EVIDENCE: The home had a statement of purpose and service user guide. 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. A visitor said that that this information was provided when they made enquiries about the home. Prospective residents were assessed by the home’s manager or her deputy prior to admission, and case files seen contained documentary evidence that Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 10 such assessments fully met the criteria contained within this standard. The assessment document, in conjunction with the social worker’s assessment, were used as a basis for formulating a plan of care. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10. There is a clear and consistent care planning system in place to provide staff with the information they need to meet residents’ needs. In the main, residents’ health needs are well met with evidence of good multidisciplinary work taking place on a regular basis. Residents considered that their right to privacy and dignity was respected by staff. EVIDENCE: Individual care plans were in operation for all residents. As part of the inspection process seven case files were reviewed. Assessments for falls, pressure areas, dependency, nutrition, continence and moving and handling had been carried out and were being reviewed on a regular basis. Where necessary, risk assessments for other conditions such as diabetes were also carried out. Care plans were found to be detailed and comprehensive, and there was evidence of on-going evaluation and monthly review by staff. Residents and/or their relatives were consulted regarding their care plans, and documentary evidence was available to confirm this fact. Case files contained evidence that residents’ healthcare needs were being clearly identified as part of the assessment process. Separate records were Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 12 maintained of visits by district nurses, general practitioners and other health care professionals and care planning documentation demonstrated that, in most cases, individual healthcare needs were being monitored. However, one resident of Ash House had Type 2 diabetes. The care plan indicated that blood sugar should be monitored twice a week, but it not been checked for eleven days. The same resident was assessed as requiring monthly weights because of a risk of malnutrition, but had not been weighed in the previous two months. See Requirement 2. Residents were supported by staff to access a full range of community healthcare services, such as optician, dentist, audiologist and chiropodist, where necessary. One resident said “As soon as I am ill they get in touch with my GP and family”. Since the last inspection the local primary care trust (PCT) had contracted with the home for two crisis beds for people who required rapid admission for a short period of rehabilitation. At the time of the inspection an occupational therapist and a physiotherapist from the PCT were visiting a resident. They said that the staff in the home worked and communicated well with them and followed their instructions. 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 good examples of the ways in which she and her colleagues try to respect residents’ privacy and dignity. Residents could have a lock on their bedroom doors if they wished. One resident spoken with had his own key. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 12, 13, 14 & 15. The range of recreational activities available has increased, providing more stimulation and interest for people living in the home. Links with the community are good and support and enrich residents’ social opportunities. The home has also improved the menu and residents are able to exercise choice and control over what they eat. EVIDENCE: The home employs an activities coordinator for 24 hours a week. A weekly activity programme was displayed on notice boards throughout the home. Activities included quizzes, beauty sessions, film shows, arts and crafts, games, sing a longs, bingo and chair exercise sessions. Photographs were on display of residents’ visits to the Albert Dock, Blackpool and Walton Gardens. There had also been visiting entertainers for a pantomime and musical entertainment. Three relatives confirmed that there were no restrictions imposed on visiting. The home had links with local schools and churches. Religious ministers visited regularly. Staff would take residents to church if they wished. Residents had visited local schools before Xmas to watch nativity plays and carol concerts. The home also sponsored Windmill Hill school football team and the children sometimes visited the home. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 14 Residents confirmed that they were able to exercise choice in aspects of daily living such as times of rising and retiring to bed, choosing what clothes they wear, how they spend their time, food menus (and where to eat), spending time in their own rooms, joining in activities etc. They were able to personalise their own rooms with small items of furniture brought from home, pictures, ornaments and other mementoes. Two care staff interviewed had a good understanding of the importance of choice in residents’ lives. The home had access to an advocacy service and had obtained the services of an advocate for one resident with no close relatives. Residents considered that the food provided by the home had improved and there was plenty of choice. The meal times had been changed so that meals were better spaced and new menus had been produced that included the option of a cooked breakfast. The manager and kitchen staff said that they were providing more home cooked meals. All soups were home made and they were making more home baked cakes. Only fresh vegetables were used. The cook confirmed that if a resident did not want any of the choices on the menu that day, she would make something else. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 18 Systems are in place to minimise the risk of any abuse of residents. EVIDENCE: The home had a satisfactory policy in relation to adult protection. This included definitions of abuse, signs or indicators and reporting procedures. The protection of vulnerable adults was included in the induction training. The manager and one of the nurses had attended training run by the local authority the previous week to enable them to provide more in-depth training in adult protection for the home’s staff. Four other staff were going on ‘abuse alerters’ training the following week. All staff had to supply references and a Criminal Records Bureau disclosure prior to employment. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 19, 20, 21, 22 & 26. EVIDENCE: The home had undergone an extensive programme of refurbishment in the previous year or two and provided a good standard of accommodation. The home met the space requirements for communal areas. Both houses had a large lounge and a dining room. The lounge in Oak House was very large and the manager said she had plans to divide it up to create a more homely environment. Since the last inspection an empty bedroom had been converted into a small smoking lounge because the home had admitted a few people who were smokers. See Requirement 3. Gardens were accessible to wheelchair users. Many of the furnishings were new, and all were domestic in character and of good quality. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 17 Bathing facilities had improved since the last inspection. Oak House had 3 bathrooms, one of which had a bath hoist and two shower rooms, both of which had wheel-in showers. Ash House had 2 bathrooms, both of which had bath hoists and a shower room with a wheel-in shower. In Ash House all the cleaning equipment was being stored in the bathrooms and had to be moved when they were in use. As well as being inconvenient for staff and residents, it could pose a potential risk if cleaning fluids were left in a corridor and storing vacuum cleaners and carpet shampooers in bathrooms is not very hygienic. When questioned, staff said there was nowhere else to store the equipment. It was agreed that a toilet that was rarely used could be converted to a cleaners’ store. See Recommendation1. All accommodation for residents was on ground-floor level. Where necessary, adaptations had been made to meet the needs of residents who had a physical disability. These included grab rails along corridors and in bathrooms and toilets, raised toilet seats, assisted baths/showers. Specialist pressure relieving mattresses were made available when necessary. The home had provided an additional mobile hoist for Ash House, as required at the last inspection. All areas were clean and free from any offensive odours. A visitor said that the home is always very clean. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 & 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 all residents’ needs. However, staff have a good understanding of residents’ support needs, which is evident from the positive relationships that have been formed. EVIDENCE: At the time of the inspection there were 36 residents in Oak House and 25 in Ash House. Staff rotas demonstrated that staffing levels on Ash House were sufficient to meet the needs of residents, but not always on Oak House. There had been three afternoon shifts (2pm to 8pm) the previous week when there were only three staff on duty in Oak House. This had been due to three of the regular staff being off sick for a couple of days each. CSCI had not been notified of this. See Requirement 4. At the previous inspection eight members of care staff only had a standard Criminal Records Bureau disclosure. The administrator produced documentary evidence to demonstrate that all staff now had an enhanced disclosure. Staff had recently had training in continence management, medicines management, catheter care and wound care. Further training scheduled included moving and handling, adult protection, record keeping and the ageing process. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 19 Residents spoken with said that staff were “lovely”. One said they were “a good group of girls”. Another said “they’re a cheery lot, you can have a laugh with them, they make my day”. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 36 & 38. The manager provides clear leadership and communicates effectively with residents, relatives and staff. EVIDENCE: The registered manager had been in post for six months. She qualified as a first level registered nurse in 1965. Since 1982 she has held various management positions in hospitals, care homes and latterly as a nurse supervisor for NHS Direct. She has additional nursing qualifications in Teaching and Assessing in Clinical Practice (ENB 998), Health Education, Gerontology, Developing the Scope of Professional Practice (R20), Tissue Viability (N49) and Rehabilitative Care in Specialist Clinical Settings (R33). She has also completed the Leading an Empowered Organisation Programme at the University of Leeds School of Healthcare Studies. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 21 Staff morale had noticeably improved. Staff spoken with said that there was much better communication since the new manager came into post. She has daily meetings with senior staff and regular meetings with all staff and relatives. The manager also held a weekly surgery for residents and relatives who wished to discuss any specific issues. The home handled residents’ personal allowances only. Storage facilities and records were reviewed and found to be satisfactory. The manager carried out staff appraisals on an annual basis and staff were supervised on a day to day basis. A system was in place for formal, documented supervision, and staff confirmed that they participated in this every two months. At the previous inspection a requirement had been made that all night staff should attend a fire drill at least twice a year. In the previous six months there had been three fire drills held, two in the day and one at night. This meant that some night staff had not attended the two drills required. The manager had added fire drills to the a matrix for statutory training and was in the process of writing in the dates that all staff had last attended to identify who should be on duty when future fire drills were held. Each resident had a risk assessment for bedrails. In the three case files reviewed in Ash House, all said that they were not at risk of rolling out of bed, but all had bedrails fitted to the bed. The member of staff who had completed the risk assessments was not on duty. The manager was asked to look into whether the staff member had made an error in completing the forms or whether bedrails were being used unnecessarily. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 22 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 3 3 3 2 X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 3 X 2 Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 23 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 OP1 Regulation 4 Sch. 1 Requirement The registered person must amend the statement of purpose to include accurate details of the accommodation provided. (Timescale of 01/08/05 not met) The registered person must ensure that residents’ weights and blood sugars are monitored at the frequency indicated in the care plan. The registered person must apply for a variation to the number of registered beds to take account of the loss of one bedroom to provide a smoking lounge. The registered person must provide at least four members of staff on duty in Oak House from 2pm to 8pm and notify the Commission of any shortfalls. (Timescale of 01/08/05 not met) Timescale for action 31/03/06 2 OP8 12(1)(a) 31/01/06 3 OP23 CSA Section 15. 28/02/06 4 OP37OP27 18(1)(a) 37(1)(e) 31/01/06 Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 24 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 OP21 Good Practice Recommendations The small toilet in Ash House should be converted into a cleaners’ store. Beechcroft Nursing & Residential Home DS0000005171.V274263.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Northwich Local Office 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. 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