Inspection on 15/10/08 for Beechcroft Nursing & Residential Home

This inspection was carried out on 15th October 2008.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

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 06/02/2009.

CARE HOMES FOR OLDER PEOPLE Beechcroft Nursing & Residential Home Lapwing Grove Palacefields Runcorn Cheshire WA7 2TP Lead Inspector Paul Kenyon and Maureen Brown Key Unannounced Inspection 09:00 15th October 2008 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.V367540.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.V367540.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) Paula Gresham (Acting) 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.V367540.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 Date of last inspection 10th April 2008 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 25 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.V367540.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 1 star. This means that the people who use the service experience adequate quality outcomes. This was the second key inspection to be held at Beechcroft this inspection year (April 2008 to March 2009). No notice of the inspection was given to the service prior to the visit. The visit included two Inspectors, one inspecting the social care unit and the other focussing on the nursing unit of the service. The inspection included an examination of the records relating to the support provided to individuals, a tour of the premises, discussions with staff and individuals who live there and an observation of care practice on the day. National Minimum Standards for Older people were used to measure the standard of care provided. What the service does well: Assessments of the needs of those who come to live at Beechcroft are obtained so that their needs can be met. The service ensures that the self-esteem of individuals is maintained through the provision of activities, enabling contact with the community and ensuring that individuals are as independent as possible. The nutritional needs of individuals are met. Those who use the service and their families can comment on the running of the service through the provision of a robust complaints procedure. Those who use the service are protected from abuse. Those who live at Beechcroft have their dignity maintained from living in a pleasant and well-maintained environment. Those who live at Beechcroft have their needs met by staff trained in the specific conditions that individuals are supported with. An experienced individual manages the service and as a result those who use the service benefit from this. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 6 Those who use the service and their families are able to make their experiences of the service known and acted upon through the quality assurance system adopted by the service. The financial affairs of individuals are safeguarded. General comments from individuals with whom the Inspectors spoke with during the visit included: One stated that the home was very nice and that the food was very good. They liked it here and the “girls” were very good too. One said that they like being here and that they had their own room, which they liked. Its very nice here and they confirmed that they had just had a nice breakfast. What has improved since the last inspection? The service now develops a care plan when a need is identified so that all staff know what care is to be provided. Care plans are now updated when residents’ needs change so that the person living in the home and staff now know the care required to meet their particular needs. All the care identified as needed in the care plan is now 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 is now provided by the service so that people’s personal care needs are met. Steps have been taken to ensure that medicines are stored below 25 degrees Celsius to maintain their shelf life. This now ensures that they are in a good condition when administered to residents. All medicines are now 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 are now reported without delay in accordance with the home’s policies and procedures to promote the safety of the people living in the home. Steps have now been taken to provide a more suitable smoking area for people who live in the home who smoke so they now do not have to go out into an area, which may present risks to them. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 7 The cleanliness of the home is now maintained to an acceptable standard ensuring the environment is a pleasant place for people to live in. Personnel records are now appropriately maintained in line with care home regulations and as a result protect those who live at Beechcroft. Staff at the home are now appropriately supervised ensuring that an adequate standard of care is provided to people living in the home. The Commission for Social Care Inspection is now informed of any adverse events that may affect the health and well being of people living in the home in accordance with regulations. Records completed by staff are now accurate and up to date. Safe working practices are now used by all staff at all times enabling people living in the home to be free from risk of harm or injury. Suitable equipment has now been provided for people living in the home and all equipment used is kept in good working order. 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. The summary of this inspection report can be made available in other formats on request. Beechcroft Nursing & Residential Home DS0000005171.V367540.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.V367540.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who come to live at Beechcroft have their needs assessed prior to them coming to live there which enables them to benefit from having their needs met. EVIDENCE: The current inspection report was available for people to look at. Previous copies were also included and it was suggested that these be removed so that people could easily identify which was the most up to date copy. This was agreed and actioned by the Acting Manager during the visit. The statement of purpose and service users’ guide had all the necessary information available so that prospective people who wish to use the service could decide if this home was suitable for them. A copy of the service users’ guide was available in each person’s bedroom. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 10 Assessments were viewed for five individuals living on the nursing unit who had been admitted since the last key inspection in April 2008. In all cases, a copy of a Local Authority assessment had been obtained before they had come to live at Beechcroft. In all cases the service had also conducted its own pre assessment document with respect to the needs of individuals. These needs covered a host of medical and health issues that were relevant to them. These assessments had not been fully completed in all cases and this is raised as a recommendation in this report. In addition to this, there appeared to be an emphasis solely on the nursing and health needs with little emphasis on their social needs. The need to place more emphasis on the social care needs of these individuals is raised as a recommendation in this report. Once the pre admission assessment is done, this then is used to create a draft care plan, which then is translated into the main care plan for each individual. The manager stated that the home didn’t provide intermediate care at Beechcroft at present. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those who use the service benefit from having their needs met by the care planning process. The health needs of individuals are met. Those who use the service have their health promoted through the safe management of medication. The privacy of individuals is not always taken into account. EVIDENCE: A sample of five care plans was examined relating to those living on the nursing unit and who had been admitted since the last key inspection in April 2008. In all cases, individuals had a care plan which outlined in details their needs and the things staff needed to do in order to meet their needs. In all cases, care plans had been reviewed on a monthly basis and as part of that review, a meeting had been held between the individual, their family and social worker Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 12 agreeing the contents of the care plan and agreeing any changes to their care that may be necessary. As part of the care planning process, daily records were available which outlined progress that had been made in respect of the care of each person. These provided a trail of how their needs had been met and how care plans had been altered to best meet their needs. Advice was given to the Acting Manager in respect of the use of words within daily records. Training records suggested that some staff had received training in care plans and this was part of the training schedule. Three care records were viewed from the residential unit. They all contained a pre-assessment of needs and this formed the basis of the care plan. Significant improvements had been made with the care plans. Reviews by social services were seen and up to date and the home was carrying out their own reviews as well. Care plans were being reviewed on a monthly basis. Daily notes were seen to be completed by the staff team and these were a good record of the persons wellbeing and it also noted daily tasks undertaken etc. The manager stated that the care plan records were being updated and new files being implemented, this should further improve the system in place. The health needs of five individuals on the nursing unit were examined. One individual had developed pressure sores since being admitted into Beechcroft, there was evidence that a tissue viability nurse had been involved in this person’s care. An assessment of the risk of the development of pressure sores was in place for all five individuals. There was evidence of Dietiticians being involved when necessary and nutritional assessments had been done in all cases with weights monitored on a regular basis. Other assessments included continence assessments and manual handling risk assessments were available for all individuals. Care plans outlined the health needs of individuals and there was evidence in each case that a response to these health needs had been done though evidence in daily records and through relevant assessments made on individuals. Evidence was available that other health care professionals had been involved in the care of people. These included visits from General Practitioners, physiotherapists, Optometrists, tissue viability nurses, dentists and Dietitician. Each visit from these individuals had been recorded with the reasons for their visits and actions to take as a result. All individuals had also had an assessment on their dependency levels outlining how many staff were needed for each part of care such as bathing or toileting. One person had a risk assessment for a particular medical condition and details of anti coagulant records were maintained. Health care professionals records were included in the three care plans viewed on the residential unit. They contained information regarding the visits made Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 13 by Doctors, District Nurses, social workers, chiropodist, optician and continence advisor. These were well documented and up to date. All medication prescribed is listed on care plans. No individuals self-administer medication at present although this is assessed in the initial pre admission assessment completed by the service. Issues have occurred in the recent past in relation to problems with medication supply but there was evidence that these have now been addressed and the system has been reinforced. Medication on the nursing unit is stored in a secured trolley, which is stored in a medication room and tethered securely when not in use. The medication room is also locked when not in use. The medication administration round on the nursing unit was observed. Tablets are dispensed from a blister pack system; the trolley is then locked while medication taken to each individual. The nurse on duty was observed speaking to each person individually and explained what he was doing. Encouragement was given to each person to take the medication and this was done in a dignified and reassuring manner. Medication administration records showed evidence of medication being signed when received. There were no signature omissions noted on records and photographs of each person are present. No controlled medications are prescribed at the moment. One person is insulin dependent and a sharps box is available for the disposal of used syringes after injections. Disposed medications have their own container and disposal records are maintained. Liquid medications are stored in a refrigerator whose temperature is recorded daily as evidenced by records and maintained at appropriate temperatures. Only a registered nurse administers all medications and medication keys are kept with that person at all times. The medication system on the residential care unit is a monitored dosage system, which is provided by the local Boots Chemist. The medication was seen administered during the morning time and the Medication Administration Record sheets were completed. A senior person was administering medication and she was observed to be doing this with knowledge and understanding of peoples needs. Small glasses of water were offered with each person’s medication and she approached people in different ways dependent upon their needs. Evidence was available throughout the visit on the nursing unit of staff knocking on bedroom doors and toilet doors before entering. A number of individuals are confined to bed because of their health needs. Their bedroom doors are left open and as a result the privacy of individuals are not maintained given that there is no evidence that this is their preference. There is also an issue with this in respect of fire safety. It is required that the preferences of individuals are obtained so that their privacy can be promoted. There was evidence that the preferred terms of address of individuals are in place on care plans. There was also evidence of inventories of possessions in place also on care plan. Three bedrooms were viewed. All have a patio door leading to garden area, which enables a degree of privacy. Advice was given to Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 14 the Acting Manager of a term used to refer to those who use the service, which was too informal. Locks are on bedroom doors if needed and mail addressed to one individual remained unopened until it was given to the person or their family. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who use the service benefit from being able to participate in daily activities and maintain contact with their families in order to promote their self esteem. Individuals are able to be as independent as possible and their nutritional needs are met. EVIDENCE: An activities co coordinator is employed by the service and they have developed an activities file. Within this each person’s social profile on the residential unit had been completed. This details preferences such as foods, drinks, hobbies and activities. Also with each persons care plan a life profile and map of life had been included. Some of these had been completed, however, this needs to be completed for all people within the home. When completed this would assist the staff in understanding a persons past and it would assist in how to care for them in the future. On the notice board is a plan of activities that will be held over the forthcoming weeks. Also available were pictures showing where some of the residents had been over the last few Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 16 months. This included visiting Liverpool Museum, a visit to Southport and a Canal Trip. Activities within the home included bowls, bingo, board games, jigsaws, watching DVDs and videos, story telling, gentle exercises, crosswords, manicures, hairdressing and ‘Pat a dog’ therapy. A mobile library also visits the home on a regular basis. It was noted that opportunity for religious observance was not good. The vicar who usually visits has not been to the home for some time due to illness and no other religious support has been available within the home. The manager stated that one person attends a local church each week. Records show that many people within the home are of the Roman Catholic or Christian faith and it is unclear if they would wish to have more support in this area or not. A recommendation was made regarding this. It was also noted that the activity support in general was good on the residential unit but that records had not been fully completed on the nursing unit and on discussion with the manager she agreed that this was an area that needed development. A recommendation was made regarding this. The activities co-ordinator was observed during part of the morning on the nursing unit doing a quiz with two individuals. The co-ordinator was involved in this and was noted to be assisting in communication with these two people and the whole activity was light-hearted. Visits by family members were noted on the nursing unit and in some cases individual’s visits from families are recorded. Professionals were seen entering the home with the staff team greeting them warmly and refreshments were offered. On the nursing unit, individuals were noted where possible to mobilise independently throughout the building with staff promoting this independence through care practice, for example those with poor sight being assisted in mobility. For this person, staff sought to assist him when necessary and to encourage him to do things for himself when possible. In respect of finances, the service does not act, as appointee for anyone but prefers to hold money for individuals and to account for it through records. Personal possessions were noted to be included in bedrooms, for example, pictures, photographs and furniture. A discussion was witnessed between an outside agency and lead nurse in respect of the access one person wanted in his mobile wheelchair in the wider community. The individual is to be assessed and a risk assessment is to be done to ensure that his independence is maintained but in a safe manner. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 17 A new menu had been devised with a good choice of meals and more home cooked dishes. The range of meals was well balanced and had a mix of traditional and modern dishes. People are asked to choose they meal beforehand for lunch and dinner and the cook stated that this seemed to work well. During discussions with the cook she said that she liked the new menu and that since the last visit she had been given more freedom in the kitchen and this was working well. People have a range of choices at breakfast time including a full cooked breakfast if desired. Fresh fruit, cakes, biscuits and other “treats” were offered mid afternoon. Drinks were available throughout the day and orange and blackcurrant squash were available in the lounge. During this visit staff offered soft drinks and hot ones to people throughout the day. People spoken with after lunch said that they had enjoyed their meal. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who use the service and their families are able to influence the quality of care provided by the service through the service’s complaints procedure. Those who use the service are protected from abuse. EVIDENCE: A complaints procedure is available and is on prominent display. This includes reference to the Commission for Social Care Inspection and has the current contact address for this organisation. Complaints records are maintained yet it was noted that in some cases in May 2008 there had been no recorded outcomes of complaints. This is raised as a recommendation in this report. In respect of safeguarding adults, the Local Authority procedure for Halton Social Services is available. Staff interviews confirmed that they had had received safeguarding training and were aware of the whistle blowing procedure. One safeguarding referral has been made a since the last inspection and was resolved by the service. Beechcroft Nursing & Residential Home DS0000005171.V367540.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who use the service benefit from living in a well-maintained and hygienic environment. EVIDENCE: A tour was made of the nursing unit. All areas are pleasantly decorated. A repairs book is in place for the addressing of day-to-day issues. No major decorative issues were noted apart from acceptable wear and tear and all bedrooms and communal areas pleasantly presented. No CCTV is in operation in any areas of the building. The building is on one floor and all individuals living there are able to mobilise throughout the building and independently. Access is available to all garden areas. All garden areas are not overlooked and are private. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 20 During a tour of the residential unit it was noticed that the décor and general condition of the home was good. The home employs a handyperson who helps with day-to-day maintenance around the home. A selection of bedrooms was seen and it was noted that these had been personalised with photographs, ornaments and other mementoes by the residents. During this tour two bedrooms had an odour of urine, on discussions with one of the domestic assistants they stated that these rooms had recently had new mattresses, the beds were completely stripped and washed each day and that the carpets were cleaned twice a week. However, the odour remains and she said that these rooms had been allocated to have new flooring in the near future and it was hoped that this would alleviate the problem. Since the last visit the car park has been resurfaced and gates have been added to the walkway at the side of the building to deter the public from using this as a cut-through to the local school. Also it has improved the security of the area and the privacy of residents on the ground floor next to this walkway. A transient odour was noted on arrival at the home yet as the day went on the odour diminished on the nursing side of the home. All toilet and bathroom areas had paper towels and soap dispensers as well as notices outlining correct hand-washing procedures. Domestic staff are employed and were noted to be cleaning during the day and no concerns noted with standards of hygiene. Beechcroft Nursing & Residential Home DS0000005171.V367540.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those who use the service benefit from having a staff team who are trained and qualified to meet their needs. The recruitment process protects individuals. EVIDENCE: The staff rota was examined on the nursing unit. A Registered nurse is on duty at all times. The daytime care staff rota consisted of: -1x Nurse -4x Nursing Assistants. During the afternoon this reduces to 3 nursing assistants. It was noted that staff work twelve-hour shifts. Staff interviews noted that they did not consider that they had sufficient staff. It was observed that staff did not seem to have time to sit and talk with individuals although staff noted to interact with individuals in an informal and friendly manner at all times. Staff views were that one more member of staff was needed especially at key times. One member of staff has made her observations about this formally to the Acting Manager. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 22 In respect of qualifications, it was noted that the service had not yet ensured that fifty per cent of care staff had attained at least National Vocational Qualifications at Level Two. This is raised as a recommendation in this report. Staff on the nursing unit confirmed that they had training on a regular basis and had received all mandatory health and safety training as well as training in safeguarding adults. The staff team undertakes regular mandatory and specialist training. Training undertaken by all staff includes fire safety, fire drills, food hygiene, moving and handling and abuse and Protection of vulnerable. Other courses undertaken by some of the staff team include Control of Substances Hazardous to Health, infection control, nutrition, medication, pressure area care, care planning, first aid, dementia awareness, oral health, person centred planning and safe use of bedrails. Information on display in the nursing unit outlined forthcoming training that was to be available. This included manual handling, protection of vulnerable adults, bedrail care, continence, fire training, care plan training, nutrition and infection control. This timetable of events was spread over three months. Staff rotas were examined on the residential unit and it was seen that most care staff work twelve-hour shifts. Usually there were four or five care staff on duty each day with the manager, cook, kitchen assistant, laundry staff, activities coordinator, administrator, domestic assistants and handyperson supporting completing the staff team. When looking at the staff team it was noted that there was a good mix of age, culture and gender amongst the team. During the visit there appeared to be enough staff around to meet the needs of the people using the service. Staff meetings are held on a regular basis, the last one being 12th September 2008. Minutes of the meeting were available and issues discussed included staffing, residents and any other business. Staff supervision had taken place regularly since the previous visit and all staff had received supervision during August and September 2008, with records kept. Staff appraisals were not up to date. During a discussion with the manager she stated that these would be a priority. A recommendation is raised in this report. Five staff files relating to both the nursing and residential were examined and were see to have all the appropriate pre-employment checks made. The nurses had copies of their Personal Identification Numbers and Criminal Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 23 Records Bureau checks and/or initial Police checks (POVA First) had been made. Staff files were well kept and they were divided in to applications, absence, annual leave, training, appraisals, payroll, contract, disciplinary, grievance and miscellaneous. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those who use the service benefit from receiving a service that is managed by an experienced individual. Individuals and their families are able to influence the quality of the service through the quality assurance system adopted by the service. The financial interests of individuals are safeguarded. The health and safety of all is not fully promoted. EVIDENCE: The current Acting manager is on temporary standby while the other acting manager is on sick leave. This person is due to return to work soon on a part Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 25 time basis and will be supported by the existing acting manager until December 2008. It is understood that the main Acting Manager is to submit an application form to the Commission For Social Care Inspection to become the Registered Manager. The current Acting Manager is a registered manager in another service within the organisation and has brought her experience to the service given that the home has had issues in respect of the standard of care and given that the service had a poor quality rating from the last key inspection. The Quality assurance processes includes: surveys, social services reviews, reviews completed by the home, visits by representatives of the organisation, meetings for those who use the service and relatives. Those who use the service and their relatives have a coffee morning or afternoon tea session each Friday where any discussions can take place and the manager is available to speak to. These have proved very popular and a change from the formal type of meeting often held. Also the manager is available for a weekly surgery and she keeps notes of these sessions for further development. Satisfaction surveys are completed regularly. The last one was completed within the last six months. These are completed by an outside agency that produces an analysis of the information received. The surveys are sent to people using the service, their families and other professionals. Comments from people using the service said “I find the staff very helpful and cheerful”, “could not be better looked after anywhere else”, “activities are varied and consistent”, “and I enjoy my food, please keep up the good work “and” l like my room very much”. Comments from people using the service where improvements could be made included “I ordered newspapers but they were not delivered”, “no individual time with staff” and “more variety of food would be good”. One relatives stated an area for improvement would be that “not enough activities available.” Visits by representatives of the organisation are undertaken on a monthly basis. Records of these were seen within the home and it was notes that some minor issues had been raised, which had subsequently been dealt with. The home does not act as appointee for any individual but has a system for the safekeeping of individual’s monies. Monies are stored individually and records maintained and an individual external to the service audits these and administrator employed. Part of their role is to ensure that records are maintained. The system is accountable. Staff confirmed through staff interviews that they have received health and safety training through staff interviews. The service sends notifications to the Commission for Social Care Inspection of those incidents, which adversely affect individuals living at Beechcroft. Fire systems are checked regularly, Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 26 electric and gas certificates were evidenced as well as the testing of portable appliances. Records relating to the control of substances hazardous to health are in place as well as evidence of a legionella check. Water temperatures are tested, radiators within the building are covered covered, accidents records are in place and completed as needed. The Inspectors were initially able to access the building despite the presence of a security code and lock. It is required that this is addressed to ensure the security of all. Those individuals who are confined to their rooms have their doors opened. This was identified earlier in this report as an issue relating to privacy but this may also reduce the efficiency of fire prevention and confinement. It is required that fire doors are either closed or approved devices fitted to ensure that the breakout of fire is confined. The service’s certificate of registration is in place as well as a certificate of liability insurance on display. Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 OP10 Regulation 12 Requirement The privacy of those who are confined to their beds through ill health must be taken into account in respect of the leaving open of bedroom doors The service must ensure that the front door is secure at all times The service must ensure that the health and safety of individuals who are confined to their beds through ill health is promoted through the use of fire prevention equipment. Timescale for action 30/11/08 2. 3. OP38 OP38 12 23 15/10/08 30/11/08 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. Refer to Standard OP3 OP3 Good Practice Recommendations Pre admission assessments carried out by the service should be fully completed Pre admission assessments completed in relation to those who have nursing needs should include more reference to DS0000005171.V367540.R01.S.doc Version 5.2 Page 29 Beechcroft Nursing & Residential Home their social needs 3. OP12 Activities held on the nursing unit should be more developed in line with those carried out on the residential unit. The religious needs of those living at Beechcroft should be more developed to include visits from representatives of all relevant denominations The outcomes of complaints should be consistently recorded 50 of care staff should attain a National Vocational Qualification at Level 2. Staff appraisals should be brought up to date. 4. OP12 5. 6. 7. OP16 OP28 OP36 Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North West Region CSCI Preston 3rd Floor, 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. Extracts may not be used or reproduced without the express permission of CSCI Beechcroft Nursing & Residential Home DS0000005171.V367540.R01.S.doc Version 5.2 Page 31 - 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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