Inspection on 18/03/09 for Beechdale House Care Home

This inspection was carried out on 18th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beechdale House Care Home Beechdale Rd Aspley Nottingham NG8 3EZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary OLoughlin     Date: 1 8 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Beechdale House Care Home Aspley Beechdale Rd Nottingham NG8 3EZ 01159292792 01159426094 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : B L Premier Care Ltd care home 40 Number of places (if applicable): Under 65 Over 65 0 40 0 dementia old age, not falling within any other category terminally ill Additional conditions: 10 0 2 Within the total number of beds two beds may be used for the category of TI. Within the total number of beds ten may be used for category of DE(E) Date of last inspection Brief description of the care home Beechdale House is registered to provide 40 places for older people. The home is accessible to wheelchair users and has a passenger lift to the first floor. Set in its own grounds with an enclosed rear garden it is situated on a bus route and is close to shops. There is information on the services and facilities available within the homes statement of purpose which is available on request. The most recent inspection report is also available at the home. The weekly fees range from £335-£380 extra charges are made for chiropody and hairdressing. Care Homes for Older People Page 4 of 28 Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection is about the outcome of the care provided to people using the service. This process considers the providers capacity to meet regulatory requirements and focuses on aspects of service provision that need further development. The main method of inspection used was called case tracking. This involves selecting the care records and looking at the quality of the care people receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Some of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgments in this report are from observation and reading records and documents. Care Homes for Older People Page 6 of 28 People living at the home, members of staff, the manager and the provider were spoken with as part of this inspection. Documents were read and medication inspected to form an opinion about the quality of the care provided. We looked at what the manager told us they were doing in their Annual Quality Assurance document (AQAA) that they sent to us. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a proper assessment of their needs before they move into the home so that they can be assured the home has the facilities and services they need to support them safely. Intermediate care is not provided. Evidence: We looked at the way 2 recent admissions to the home were organised and found that the manager ensured that she made a full assessment of each persons needs to make sure that the home was suitable for them and had the appropriate aids, equipment and staff skills to support people safely. We asked 5 people about their experiences around their admission and all of them told us that they had received enough information about the home so they could decide if it Care Homes for Older People Page 10 of 28 Evidence: was the right place for them. They were also given opportunities to visit or have respite stays before they made a decision to come in. The AQAA told us that the home has a multi cultural staff team to provide for the diverse needs of people wishing to come into the home. We saw that peoples records contained a best interests form to make sure that people who are unable to make their own decisions about their care and treatment are properly protected, but these were not completed. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive consistent and reliable support to maintain their health and wellbeing, having their health monitored and medicines managed safely. Evidence: The AQAA gave us only brief information about this group of standards and whilst telling us that each person had a care plan that was regularly reviewed it did not inform us if people were consulted on the care plans to make sure they agreed to them. We saw by case tracking that although care plans were reviewed regularly there was no evidence of who had been involved or consulted about these reviews to show that people were satisfied with the care and support they were receiving. We received 5 written responses to our surveys from people who use the service and all of them said that they always receive the medical support they need. Responses included,Very impressed in this area. Care Homes for Older People Page 12 of 28 Evidence: We case tracked 3 people, each person had an assessment of each area of activity in their daily lives. Health risks such as pressure sores, swallowing, nutrition and falls prevention were regularly assessed and a care plan developed to describe the support people needed to maintain their health and wellbeing. Some shortfalls were seen in recording specific health problems such as diabetes, the care plans did not describe how this was managed for one person, or who was responsible for taking blood sugar measurements or how often. For one person the record of treatment for a urine infection and bladder washouts was not used when the care plan was reviewed and as such information was not up to date in the actual plan of care. Although the gaps in care plans were evident staff were able to give a verbal update on the care people required and were sensitive to peoples changes in need. 5 People told us that they receive the care and support they need, a relative told us I am impressed by the warm, loving and caring atmosphere at the home. Throughout the day from observation and talking to members of the staff team we found the staff were caring and professional, carrying out personal care in private and maintaining peoples dignity. We examined the way medicines were managed at the home and found that there is suitable recording and storage for medicines including those medicines that require controlled storage and recording. The manager said that trained staff complete medicine administration and we saw that medicine record sheets were fully completed at the times medicines were prescribed. However, medicines prescribed on an as required basis did not have the amount that was administered recorded which would not provide a suitable audit trail. People that needed their blood sugar monitored had their own individual equipment but these lacked any identification for use which would not ensure that anyone unfamiliar with the individual equipment would know whos lancet device they were using. Where people required long term as required pain relief there was no record in the care plan of what the pain was or whether the medicine was reviewed as effectively controlling the persons pain. Care Homes for Older People Page 13 of 28 Evidence: Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have lots of opportunities to take part in activities both inside and outside of the home and mealtimes are seen as important offering variety and choice. Evidence: The staff at the home show a commitment to helping people maintain contact with their family and take part in suitable activities. The AQAA told us that the manager is continuing to develop the social activities programme and looking at ways of providing meaningful activities for everyone including people who may have difficulty due to their illness. We saw records within peoples care plans of events that people have taken part in and holidays that they have taken whilst living at the home. People responding to our surveys told us that they usually have activities that they can take part in. The manager ensures that people have an assessment of their nutritional needs and Care Homes for Older People Page 15 of 28 Evidence: that they are weighed regularly to make sure they are receiving a suitable level of nutrition. People responding to our surveys said they enjoyed the food and had suitable options to choose from at mealtimes. Relatives told us that there was always plenty of food available when they visited at mealtimes. We observed lunch and saw that it was well presented and people were assisted as needed at the mealtime. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have access to a suitable complaint procedure and are protected from abuse. Evidence: The responses we received from people we surveyed told us that they all knew how to make a complaint and felt listened to and taken seriously. People told us that they found the manager very approachable and were able to discuss any concerns they may have. Staff told us that they had recently attended training on abuse awareness and have access to a suitable policy on protecting vulnerable people from abuse. We have not received any complaints or safeguarding referrals for the service since its registration. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environmental risks have not been suitably monitored to ensure the heath and safety of people living at the home. Evidence: Since the new provider registered with us in August 2008 there have been lots of areas of improvement within the environment and a full plan of refurbishment is now in place. We looked at the facilities for the 3 people that we case tracked and found that they each had an individual room which was personalised and clean. They had access to a call bell close to their bedside. The care plans contained evidence that staff had looked at environmental risks to peoples safety, however these lacked any real evaluation as we saw how serious risks from hot water had not been considered. The bathroom on the first floor had excessively hot water as did all 3 wash hand basins in bedrooms. The provider agreed to stop access to the bathroom until essential maintenance had been completed, we confirmed after this inspection that work had been carried out to install new hot water regulators both within the bathroom and Care Homes for Older People Page 18 of 28 Evidence: peoples individual rooms. The manager was unable to access a policy on the control of Legionella and could not identify any safeguards that should be in place to manage this risk. Fire tests were not being done at regular intervals as required for the safe monitoring of the fire detection system. The manager told us that the local Primary Care Team had completed an infection control audit at the home and that improvements had been made following this visit. Everyone that responded to our surveys said the home was always clean and fresh, one person told us that sometimes the coffee tables could do with an extra wipe. We saw how one persons bed table was dirty and the adhesive cover was torn and did not provide a suitable surface to keep clean. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the staff team and are protected by a robust recruitment practice. Evidence: The AQAA told us that the manager takes training and development of the staff team seriously with 75 of the staff team being trained to National Vocational level 2 or 3 in care. We spoke to staff about their training and they confirmed that they receive opportunities to have regular updates in subjects such as moving and handling to make sure that they know about best practice. We identified that new staff receive a thorough induction into their role to make sure they are not left in positions they cannot manage. People we spoke to and people responding to our surveys felt that there was always enough staff on duty to meet their needs. We examined staff recruitment and found that the manager ensures a safe recruitment procedure is followed which prevents people being employed if they are known to be Care Homes for Older People Page 20 of 28 Evidence: unsuitable to work with vulnerable people. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed but there are shortfalls in the management of health and safety which presents a potential risk to people living at the home. Evidence: The manager has been in post for many years and continues to update her skills and knowledge in the care of older people. All the responses we received from surveys, talking to people living at the home and the staff team tell us that the manager is respected for her openness and caring attitude. People told us that she was always available to speak to. During our inspection the manager was constantly having to respond to phone calls and visitors throughout the day. Our inspection found that the management of health and safety showed that there were potential areas of risk to people from the lack of regular testing of the fire alarms, control of hot water safety and suitable management Care Homes for Older People Page 22 of 28 Evidence: of the risk of Legionella. We saw that one first floor bathroom window did not have a restrictor fitted and there was a visible hazard as people could potentially open it and fall out. The manager completed the AQAA accurately and it gave a fairly good picture of the service. There were some outcome groups that could have contained more information that was relevant to those standards. The manager told us that people are sent surveys about their satisfaction with the services provided to help them improve the service. People who used the homes facilities for holding small amounts of personal monies are protected by suitable accounting practices, however there were 3 people who could not manage their own finances and their money was held in a pooled account, the manager was advised to contact the local authority about this matter to ensure that the arrangements were in the best interests of these people. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 You must take adequate arrangements for fire tests at regular intervals. To make sure equipment is in working order. 16/04/2009 2 38 13 Identify all areas of health 30/04/2009 and safety management and appoint responsible persons to undertake appropriate monitoring of the environment. To ensure that any unnecessary risks to the health and safety of people is identified and as far as possible eliminated. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Identify people who are at risk of deprivation of liberty and refer them to the appropriate authority for assessment. Care Homes for Older People Page 25 of 28 2 7 Improve how care plans are drawn up and reviewed to make sure they are person centred, giving people the opportunity to say if the plan is working for them, what is working well or what needs to change. Make sure that specific conditions such as Diabetes have a suitable care plan that informs staff how this condition is to be monitored and managed. Make sure that any changes to peoples health and wellbeing is recorded at their review and used to inform changes to the plan of care. Make sure that blood sugar monitoring devices are labeled for individual use and easily identifiable for staff that may not be familiar with the home. Record how many tablets are administered on as required medicines and have an associated plan of care that records the type of pain and management. You should have a comprehensive risk assessment in place for Legionella, a scheme for prevention, management and control. You should carry out a risk assessment for people who may be vulnerable from hot water surface temperatures when using supplementary radiators. Make sure that bed-tables and coffee tables have a suitable wipe clean surface and that they are regularly cleaned. When completing the AQAA input any information on progress with outstanding requirements or recommendations from the last inspection and use the National Minimum Standards to make sure that each area has appropriate information related to the standard required. You should make an appropriate referral for people who lack capacity to manage their own finances to the local authority for assessment and review. In exceptional circumstances where there is no other option than a pooled account you should provide a statement on how the interests is divided, how people have access to the money and how the account is managed. Include within the statement of purpose and service user guide the arrangements for the management of personal finances. Complete risk assessments for potential risks to people from hot water outlets. Window restrictors should be fitted to all first floor windows unless risk assessment determines that there is no hazard Page 26 of 28 3 8 4 8 5 9 6 25 7 25 8 9 26 33 10 35 11 35 12 35 13 14 38 38 Care Homes for Older People for people living at the home. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!