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Inspection on 11/04/06 for Beeches Care Home (Arnold)

Also see our care home review for Beeches Care Home (Arnold) for more information

This inspection was carried out on 11th April 2006.

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

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

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

What the care home does well

The residents who were spoken with, said they like living at the Beeches, and they feel staff treat them with respect and preserve their dignity. The care planning process is comprehensive and professionally maintained. Residents have an activities co-ordinator to arrange in-house activities, a number of these activities focussed on the Easter celebrations, which were imminent.

What has improved since the last inspection?

The majority of requirements set at the last Inspection have been met. Care planning has improved, Meals are no longer arriving at the dinner table before the residents, and staff are undertaking training in Adult Protection.

What the care home could do better:

Every resident must have a contract and/or a written copy of the terms and conditions of residence. Potential residents must be assessed by a suitably qualified and experienced professional prior to moving into the Beeches. Residents must be individually assessed to use hoists, and professionally assessed and fitted for the slings used with those hoists. Every member of staff must have a Criminal Records Bureau check, and that; there is evidence of that check available for Inspection. Regulation 26 visits, which are visits by the Service Provider (or their representative) to consider Management issues relating to the home on a monthly basis, must be taking place in line with Care Homes Regulations. Every bedroom must have a lockable space for the use of residents to store their personal items. All resident`s financial transactions arereceipted to maintain a clear financial audit trail. The Management arrangements for the Beeches must be clarified, in the light of the acting manager leaving imminently.

CARE HOMES FOR OLDER PEOPLE Beeches Care Home 55 Furlong Street Arnold Nottingham NG5 7AT Lead Inspector Rob Cooper Key Unannounced Inspection 11th April 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beeches Care Home DS0000026418.V289089.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. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beeches Care Home Address 55 Furlong Street Arnold Nottingham NG5 7AT 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) 01159262838 011591204397 Southern Cross Healthcare Services Limited Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability (4), Terminally ill (5) of places Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the total number of beds a maximum of 4 bed maybe used for the category PD, where service users will be aged between 50 and 65 years. Within the total number of beds a maximum of 5 bed maybe used for the category TI 5th January 2006 Date of last inspection Brief Description of the Service: The home was opened in 1995 and is situated close to the centre of Arnold in Nottingham. The home is a two-storey building. The home has one large lounge, incorporating a designated dining area. A small lounge facility predominantly used, as hairdressing room is available on the first floor as well as a separate smoking room. There are four bathrooms, of which two are fitted with an assisted, bathing hoist and one with a Parker bath and two separate shower rooms. All the homes bedrooms are single with the exception of one, and twenty-eight of the bedrooms have an en-suite facility. Four adjoining rooms are available. There is a passenger lift. The home has a compact garden that is well maintained and easily accessible. Fees for The Beeches range from £339 – 480 per week. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection lasted approximately five hours with one Inspector present. The methodology used was to case track three residents, case tracking involves looking at a range of care records, and making a judgement about the quality of care that the residents are actually receiving. This is done by consideration of all elements in a resident’s life – for example how they spend their day, who visits them, what their bedroom is like, how comfortable life is for them living at this particular care home. Two residents and three members of staff were spoken with, and a visual inspection of some areas of the premises, together with a review of a range of records and documentation. The acting manager was due to leave her post shortly, and the arrangements for a replacement were not clear. The findings of this Inspection raised questions and concerns regarding the overall management of the Beeches. What the service does well: What has improved since the last inspection? What they could do better: Every resident must have a contract and/or a written copy of the terms and conditions of residence. Potential residents must be assessed by a suitably qualified and experienced professional prior to moving into the Beeches. Residents must be individually assessed to use hoists, and professionally assessed and fitted for the slings used with those hoists. Every member of staff must have a Criminal Records Bureau check, and that; there is evidence of that check available for Inspection. Regulation 26 visits, which are visits by the Service Provider (or their representative) to consider Management issues relating to the home on a monthly basis, must be taking place in line with Care Homes Regulations. Every bedroom must have a lockable space for the use of residents to store their personal items. All resident’s financial transactions are Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 6 receipted to maintain a clear financial audit trail. The Management arrangements for the Beeches must be clarified, in the light of the acting manager leaving imminently. 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. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 123&6 The quality outcome in this area is: Poor Prospective residents have the information they would need to make an informed choice about living at the Beeches. Each resident does not have a written contract or statement of terms and conditions within the home, which is required to enable residents and their families to be aware of the services and costs of services. Residents are not always assessed prior to moving into The Beeches. The Beeches does not offer intermediate care. EVIDENCE: The Statement of Purpose and Service User Guide were seen, these contained all of the information required by Care Homes Regulations, and were presented in an easy to read format. Three service users files were seen, and none contained a copy of the contract or terms and conditions of residence. Staff said they thought that there were copies, but were unable to locate them. Two residents were asked, but they did not know if they had seen a copy of the contract or not. The resident’s files that were seen contained comprehensive assessment tools for use following admission. However no Community Care Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 9 Assessments – either Standard or Extended could be located within the Beeches, which would show that residents had been assessed prior to admission. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10 The quality outcome in this area is: Excellent Resident’s health, personal and social care needs are set out in an individual plan of care. Resident’s health care needs are fully met. At the Beeches none of the residents currently self-medicate. There are policies and procedures in place to protect residents around medication issues. Residents do feel that they are treated with respect and dignity, and their right to privacy is upheld. EVIDENCE: The three resident’s files each contained a comprehensive plan of care, which was set out in a logical and detailed manner using a recognised professional model. Within the individual plans, there were comprehensive care plans relating to all aspects of health care. These were found to be complete and well written. There is a monitored dosage system in place, and the lunchtime medication round was seen. Staff were observed to be following the policies and procedures, and appeared knowledgeable around medication issues. Two residents were spoken with, and both said that they liked living at the Beeches, and that the staff were “very nice.” When asked both said that staff Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 11 knocked on their bedroom door before entering, and that they were ‘usually asked not told.’ During the course of the day staff were observed interacting with a number of residents, and this was seen to be in a respectful and positive manner. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 12 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 quality outcome in this area is: Good Residents at the Beeches experience a lifestyle that matches their expectations and preferences, and satisfies their social, cultural, religious and recreational needs. Residents are able to maintain contact with family and friends, together with contact with representatives from the local community. Residents are helped to exercise choice and control over their lives while staying at the Beeches. Residents do receive a wholesome, appealing and balanced diet, which is taken in pleasant surroundings at convenient times. EVIDENCE: At the last Inspection a requirement was set to ensure that social and recreational needs of the residents are planned for and met. Evidence seen in resident’s files and through talking to residents and staff indicates that this requirement has been met. The notice board displayed an activities programme, and the activities co-ordinator was spoken with, this gave a clear indication of the types of activities been arranged and organised. One resident said that they did not join in any of the organised activities, through personal choice, but was aware that activities were available if desired. It became clear that a number of visitors to the home come in to carry out social, cultural and Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 13 religious activities. On the day of the Inspection the Beeches was very busy with a number of visitors. Three relatives were spoken with, and they said that they were able to visit freely, and were always made to feel welcome by the staff. One resident said that their friend came to see them quite often. Both residents who were spoken with said that they felt able to exercise choice in their daily lives, this was from choice of food for meals through to choices involving their personal care. During the course of the Inspection, a number of residents were seen to be making choices, and to be supported by the staff to do so. There is a four-week repeating menu, which was seen, and which provided both plenty of choice, and a balanced diet. The dining room was found to be spacious, comfortable and easily accessed by residents. The kitchens were seen and were clean and tidy, with obvious evidence of being well organised. All of the records relating to refrigerator and freezer temperatures, together with cooking temperatures, and records of food choices made by individual residents were seen, and found to be complete and correct. The lunchtime meal was observed, and the food appeared to be nutritious and at a suitable temperature. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 14 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): 16 17 & 18 The quality outcome in this area is: Good Residents and their relatives and friends at the Beeches are confident that their complaints will be listened to, taken seriously and acted upon. Resident’s legal rights are protected while they are living at the Beeches. Residents are protected from abuse. EVIDENCE: The complaints policy and procedure was prominently displayed throughout the building, and forms part of the Service User Guide. Complaints records were seen and these showed that complaints had been dealt with in line with the Beeches complaints policy, and dealt with within the identified time frame. Two residents were asked about complaints, and both said that they knew how to complain, and who to complain to – one saying loudly: “The Boss” and pointed towards the Office. Neither resident said that they had ever complained. Residents are registered for postal voting at elections, although some residents have attended the polling station in the past, and arrangements had been made to facilitate this. Staff training records showed that staff were undergoing training in the Protection of Vulnerable Adults and Abuse. This training is being rolled out for all staff, with dates for future training booked. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 15 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 22 24 & 26 The quality outcome in this area is: Adequate Residents at the Beeches live in a mostly safe and well-maintained environment, although the hoist issues identified below do leave resident’s potentially at risk. The Beeches provides residents with the specialist equipment they might require to maximise their independence. Residents at the Beeches live in safe, comfortable bedrooms with their own possessions, however many lack secure storage facilities within their rooms. The Beeches is clean and hygienic. EVIDENCE: A visual Inspection and tour of the building showed it to be comfortable and safe. The fixtures and fittings were to a high standard, and the layout of the communal areas had a ‘homely feel’ rather than being institutionalized. There is a range of specialist equipment available, including specialist bathing, walkin showers, grab rails and hoists. At the last Inspection it was identified and Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 16 set as a requirement that slings to be used in conjunction with hoists should not be general, and used by all residents, but should be purchased for a specific resident following an assessment by health care professional. This requirement has still not been met, and potentially residents are at risk by using equipment that has not been assessed as being suitable for their needs. A number of bedrooms were seen, and some have a lockable storage facility within the room, while some do not. The staff said that the bedroom door could be locked in those bedrooms without a lockable storage space within them. It is strongly recommended that all bedrooms have a secure lockable storage facility for the use of the residents irrespective of whether the door to the room is or is not locked. Three residents were asked about their views of their bedrooms and the building: One said that it was “Very nice, yes, very good”, a second agreed, while the third said that they liked their bedroom as it was very comfortable – “I like my bed, it’s very nice” being the specific view. The building appeared fresh and clean, and during the Inspection several areas were seen to be being cleaned. The cleaning cupboards were well stocked with suitable cleaning materials, and there was an organised cleaning plan in place. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 17 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 28 29 & 30 The quality outcome in this area is: Adequate Resident’s needs are met by the numbers and skill mix of staff at the Beeches. Residents are in safe hands at all times. Residents at the Beeches are not fully supported and protected by the recruitment policy and practices. Staff members are trained and competent to do their jobs. EVIDENCE: The staffing rota was seen and this showed that there were sufficient numbers of staff on duty for the period covered by the staffing rota (4 weeks). At the last Inspection it was identified that staff were not deployed in sufficient numbers to meet the needs of the residents. Discussions with residents, and the acting manager together with observation during the Inspection, evidenced that staff were being deployed in a much more effective manner. The staffing rota showed that qualified nurses were always on duty, to provide the knowledge and experience to keep residents safe. The Beeches is a one of a number of homes operated by Southern Cross – who have robust recruitment policies in place, two staff files were seen, and these had many of the recruitment records required by care homes regulations, although no details of criminal records bureau checks could be found, which is a requirement under Care Homes Regulations to ensure resident’s protection. Staff said that they were held in a separate file, but this could not be located. Staff training records were seen and these evidenced that there is an ongoing training programme for all staff covering a range of care and mandatory training. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 18 Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 19 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 33 35 & 38 The quality outcome in this area is: Poor Residents at the Beeches do not live in a care home that currently has as Registered manager in post. The Beeches is not being run in the best interests of its residents. Resident’s financial interests at the Beeches are not safeguarded. The health, safety and welfare of residents and staff at the Beeches are promoted and protected. EVIDENCE: The acting manager has been in post for approximately six months, but is leaving in mid April to take up a post elsewhere. Staff members at the Beeches were unaware what arrangements would be in place after the acting manager leaves. It was not possible to evidence that an effective quality assurance system was in place, and Regulation 26 visits, which are required to be carried out monthly are not taking place. The last Regulation 26 visit that Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 20 could be evidenced as having taken place was in September 2005. The policies and procedures for dealing with resident’s finances were seen, and balances were checked. Individual receipts for expenditure – for example hairdressing were not being issued, and while monies is receipted in, expenditure being spent is not always receipted. This leaves residents potentially at risk. A range of health & safety records including fire records and Control of Substances Hazardous to Health (COSHH) were seen and checked. These records were found to be complete and correct, and indicated that health & safety is given due consideration and importance at the Beeches. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 21 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 4 2 2 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 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 3 17 3 18 3 3 X X 2 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 22 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 OP2 Regulation Requirement Timescale for action 31/05/06 2 OP3 3 OP29 4 OP33 Regulation The Registered person shall 5 produce a written guide to the care home which shall include – the terms and conditions in respect of accommodation to be provided for service users and a standard form of contract for the provision of services and facilities by the Registered provider to service users. Regulation The Registered person shall not 14 provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so – the needs of the service user have been assessed by a suitably qualified or suitably trained person. Regulation The Registered person must 19 ensure that criminal records bureau checks are carried out on all staff and that evidence is available for Inspection that criminal bureau checks have been carried out. Regulation The Registered person must 24 & 26 establish and maintain a system for reviewing at DS0000026418.V289089.R01.S.doc 31/05/06 31/05/06 30/04/06 Beeches Care Home Version 5.1 Page 23 5 OP22 appropriate intervals and improving. This will include carrying our monthly Regulation 26 visits, and sending a copy of those visits to the Commission for Social Care Inspection. Regulation The Registered person shall 13 ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated, by the provision of slings for the hoist for individual residents, rather than a ‘one size fits all’ approach. This requirement is outstanding from the Inspection of 05/01/06 30/06/06 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 OP24 OP35 Good Practice Recommendations The Registered person should ensure that each resident’s bedroom is provided with a lockable storage space that is independent of the lock on the bedroom door. The Registered person should ensure that where money of individual residents is handled, the manager ensures that the personal allowances of these residents are not pooled and appropriate records and receipts are kept. Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beeches Care Home DS0000026418.V289089.R01.S.doc Version 5.1 Page 25 - 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. 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