CARE HOMES FOR OLDER PEOPLE
Beeches Care Home 55 Furlong Street Arnold Nottingham NG5 7AT Lead Inspector
Andrew Sales Unannounced 26 July 2005 10:00
th 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 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 C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Beeches Care Home Address 55 Furlong Street Arnold Nottingham NG5 7AT 0115 926 2838 0115 920 4397 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Services Limited Care Home with Nursing 54 Category(ies) of OP Old Age - 45 registration, with number PD Physical Disability - 4 of places TI Terminally Ill - 5 Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Within the total number of beds a maximum of 4 beds maybe used for the category PD. Within the total number of beds a maximum of 5 beds maybe be used for the category TI. Date of last inspection 03/11/04 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 home’s 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. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and conducted by A.Sales, Regulation Inspector on 26 July 2005. The inspection lasted three and a half hours. The process of case tracking was used to determine the outcomes for residents. This involves assessing individuals care plans and discussing with them the care they receive and their views on the home, management, staff and facilities. During the inspection process the inspector was provided with very positive feed back from the residents and relatives in respect of the service and the care provided. What the service does well: What has improved since the last inspection?
Relatives and residents reported they feel residents are well looked after and are reassured by the continuing improvements made in the overall quality of care. Staff also spoke of the improvements they felt had been made in respect of training and support by the current manager. All of the requirements set at the previous inspection have been addressed. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 6 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. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 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 standard(s) 3,4 Residents receive a full needs assessment prior to moving into the home. The home is able to meet the needs of residents it admits. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 9 EVIDENCE: The Inspector viewed 3 resident’s files as part of the case tracking process. Evidence was found in all files of a comprehensive pre-assessment to ensure the home is able to meet the needs of prospective resident. All areas of needs assessment required in standard three were present. The home obtains specialist advise from other health care professionals including tissue viability, infection control, general practitioners and continence advisors. This was supported by documentation in care plans. Residents and their relatives also spoke of visiting healthcare professionals and domiciliary community services, such as Dentist services. A training programme was observed, this has been implemented to ensure staff are up to date with current good practice and to meet the needs of the residents. All relatives and residents spoken with felt the staff were competent and professional. Staff discussed training events previously attended and courses they were due to attend. These were; mandatory health and safety training, dementia awareness, pressure area/skin care, NVQ level 2 and Adult Protection. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 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 standard(s) 7,8,10,11 Residents are comprehensively assessed and their healthcare needs are met. Residents feel they are treated with dignity and respect. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 11 EVIDENCE: Care plans examined by the inspector provide valuable information on how to meet the needs of the individual resident. They contain information of multidisciplinary visits carried out to individual residents. risk assessments are carried out for tissue viability, moving and handling, falls and continence; evidence of monthly reviews and action taken to address areas of concern. The home provides a range of specialist equipment. The inspector spoke to a resident who is terminally ill and their relative. The inspector observed the resident to be supplied with all the equipment required for comfort and intervention to prevent pressure ulcers. They both described the excellent nursing care received at the home and were very complementary about the homes care and nursing staff. Generally the feedback from all residents and relatives about the conduct of the staff team and their manner, was extremely positive. The inspector evidenced information in residents care plans of their wishes in respect of death and dying. A relative of a terminally ill resident commented that they were well supported by staff and were offered accommodation at the home as and when necessary. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 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 standard(s) 12,13,15 The home supports residents to maintain community and family links. The home provides a good catering service and caters for different diets and preferences . EVIDENCE: Interests and preferences are recorded on care plans seen by the inspector. Residents and relatives reported that the staff provide activities wherever time permits. The Inspector was also informed by three of relatives that they are encouraged to visit the home and have thoroughly enjoyed participating in the activities provided. A recent fete held at the home was a great success. Residents and relatives spoke highly of the entertainment and were touched that staff who were off duty, made time to attend. All the residents and relatives spoken with, reported the home offers a relaxed atmosphere and feel the quality of care is constantly improving. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 13 Relatives all commented that they are always made to feel welcome. A high number of visitors attended on the day of the inspection. Residents and relatives expressed their satisfaction with the management team and the staff. The inspector observed food served on the day of inspection. Food served looked wholesome and nutritious. Also food served that was liquidised was presentable. All the residents and relatives spoken with, reported to the inspector how excellent the staff are and ensure they provide assistance to the residents that require assistance with eating. The cook showed the inspector menus and choices of food available and details of dietary requirements recorded. Comprehensive cleaning schedules are also in place. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 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 standard(s) 16,18 The home operates suitable complaints and adult protection procedures. EVIDENCE: Residents reported to the inspector that they felt empowered to report any concern and felt these would be listened to and dealt with in a professional manner. Relatives reported to the Inspector that they felt comfortable to discuss any issues with the management of the home and felt equally confident that any matters identified would be duly addressed. Complaints are well documented and policies are in place. Adult Protection policies and procedures are in place in the home. Staff demonstrated an understanding of Adult Protection procedures. A staff training event in Adult Protection is planned for August 2.2005. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 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 standard(s) 19,25,26 The home is clean, hygienic, comfortable and well maintained. EVIDENCE: The manager spoke briefly to the maintenance officer. There is a rolling maintenance programme to maintain the home with records of action taken. The home is clean and tidy, free from odours. Any issues are dealt with quickly. Residents commented that the home offers a pleasant environment and feels homely. The home was noted to be warm and domestic on the day of inspection and residents spoken with reported the home to be maintained at a consistent temperature throughout the day and night. The inspector examined the maintenance records, which evidenced water temperatures are maintained at or below 43°C. One outlet was tested at 41.5c. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 Staff are employed in sufficient numbers and receive appropriate training. EVIDENCE: On the day of the inspection sufficient numbers of staff were on duty. Whilst the home recruits and assigns sufficient numbers of staff to meet the needs of residents, the levels are affected by recurring absences from a core of the staff group. Eight staff are currently studying the NVQ level 2. The induction process was discussed with staff and on going training includes all mandatory subjects as well as specific subjects potentially relating to the care of older people. ie; confusion, adult protection and pressure area care and prevention. Appropriate training plans have been developed by the current manager and deputy manager. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,38 The home is well managed and the health, welfare and safety of the residents is promoted through policy and practice. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 18 EVIDENCE: Residents, relatives and staff told the inspector how the manager is supportive responsive and approachable. Relatives were very complimentary about the running of the home and how committed the staff are to the residents. Systems are in place to ensure all equipment is serviced and in good working order, recorded evidence was made available to the inspector. Systems and appliances were found to be monitored and serviced at the appropriate intervals. The manager and the maintenance person demonstrated a commitment to their role and function in respect of health and safety within the home. Evidence was provided by the management and staff, of staff training in mandatory health and safety subjects. i.e; moving and handling, infection control and first aid. Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x x x 3 Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 20 no Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Beeches Care Home C53 C03 S26418 Beeches V233389 260705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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
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