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Inspection on 05/01/06 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 5th January 2006.

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

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

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 inspector spent time talking to four residents in the home and two members of staff. Overall the feedback was very good. Residents were happy to express their views about the home, they were positive in terms of the skills and attitude of the staff and of the overall standards of care, food and the environment. Residents reported to the inspector that the staff are kind and respectful and do their utmost to ensure their needs are maintained. Everyone spoken with felt confident that the new manager would prove to be of great benefit to the home and were hoping for a period of management stability. The home provides excellent nursing care to those who have become terminally ill, whilst also supporting their relatives during this time.

What has improved since the last inspection?

A new manager has been appointed and the feedback generally from staff and residents is very positive. They feel she is committed to improving standards within the home and is approachable and supportive. The care planning process and training plans are continuing to be further developed.

What the care home could do better:

Residents indicated to the inspector that a lot of time was spent sitting in the lounge without any stimulation or activity. This was observed by the inspector. Staff and residents also indicated that they felt staffing hours for personal care at key times and social recreation were insufficient. The manager/organisation needs to review the numbers and/or roles of staff on duty to ensure the effective deployment of resources. Attention needs to be paid to mealtimes, to ensure hot meals are not put out in someone`s absence, leaving them to go cold. All staff require adult protection training. Hoisting slings need to be obtained/employed individually for each resident and the practice of using one sling for each resident must cease immediately. Wheelchairs are not stored appropriately and adequate storage needs to be supplied. Some foreign nationals employed at the home cannot communicate effectively with residents and staff. These staff must be closely supervised until they can communicate effectively and trained appropriately for the work they re to perform. The organisation must ensure that no one who cannot communicate effectively is employed at the home until they can do so.

CARE HOMES FOR OLDER PEOPLE Beeches Care Home 55 Furlong Street Arnold Nottingham NG5 7AT Lead Inspector Andrew Sales Unannounced Inspection 5th January 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.V275056.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.V275056.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.V275056.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 26th July 2005 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. Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted by A.J.Sales on 5 January 2006. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. What the service does well: What has improved since the last inspection? A new manager has been appointed and the feedback generally from staff and residents is very positive. They feel she is committed to improving standards within the home and is approachable and supportive. The care planning process and training plans are continuing to be further developed. Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 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 DS0000026418.V275056.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.V275056.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): 3,4,6. Residents receive a full needs assessment prior to moving into the home. The home is able to meet the needs of residents it admits. The home does not provide intermediate care. EVIDENCE: The Inspector viewed three 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 residents. All areas of needs assessment required in standard three were present. The home obtains specialist advise from resident nurses and other health care professionals including tissue viability, infection control, general practitioners and continence advisors. This was supported by documentation in care plans. Residents also spoke of visiting healthcare professionals and domiciliary community services, such as Dentist services. All residents spoken with felt that the staff were competent and professional. Staff discussed training events previously attended and courses they were due Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 Page 9 to attend. These were; mandatory health and safety training, dementia awareness, pressure area/skin care, NVQ level 2 and Adult Protection. Beeches Care Home DS0000026418.V275056.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): 7,8,9,10,11. Residents receive a comprehensive assessment. Assessments are updated following a review. The home is able to meet the healthcare needs of it’s residents. Medication issues are managed appropriately. Residents are treated appropriately. EVIDENCE: Three care plans observed, were well set out and detail each area of need and an action plan is drawn up to meet this need. Risk assessments were well documented in each of the resident’s plans that were inspected. Particular attention is placed in the need to prevent pressure sores, falls and safe working practices. Daily records are well maintained by care staff and professional input from district nurses and GP’s is well documented. Evidence gained from speaking to residents and staff suggested the care planning process was accurate and outcomes satisfactory. Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 Page 11 Resident’s plans contain details of each individual’s health care needs, including tissue viability and continence risk assessments. There is evidence that people have been appropriately referred to health care professionals. Care plans viewed contained records of visits by General Practitioners and other professionals. Healthcare professionals were observed visiting on the day. The inspector was informed that the residents can register with a GP of their choice. Staff training records evidenced that medication training was provided for staff responsible for the administration of medication. The homes medication administration systems have been well maintained. There is a policy and procedures for receiving, recording, storing, handling, administering and disposing of medicines. The home is registered with the local pharmacist and support and advice obtained as and when needed. Medication records and storage were observed and were found to be well managed. Staff were observed during the visit interacting positively with individuals, four resident’s spoken with, reported staff provide a good standard of care and areas of concern would be discussed with the registered manager. All of the residents who spoke with the Inspector commented very positively on the conduct and attitude of the staff. Care plans evidenced discussion with residents and family as to the preferences of all parties in the event of a death. Beeches Care Home DS0000026418.V275056.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. Residents are supported to pursue, religious and some social interests. Residents are helped to exercise choice and control over their lives. Some residents and staff feel there is not enough social stimulation and recreational interest provided at the home. 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 a relative reported that the staff provide activities wherever time permits. However some residents and staff feel that often residents have to wait for help with personal care tasks, there is little time left to help residents with any other activity. The Inspector observed many relatives visiting the home on the day of the inspection. Many who visit the home enjoy participating in activities provided. Meetings are held monthly for residents and relatives who wish to attend. A poster is sited on the main notice board. All the residents and a relative spoken with, reported the home offers a relaxed atmosphere and feel the quality of care is constantly improving. Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 Page 13 The inspector observed food served on the day of inspection. Food served looked wholesome and nutritious. All the residents spoken with, reported to the inspector that they enjoyed meals at the home, how excellent the staff are and how they ensure they provide assistance to the residents that require assistance with eating. One resident told the inspector that often at mealtimes, food is put out on the table and by the time they reach the dining room, their meals are cold. One resident said the evening meal was at 4.30 and that it was far too long to go until the next morning, to receive anything to eat, though other residents could not confirm this. The manager needs to review each resident’s requirements in this area. The staff group also needs to be made aware of these issues. Beeches Care Home DS0000026418.V275056.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): 16,18. The home operates suitable complaints and adult protection procedures. Staff require training in 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. The inspector discussed a complaint with one resident, which was being investigated by the home. The inspector left the commission’s information leaflet with this resident. A relative 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 members, who spoke with the inspector, demonstrated an understanding of Adult Protection procedures. Both of the staff had not received training in Adult Protection. The manager needs to ensure all staff receive training in this area. Beeches Care Home DS0000026418.V275056.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): 19,22,26. The home is clean, hygienic, comfortable and well maintained. There are insufficient lifting aids in use ion the home. There is insufficient storage space for wheelchairs. 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 manager provided the inspector with information that suggests services, equipment and appliances are tested and maintained appropriately. Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 Page 16 A number of staff stated that one sling was used for a number of residents. This presents a major health and safety hazard. Each resident should be individual assessed for hoisting and assisting to move. This also presents risk of infection from cross contamination. This practice must cease immediately. The inspector noticed in two bathrooms, there were three to four wheelchairs surrounding the bath. One care worker was observed assistant a resident in to one of these rooms for a bath. Despite being unsightly this also presents a health and safety hazard. Beeches Care Home DS0000026418.V275056.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 resident’s needs are not currently being met by the number and skills of the staff group. The organisation’s recruitment policy is not sufficiently ensuring the health and welfare of the residents. Not all of the staff are trained and competent. EVIDENCE: The current number of six care staff to forty six residents appears to be meeting the guidance. However, a number of factors contribute to this not being the case. Evidence gathered from speaking to staff, residents and studying rota’s indicates that the resident’s needs are not being met. Residents, whilst complementing the care staff and nurses on the quality of personal and health care support, stated that they often have to wait for services, particularly at key times. They also felt staff did not have time to support them in daily recreational and stimulating activities. It emerged throughout the inspection that whilst there are six care staff on duty with two registered nurses, the nurses being included in the staffing ratio, the nurses (or a proportion of them) do not expect to undertake care duties despite shortages. This needs to be addressed by the organisation, by either increasing the complement of care staff or reviewing the current roles and responsibilities of nursing staff, particularly at key times. Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 Page 18 Additionally, the organisation has recruited foreign nationals to address the shortfall in recruiting of care staff. From discussion with residents, staff and management, these staff members have largely been well received and whilst their commitment and standards of care are not questioned, a proportion of them are unable to communicate with residents and staff. This clearly presents risks to residents and potentially other staff. Additionally this poses the question as to how they are to be effectively trained and at what level they will understand any training, supervision, instruction and requests from resident’s. An immediate requirement has been set to halt employing staff, who cannot communicate effectively. Also the members of staff in question need to be closely supervised until they are able to communicate effectively. The manager indicated that a large proportion of staff have or 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. i.e.; confusion, adult protection and pressure area care and prevention. Certificates were observed on files. Appropriate training plans were observed and are being further developed by the current manager. Residents spoken with feel a majority of the staff are competent and professional and are aware of their needs. Beeches Care Home DS0000026418.V275056.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): 32,38 The home is well managed and the health, welfare and safety of the residents is promoted through policy and practice. EVIDENCE: Residents, relatives and staff told the inspector how the new manager is supportive, responsive and approachable. Relatives were very complimentary about the running of the home and how committed the staff team is. Evidence of regular residents and relatives meetings was observed and weekly surgeries are posted for anyone to attend. Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 Page 20 Systems are in place to ensure all equipment is serviced and in good working order, recorded evidence was made available to the inspector. The organisation conducts a joint audit at the home on monthly basis. 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 and demonstrated a rolling program of redecoration. Evidence was provided by the manager and staff, for staff training in mandatory health and safety subjects. i.e.; moving and handling, infection control and first aid. Beeches Care Home DS0000026418.V275056.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 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 2 Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 Page 22 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 12 Regulation 16 2mn Requirement Ensure the individual social and recreational needs of the residents are planned for and met. Ensure meals are not put out until residents are seated at the dining table Ensure all staff receive training in Adult Protection Ensure hoists and slings are provided in sufficient numbers for each individual resident. Ensure staff are deployed in sufficient numbers to provide support for the needs of the residents. Ensure foreign nationals are able to receive and understand training and are appropriately supervised. Ensure staff are not employed at the home unless they are able to communicate with the residents Timescale for action 30/03/06 2 3 4 5 15 18 22.3 27,29 16 2 i 12 13 13 13 16 18 1a 6 3 4 a-c 2j 1a 04/01/06 28/02/06 10/02/06 30/01/06 6 28 134c 56 121a 134a-c 181ac,i 04/01/06 7 38 04/01/06 Beeches Care Home DS0000026418.V275056.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beeches Care Home DS0000026418.V275056.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.V275056.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. 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!