Inspection on 16/02/07 for Beeches House

This inspection was carried out on 16th February 2007.

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.

Other inspections for this house

Beeches House 10/01/06

Beeches House 29/09/05

Beeches House 14/03/05

Beeches House 21/10/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beeches House 53 Park Hill Carshalton Surrey SM5 3SE Lead Inspector David Pennells Key Unannounced Inspection 16th February 2007 1:30pm 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 House DS0000007171.V311659.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beeches House Address 53 Park Hill Carshalton Surrey SM5 3SE 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) 020 8401 0071 020 8395 5668 brookcarehomes@blueyonder.co.uk Brook Care Homes Mrs Bridget Teresa Brook Care Home 13 Category(ies) of Learning disability over 65 years of age (13) registration, with number of places Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 service users under the age of 65. Date of last inspection 10th January 2006 Brief Description of the Service: Beeches House is a large family-style house set on a busy road centrally located to the community of Carshalton Beeches - thus being close to bus and train connections and local amenities such as newsagents, shops and restaurants, etc. This service has been provided here at Beeches House - for the current user group - since the end of July 2004 - when almost the entire community moved en masse to this new location from another residence, Woodcote House (located at the bottom of Sandy Lane South). The locational ‘swap’ (some of the previous service users from Beeches have now moved to Woodcote House) was arranged to enable this present client group to benefit from the better community facilities close by, and the more central location of the house. Certainly service users indicate they are very happy with both the location of the house, and the facilities they now enjoy here. The house provides services predominantly for older service users, the majority having learning difficulties - though five of the current service user group are under the 65 threshold. The house has five single bedrooms and four double-occupancy rooms (not all being doubly-occupied, however). The house has a large communal lounge and separate dining room, and the garden area at the side is much enjoyed in better weather. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was conducted across three shorter visits - the first with the registered manager present - a five-hour visit. The second was undertaken the following week (25/02/07) - when the manager was not available on site, and the proprietor’s son - the general manager - was disabled from spending sufficient time with the inspector to complete the audit. A third pre-planned visit on 01/03/07 for a couple of hours allowed the inspector and general manager Jeremy Brook to complete their discussions, and for the audit to be concluded. During the visit the inspector was able to assess progress, where applicable, of the home in meeting the requirements and recommendations set in the report of the last inspection visit from January 2006. Documentation was examined and discussions with staff enabled the inspector to assess the current situation regarding care and other issues that were raised through this auditing process. Time was also spent speaking to both individuals and groups of people who use the service. Throughout all three visits, the inspector is grateful to the people who live at the home, the care staff and the management of the home for their warm welcome, general cooperation and hospitality. What the service does well: The home provides a warm and comfortable environment for the eleven current service users; a good sense of ‘community’ being promoted - and staff members continuing to offer an intimate and warm and familiar service of support to all - responding to the significantly varying needs of younger and significantly older people. The age span is forty-three years, from 54 to 97. Four people are aged below 65 (one in their 50’s and three in their early 60’s), and the average age of the entire population is 71. Although the culture, therefore of the home is ‘elderly’ the fact that the focus is on active learning disabled people, leads to the feel of the place being decidedly ‘younger’ than this figure would ordinarily suggest. Care is provided on an individual basis, with assessments and care plans being well-maintained and daily notes being generally concise and helpful. The transfer in July 2004 from another care home to Beeches House has been well coped with by all service users at the home - who have now taken this establishment to their hearts. Written feedback about the home was given by five relatives and a friend of people living at the home, and by a local authority placement reviewing officer. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 6 The relatives / friend stated that they were all happy with the overall standard of care at the home; none of these six ever having had to complain about the service, and all feeling that they were welcomed by the staff / owners to visit their loved one - in private, where appropriate. The reviewing officer was also positive about their charge’s placement at the home. What has improved since the last inspection? What they could do better: Two requirements relate to furniture in bedrooms - highlighting the need to replace the vanity / washbasin units in a number of rooms and also to review the furniture and upgrade such facilities as may be necessary. A requirement relates to a requirement to review staffing input to the home in its entirety and to determine any adjustments that may be necessary to meet the needs of those who use the service. The Commission requires that the home hold written evidence by way of amended rotas if need be, of the additional hours worked by the registered manager - who currently provides a management input to the home on a core three-day-a-week basis with additional hours as required by the service. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 7 Health & safety requirements relate to both fire alarm testing - which must be strictly regularised - and fire drills - which, having not been recorded since last July (2006), were to be urgently restored to a minimally quarterly routine. A final requirement relates to ensuring that car insurance is appropriate for transporting people who use the service when using the proprietors’ or staff member’s cars. Recommendations that follow cover issues relating to: medication storage; to developing best practice relating to ‘prn’ medication records; to ensuring the most contemporary edition of the Borough’s Adult Protection procedure is available to staff; to the need for additional space for service users to smoke and visitors to visit in private; and to the need to promote privacy and dignity by ensuring that call bell cancellation points are situated at the point of call inside the room. 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 House DS0000007171.V311659.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that their needs and aspirations will be fully assessed and recorded both prior to a placement and on an ongoing basis once they are resident at the home. Beeches House does not provide Intermediate care and therefore Standard 6 does not apply. EVIDENCE: One service user has left the home - for another care home in the proprietor’s ownership - this leaving the entire population at Beeches House now broadly being categorised within the ‘learning disability’ spectrum. The age span is forty-three years, from 54 to 97. Four people are aged below 65 (one in their 50’s and three in their early 60’s), and the average age of the entire home’s population is 71. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 10 Fees are currently charged in the range from £445 - £672 per week. Assessment documents are available for the home to use, but the community has not grown, nor has anybody been admitted to the house since the transfer from previous establishments within the proprietor’s ownership in 2004. The home provides long-term care to service users, two of whom have been with the Brook family since 1985, one since 1993, three since 1997, one since 1998 and the remaining four more ‘recently’ - within the past four / five years or so. The home does not provide any other care service; the intermediate care standard – Standard 6 – does not, therefore apply to this establishment. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect that their care will be arranged through considered care planning, and the regular monitoring of goals & achievements. The maximisation of goals identified can, however, be compromised by the lack of care staff available. Service users can be assured that their health care, in all dimensions, will be attended to, through appropriate contact with health care professionals - as appropriate. Service users can be assured that the management of medication in regard to their individual needs will be managed and administered within a clear policy and procedure framework currently in place. Service users confirmed through their experience that they are treated with respect and their right to privacy is upheld - resulting in a culture of mutual respect, positive self-esteem and tolerance. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 12 EVIDENCE: The manager and general manager have attended courses on Health Action Planning and also Person-Centred Planning. Person-Centred plans have been ‘mapped out’ for a number of people living at the home - and the next stage of integrating intentions into care plans - setting the goals and outcomes alongside actions, is developing. Goals set in PCPs have implications for staffing, as do the care needs of the community at the home - which are increasing as the years roll by. As well as the general needs of the more elderly people at the home being present, there have been marked increases in dependency for a number of the other people using the service. The need for escorting some people - both around the home itself, or when going out - has increased, as has the need for supervision / encouragement / monitoring also grown. One or two people are decidedly more ‘poorly’ than they used to be - due to different developing conditions. It was reported that night staff continue to get all people up for the day prior to leaving the home at 8.00am - and there may well be a need to revise the care plans - to enable those who so wish, to lie in, and take an easier approach to the start of the day. The level of staffing may well need increasing to address these issues; certainly feedback from care staff indicated there was a strong opinion in this regard - and staff reported the conflict of both having to undertake catering and cleaning duties - as well as the increasing care tasks. The inspector observed the conflict that staff faced when short-staffed on the evening of his staying at the home until 7.00pm; when there was just two carers providing the care that evening (not an unusual situation, apparently) one showering a service user, and the other was finishing the tea time clearing tasks in the kitchen - then the door bell rang for some people to go out - there was a need for some money - but the senior was assisting a service user in the bathroom, meanwhile another service user was becoming very irritable and needing 1:1 time. This clearly reflected the level of demand from the group of people resident, at times - which clearly could have been better handled if the catering tasks were not required of the care staff. Staffing levels are discussed - in the staffing section further on in this report. Four GPs from three different practices provide GP services to service users at the home; three having separately named doctors and eight being registered with the ‘core practice’ locally in Carshalton Beeches. Some service users have learning disabilities with associated mental health problems - monitoring of this is enabled by the local mental health teams, with associated risk assessments being in place. Access to audiology, dentistry and ophthalmology services is enabled, but some service users positively do not wish to use the equipment supplied for them. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 13 Medication procedures and records were examined and found generally well managed. Several staff members have more recently undertaken care practice modules with John Ruskin and Nescot Colleges - covering medication administration. It is recommended as ‘best practice’ that guidance concerning ‘PRN’ medication - currently available on the care plan documents - should be also copied alongside the MAR sheets, to assist in ensuring that the approach to providing such extra (‘discretionary’) medication is managed appropriately by staff. Standard 10 - concerning privacy and a service users’ right to respect was closely explored at the last visit with both service users and staff, and the standard was again found ‘met’ on this occasion. Service users all have their own clothes - and their own personalities are certainly expressed through this aspect, and through their own personalities shining through. Beeches House accommodates eleven very individual people! Privacy is promoted through seven service users having their own single rooms; two service users now singly occupy a double-occupancy space. Screening is provided for those who continue to share rooms; sadly, there is no visitor’s room as such - the proprietors hope - in the future - to add on a conservatory area where such privacy could be afforded. Personal care and any medical examinations are carried out in the privacy of their bedrooms and private space is respected. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 14 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 - 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect to lead a fulfilling life based on individual assessment and their expressed preferences and dislikes. Contact with families and friends and the local community is positively encouraged, and people who use the service can be assured that such links will be upheld through the home’s practices, support and encouragement. Service users are encouraged to sustain their own interests and preferences, through being enabled (with an advocate’s help) to make decisions as much as possible for themselves. Service users are provided with a pleasant & nutritious diet, with the emphasis on personal preferences - and mealtimes being generally a pleasurable community experience. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 15 EVIDENCE: Although the culture, of the home is ‘elderly’ - the fact that the focus is on active learning-disabled people leads to the feel of the place being decidedly ‘younger’ than the average age of 71 would ordinarily suggest. Religious needs are respected at the home, with one person attending St Mark’s Church, Woodcote, whilst another attends the Roman Catholic Sunday Mass in Wallington. The opportunity to practice their religion extends to all present in the home, and transport is arranged for them appropriately. Service user meetings are held and minuted; there were entries for a meeting held in Jan 07 - the previous one to that sadly being June 06. However, prior to this ‘glitch’ meetings were again every three months, maximum. Activities within the home include music and TV, video, films, sing-alongs and a weekly visit from a qualified Occupational therapist. Arts & crafts, board games and puzzles are enjoyed. Parties for birthdays and other special occasions (St Patrick’s Day was going to be well and truly celebrated!) are all opportunities for themes activities and a celebration. Varied samples of international cuisine have also been provided at such events - including a successful Caribbean evening. External trips include visits to the shops, drives out, and a general walk promoting exercise. Coach trips take people to restaurants and on smaller holidays. A holiday has been booked for four days to Butlin’s Holiday Centre in Bognor Regis for seven service users and four staff. The general manager told the inspector that the home hopes to be able to purchase a minibus from the home’s capital funds - but that this also relies on increased funding to sustain the service from year to year - for running costs. Four people attend external clubs weekly, and Mencap’s Social Club is attended on two nights every week. One younger person attends a separate Day Care centre, and three attend Hallmead Day Centre, which is run by Sutton borough. Church / Community functions, such as Fetes and Garden Parties are noted and eagerly attended. Visitors are very welcome to the home - this being confirmed by relative and friends questionnaires. There is a rotating menu - with alternative choices always available – with a wide variety of different and nutritious meals. Good portions of food were served, with ‘seconds’ being available - and fresh fruit was also noted. Service users’ comments evidenced general contentment with the food provided. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 16 The majority of service users eat ‘at table’ in the dining room - sharing two largish tables - and all were noted to thoroughly enjoy the variety of food provided. One service user, who has their ‘own’ timetable, was also provided with a separate late meal on the days of the inspector’s visits. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 17 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their advocates can be assured that complaints will be processed and dealt with swiftly and effectively, in line with the home’s Complaints policy and procedure. Service users can be assured that they will be protected from abuse of any kind through the policies, procedures and practices of the home. EVIDENCE: The home has a Complaints policy, which is available to all service users, and relatives / advocates of service users. Relatives / representatives were aware of the complaints policy of the home - evidencing that the home had made an effort to ensure that communication was strengthened in this respect. The home holds a policy concerning adult abuse and also has a separate ‘Whistleblowing ‘ policy. The abuse policy clearly states that the Community Services Care Management Team must be contacted - and that they will take the lead in and response to any allegations. Training for staff in Adult Protection / Safeguarding has also been accessed from the host Borough - the London Borough of Sutton. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 18 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, 21, 22, 24 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be assured that they will live in a well-maintained and safe environment, which is clean, hygienic and odour-free. Service users can have access to a variety of well-furnished comfortable facilities in the house suited to their assessed needs, the house providing adequate toilet and bathroom facilities to ensure ease of use. The house is suitably assessed with regard to specialist service needs, in line with current professional advice, with action taken in response to its recommendations. Service users may be assured that their privacy and dignity will be maintained to a high level, within the parameters of the home’s actual ability to do so. The existence of shared rooms and lack of a visitor’s room / area to an extent compromises the capacity of the home to provide privacy to all service users. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 19 EVIDENCE: Beeches House is a large family-style house set on a busy road centrally located to the community of Carshalton Beeches - thus being close to bus and train connections and local amenities such as newsagents, shops and restaurants, etc. Improvements noted from over the past year include the following: bathrooms and toilets have been repainted, and a third of the bedrooms have been ‘freshened’ up; the hallway, stairs and landing have been redecorated; some dining chairs have been reupholstered; a new freezer and cooker have been installed in the kitchen; the bedroom call point indicators have been rationalised to show which specific bedroom is ‘calling’ rather than one being a jointly-owned indicator. On one day of the inspection visit, the handyman was installing a new wide screen TV to the lounge - which was very well appreciated by all present. The deteriorating vanity / washbasin units in bedrooms are in a degraded state, having suffered many years of water infiltration. They must be upgraded / replaced to a more acceptable standard. On the tour of the premises, the inspector felt that some bedrooms had a poor standard of furnishings - which need reviewing and addressing; the registered provider is required to survey bedroom furnishings and replace, as appropriate, any poor standard items. The main lounge has parquet (polished wood) flooring - which is now very ‘modern’ and attractive (and presumably easy to clean) - seating is provided ‘perimeter’ style - the only practical approach bearing in mind the number of people who use the room. The adjacent dining room is used by a number of individuals for 1:1 activities -and staff also use the room for breaks and writing up records. There is, unfortunately, no room which can be dedicated to service users who smoke at the home - they smoke in the garden in pleasant weather - and in the evenings and on inclement days they smoke in the hallway / stairwell. It is again strongly recommended that this issue be addressed by the provision, perhaps, of a conservatory - or other room, being added to the ground floor communal space provision. The home - as an ‘existing’ home - has been allowed to continue providing care within the current configuration of bedrooms - including the majority of service users being accommodated in shared rooms. Two double rooms were singly occupied at the time of the inspection, and the general manager confirmed that - in line with standard 23.6 7, bedrooms Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 20 would not be doubly occupied again unless two service users have positively chosen to share - or unless the present occupant is given the opportunity to decide not to share - possibly by moving into a different room if possible. There are five toilets spread about the building two on the ground floor and three on the first (one in a bathroom) - with a separate staff toilet on the ground floor. There is one bathroom in the house on the first floor (accessible to all via a chair lift) - and a ‘custom-built’ shower facility on the ground floor to meet the varying needs of the service users. The home was noted to be generally clean - and odour-free at the time of these predominantly unannounced visits. All bedrooms have external ventilation and access to natural daylight through windows. The main communal rooms are reasonably well lit. Ventilation around the house appeared adequate. The house was well heated. All maintenance and contract details were available and in good order on the day the inspection focused on these aspects. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect that their needs will be met by suitably qualified and competent care staff, though this provision may not be in sufficient numbers to provide for the individual’s assessed and preferred needs. The recruitment policies and procedures at the home are designed both to protect (through checks and interviews), and to provide adequate and focused / appropriate care input to, the people who use the service at the home. Staff members employed at the home are encouraged to undertake training, and the home strives to ensure that relevant training and supervision is provided to ensure that the home meets its statutory obligations. EVIDENCE: The general manager has undertaken a review of staffing levels and is negotiating currently with local authorities to secure increased funding to provide a better staffing input to enhance the activities focus within the home’s staffing input. Two of the three funding local authorities have now met the requested increases in funding levels. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 22 Staffing levels could be more adequate if they did not have to undertake both the cleaning and cooking tasks as well as the caring role. A cook undertakes catering tasks on three mornings per week between 8.30am and 1.30pm - this still leaving staff to cook the evening meal on those days - and to provide all meals on the remaining four days, as well as the domestic / cleaning input. See the ‘Health & Personal Care’ section above for further comments regarding concerns about the care staffing levels. Care staff members are now achieving their NVQs in Care - and the minimum standard of a 50 proportion of care staff being qualified has now been exceeded. Of eleven carers working at the home at the time of the inspection, six had NVQ at Level 2 - or equivalent or above, and three other staff members were currently undertaking their NVQ at Level 2. The proprietor / manager has been undertaking her A1 & A2 NVQ Assessor’s course - to be able to assist staff studying / compiling their portfolio at the home. Several staff members have undertaken care practice modules with either John Ruskin or Nescot Colleges - covering Medication Administration, Infection Control and Moving & Handling. Training videos covering food safety / First Aid / Fire Safety / Moving and Handling / Customer Care and Infection Control were all being used as training opportunities. Four staff are currently undertaking ‘Activities in a Care Setting’ training. The manager stated that staff undergo a three-day in-house orientation programme and then engage with the skills for care Common Induction / Foundation programme. Mandatory courses are identified to follow on or accompany this introduction to the home. The home is planning to introduce the LDAF (Learning Disability Awards Framework) Units to ensure that the learning disability focus is also fully accommodated within this home. Ten staff members have had the Emergency First Aid at Work training enabling all shifts to be covered by a qualified First Aider. The two proprietors provide regular 1:1 staff supervision sessions. The General Manager also undertakes annual Appraisals for all staff. Staff meetings are held at least every three months; minutes of such meetings were seen. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 23 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can expect the home to be generally well run, under the guiding eyes of the proprietors. The proprietors must, however, seek to ensure that the home’s manager is qualified in management skills to fully benefit the home. Service users can be confident in the knowledge that their finances held in safekeeping are properly managed, and that rigorous accounting ensures that any such transactions are clearly recorded and accounted for. Service users and their representatives can be confident that the home is kept in a safe and well-maintained way, thus ensuring the health and safety of all who engage with the home, except in relation to missed fire safety checks. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 24 EVIDENCE: The general manager stated that both he and the registered manager (along with the manager of the other home in their ownership) were undertaking the Registered Manager’s Award qualification with ‘Role Model Consultancy’ via Learn Direct. The general manager was required to provide evidence of this training being in process. Mrs Brook, co-proprietor and named registered manager, is present in the home on three core days each week - usually on Mondays, Wednesdays and Fridays - and works additional hours on other days to the requirements of the service. She has an RMN / SEN qualification and twenty-three years’ experience in residential care settings. The proprietor’s son, Jerry Brook - the ‘general manager’ (overseeing both the homes in their ownership), has his office ‘on site’ upstairs at this home. The Commission continues to consider Mrs Brook’s NVQ Registered Manager qualifications to be inadequate - without the management training component completed - and her presence in the home more than the three core days out of seven is to be more clearly indicated on the live rotas held in the home. The general manager reported that the proprietors have again been advertising in November 2006 in local borough Guardian newspapers for a qualified social care manager, interviewing candidates to take on this management role, but to date not finding a suitable candidate to employ. Independent quality assurance questionnaires are being undertaken by the proprietors - the collated outcome, alongside the proprietor’s response - should be made known to service users and the Commission. A joint Lloyds TSB Account held in the service users collective name is held by the home and interest is regularly awarded to each, dependent on the amount held by the individual. Accounts previously seen - presented by the company’s bookkeeper were well kept, with cross-referencing agreeing. Extras which people living at the home have to fund include: hairdressing, personal clothing, personal effects, toiletries, holidays and outings clubs and special events, taxis and luxury items of choice. Placing Local Authorities are the predominant agent for service users’ finances, with four service users continuing to have Mr Brook (senior) as Appointee. A single service user has recently been accepted under the jurisdiction of the Public Guardianship Office. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 25 Maintenance and servicing records evidenced that all the required health & safety and contract examinations - including for the chair lift - were being conducted on a regular and responsible basis. The Accident book was noted to have very concise and well-recorded details. Fire alarm tests were not being conducted on a consistently weekly basis; with a number of larger gaps in records showing a disregard for the usual seven day cycle of checks: gaps of up to over two weeks were noted. Consistency must be brought to this ‘routine’. Fire Drills were also not recorded to have occurred since July 2006 - this failure - if it is a reality, was to be resolved without delay following the inspection visits. A senior carer stated that the drills had taken place, but without a record of such events this was difficult to verify. Care must be taken to ensure that all such fire safety measures are fully recorded immediately at the time of the event. The issue of car insurance was raised with the general manager - as it appeared that no staff - or the proprietors - had ‘business use’ insurance to cover their carrying people from the home in the discharge (formally or informally) of their working duties, or for when they were ‘off duty’. Such clarification is vital to ensure that appropriate cover is provided for those who live at the home at all times. Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 X 18 3 2 X 2 3 X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 1 Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 27 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 OP21 Regulation 23(2)(b) Requirement The deteriorating vanity / washbasin units in bedrooms must be upgraded to a more acceptable standard. Timescale for action 31/07/07 2. OP24 23(2)(b) The registered provider must 31/07/07 survey bedroom furnishings and replace, as appropriate, any poor standard items. The proprietors are required to undertake a review of staffing at the home, in the light of growing dependency, to ensure the specific and individual needs of the service users are being adequately met. Details of this completed review and actions determined must be sent to the Commission. The registered manager must hold a qualification in managing care services at NVQ Level 4 (RMA) or 5 - or another suitable management qualification recognised by the Commission. 31/05/07 3. OP27 18(1) 4. OP31 9 & 10 31/12/07 Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 28 5. OP31 7&9 Evidence of the manager / proprietors undertaking the Registered Manager’s Award must be forwarded to the Commission. Full and accurate rotas showing the hours actually worked by the registered manager must be kept in the home to adequately evidence the management input to the home. Fire alarm call points checking must be regularised to a minimally weekly event. Fire drills must be undertaken regularly and formally recorded. Car insurance for any journeys undertaken with people who use the service at the home must be clarified - and appropriate action must be taken to ensure appropriate cover. 31/05/07 6. OP31 17(2) Sch 4.7 30/06/07 7. OP38 23(4)(c) 08/03/07 8. 9. OP38 OP38 23(4)(e) 13(4) & 25(2)(e) 08/03/07 15/03/07 Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 29 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 OP9 Good Practice Recommendations That guidance concerning ‘PRN’ medication - currently available on the care plan documents - should be also copied alongside the MAR sheets, to assist in ensuring the approach to providing such extra medication is managed appropriately by staff. That the Sutton Borough Adult Protection Policy document held in the dining room be updated to the 2005 version, rather than the outdated 2002 document. It was believed that the modern version was held in the upstairs office. That additional space (perhaps a conservatory / garden room) should be created at the home for those who wish to smoke - so that the ‘passive’ experience is not passed on to those who do not smoke. The call bell system at the home, being of an age, has cancellation points outside bedrooms which means they could be (inadvertently) switched off without the call being answered. The cancellation points should be moved into the rooms where the call is actually made from. 2. OP18 3. OP20 4. OP22 Beeches House DS0000007171.V311659.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 House DS0000007171.V311659.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!