Inspection on 29/09/05 for Beeches House

This inspection was carried out on 29th September 2005.

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 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 16/02/07

Beeches House 10/01/06

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 Unannounced Inspection 29th September 2005 12:30 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.V253722.R01.S.doc Version 5.0 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.V253722.R01.S.doc Version 5.0 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 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.V253722.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 service users under the age of 65. Date of last inspection 14/03/05 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 whole 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 service users from Beeches have now moved to Woodcote House) was arranged to enable this present client group to benefit from the better 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. The house provides services predominantly for older service users, all having learning difficulties - though five of the current service user group are under the “65 ” threshold. The house has five single bedrooms and four doubleoccupancy rooms. The house has a large lounge and dining room, and the garden area at the side is much enjoyed. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector arrived, unannounced, at the house at ‘pudding time’ – service users having got half way through their midday meal - and he stayed at the house until well past suppertime. During this time, the inspector was able to engage with most service users (some returning from day care / trips out later in the afternoon); he spent time speaking to staff members on duty and was also able to discuss matters pertinent to the home with the General Manager of Brook Care Homes, Jerry Brook – including reviewing requirements and recommendations from the last report following the March 2005 inspection. The inspector was pleased to receive a substantial number of responses to the Commission’s Questionnaire from relatives and friends of service users (10 responses) – and equally he was very pleased – and grateful - to the service users at Beeches House; each of the twelve service users made a positive personal effort by individually completing a Service User’s Questionnaire. The responses received showed a very positive picture of the home and the service provided; service users being more vociferous and descriptive in their comments about the home than the relatives / friends – who nonetheless indicated that they had no complaints and were satisfied with the overall level of care provided. Service users spoke of ‘Very good care’…. ‘Staff very nice….’ ‘Looked after very well….’ ‘I have been well taken care of….’. The overarching feel of the establishment is that of a settled, warm and concerned community. All service users are very friendly and accepting towards each other, and comprehend and accept each other’s foibles / special needs. What the service does well: What has improved since the last inspection? Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 6 The Statement of Purpose has been revised, and Contracts have now been given to all service users, ensuring that everyone knows the home’s own specific ‘Terms and Conditions’. The home is developing a new perspective on care planning - the Person Centred Planning (PCP) approach – the proprietors are currently cascading the concept down to staff and developing the appropriate documentation. A medications returns record is now clearly in place, and the use of ‘prn’ (‘when required’) medication is now supported by a clear guide – this being incorporated into individual service user’s care plans. In regard to premises issues, final exit doors on the ground floor have all now have been provided with suitable locking devices, avoiding the use of a key – in line with best safety practice. A substantial part of the building has been redecorated – the lounge, kitchen, the lobby and toilets and bathrooms have all been refurbished / redecorated. An Occupational Therapist’s assessment of the entire premises has been carried out at the house, and their recommendations arising from this report have been responded to. Cross-infection issues have been addressed through provision of paper towels and liquid soap being provided rather than ‘communal’ items. On a management front, Service users’ and relatives’ surveys have been introduced; the next stage to extend the survey to other professional stakeholders is yet to be undertaken. Fire drill frequency has been substantially increased in the past six months – already five have taken place in 2005 – ensuring the highest fire safety provision for both staff and service users. What they could do better: No new requirements have been set at this inspection visit; however five have been brought forward from the previous visit. The first relates to a requirement for the confirmation of all service users being suitable to the home’s category. A second relates to the proprietors providing adequate storage containers for foodstuffs in current use in the kitchen. The third requirement relates to ensuring individual call points are identified (this relates to a double room which is now two single rooms). Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 7 A full-time, long-term Manager is also to be recruited – to ensure that a fully qualified (RMA-qualified) staff member takes over from the proprietor who currently provides a three-day input. The final requirement sets the need for the house to canvass opinions from external stakeholders – to inform the development of the service for the future. 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.V253722.R01.S.doc Version 5.0 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.V253722.R01.S.doc Version 5.0 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): 1, 2, 3 & 6. Prospective service users can be confident that the information that is necessary for making an informed choice as to whether Beeches House could meet their needs will be provided with full detail included. Service users at the home will be clear about terms and conditions set by the home through the provision of a written document served on each individual. 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. EVIDENCE: The home provides a Statement of Purpose, which now, following amendment, meets the requirements of the Care Homes Regulations and the NMS. Service users are now all given a contract / statement of terms and conditions of staying at the home – additionally to the three-way contracts put in place by the placing local authority. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 10 A requirement is brought forward from the last inspection concerning the appropriate placement of service users at the home and that of a service user with complex needs in particular. Whereas all other service users at then home have a clear ‘learning disability’ diagnosis, this specific person is placed via a mental health NHS Trust - and has both needs and behaviour which are quite different to the others. It is necessary (and has been since the ‘re-population’ of this home in July last year) for the home to obtain – and communicate to the Commission – clear, unequivocal agreement from this person’s care manager that the placement at Beeches House is the most appropriate and suitable long-term placement for the service user. This being the case, a Variation application will be appropriate to ‘regularise’ this placement. The above process, to an extent, is a legal ‘formality’ – but seeks to ensure that specific needs are recognised and not ‘lost’ amidst the general service provision. It must also be stated that this specific service user is content and happy at the home, and the inspector was impressed by the careful way in which care was (observed to be) delivered to him during the actual inspection visit. The home provides long-term care (hopefully ‘for life’) 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 five more recently, within the past two or three years. 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.V253722.R01.S.doc Version 5.0 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. Service users can expect that their care will be arranged through care planning and the regular monitoring of goals and achievements. 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 well, within a clear policy and procedure framework. EVIDENCE: Care plans were in place for each service user and comprehensive, regularly reviewed and up-to-date. Consistent day-to-day notes were also in place. Each service user file held a: Personal Profile, Admission sheet, Assessment and Review, ‘Strengths, Needs and Wants’ and ‘Likes & Dislikes’ lists. The General Manager is seeking to introduce the Person-Centred Planning (PCP) process to the home; he and Mrs Brook have recently undertaken training provided by the London Borough of Sutton in this process. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 12 Care plans had been previously carried forward from the service user’s previous Brook Care Homes settings - the current service user group being ‘familiar faces’ from the two homes in which they previously resided. Two service users from the [now closed] Cladagh nursing home were previously ‘familiar faces’ to the other service users, so integration in to the one home was not so ‘difficult’. ‘I am looked after very well’ says one service user in their answers to the Commission’s questionnaire. ‘Very good care’ reports another. ‘I have been well taken care of’ says another. Four doctors 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. Advice concerning continence problems is accessed via the district nursing service. Access to audiology, dentistry and ophthalmology services is enabled, but some service users do not wish to use the equipment supplied for them. Medication records were examined and found to be in good order; the previous requirement that a specific record book be started to ensure a central record of returns of medication be kept had been met, and previous concerns regarding service user’s ‘prn’ (‘when required’) medication – now has a clearer set of criteria for its administration held in the care plan. The local pharmacist provides medication on a regular basis in daily predispensed ‘slides’ (a system known as ‘Venalink’). This is not as satisfactory as the ‘Monitored Dosage System’ of sealed 28-day ‘blister packs’ – which the inspector still recommends as the best practice method for holding and dispensing regular medication. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 13 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 & 15. Service users can expect to lead a fulfilling life based on individual assessment and the service user’s expressed preferences and dislikes. Contact with families and friends and the local community is positively encouraged, and service users can be assured that such links will be upheld through the home’s practices, support and encouragement. Service users can expect a pleasant and nutritious diet to be provided, with the emphasis on personal preferences - and mealtimes being a pleasurable experience. EVIDENCE: Each service user has a distinctly individualised care plan suiting their specific needs, ages and condition; of the three women who generally stay at home, two have regular ‘low key’ beauty care sessions – which they thoroughly enjoy, and the third enjoys domestic chores and shopping - and also enjoys writing. The male service users who do not attend centres chose to go shopping locally (now just ‘over the road’), and help with the chores and enjoy watching TV. One other male service user is regularly ‘out and about’ on the busses and very much enjoys his own company. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 14 An occupational therapist attends the home, and different service users have their own focuses of activity - including TV and Videos, and listening to music. Arts & Crafts are encouraged and Music and Sing-alongs are popular. During the week, three service users attend Hallmead Day Centre, one attends Cherry Orchard Centre and one attends the War Memorial hospital club weekly. Social and Sports Clubs are attended in the evenings and horse riding is also enjoyed by one service user, while others attend the Mencap Club. One service user does some voluntary work in a local Charity Shop. One service user regularly travels to the ‘sister’ home in Woodcote Road South - visiting and maintaining links with old friends. Many of the previously mentioned groups/clubs arrange good external trips - and even holidays. Pub lunches for small groups of the service users with staff are probably the most popular expedition from the home. On a Sunday, a number of service users attend different denomination Church Services. There is a 28-day rotating menu - with alternative choices always available – evidencing a wide variety of different and nutritious meals. Good portions of food were served, with ‘seconds’ being available - and fruit was also noted as available. Service users’ comments evidenced contentment with the food in general. The majority of service users eat ‘at table’ in the dining room - sharing two tables - and all were observed to thoroughly enjoy the variety of food provided during the inspector’s visit. One service user, who has their ‘own’ timetable, was also provided with a late supper on the day of the inspection visit. A requirement relating to the kitchen and food storage in particular was made at the last inspection visit and has to be re-iterated: once packeted foodstuffs such as dried fruit, flour, sugar, custard powder, sponge powder and pudding ‘whips’ have been opened, their long-term storage must be within sealed containers, so as to avoid infiltration by insects / mites / etc - leading to infestation and contamination. Sadly, the list of foodstuffs itemised above were all observed to be kept in the kitchen cupboard with either the tops just loosely ‘rolled down’ or in some cases, a lidless plastic box was used, with silver foil inadequately covering the contents. Investment in a good supply of variously sized sealed containers / boxes should be seen as a priority to ensure best catering practice / food safety. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 15 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. Service users and their advocates can be assured that complaints will be processed and dealt with swiftly and effectively; though it is clear that publicity about the procedure should be made more clearly to advocates outside the home. 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. The Commission’s survey showed that service users were clear about whom they should approach if they wished to comment about the care they received. Relatives / representatives, however showed by a majority (six out of ten) that they were NOT aware of the complaints policy of the home and it is recommended that the home make a positive effort to ensure that communication is 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. The home’s general manager is aware of the need to undertake complete checking of new staff under the Criminal Records Bureau system; he is clear about his obligations regarding ensuring a safe environment for service users. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 16 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 – 26. Service users can be assured that they will live in a well-maintained and safe environment, which is clean and 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 has 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. 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 a majority of shared rooms to an extent compromises the capacity of the home to provide individual privacy. EVIDENCE: Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 17 The house is a large, comfortable, family home, ideally situated for contact with the local community shops and transport links. Concerns that all ground floor final exit doors should not be locked with a key has been resolved; the doors do not have external handles, so the use of a key is unnecessary. There is a pleasant dining room, a large lounge and a spacious hallway. The main lounge has parquet (polished wood) flooring - which is now very ‘modern’ and attractive (and presumably easy to clean) - but the inspector would recommend that carpeting is more warm and provides a safer landing if a service user were possibly to fall. Lighting and furnishings at the home are distinctly domestic and comfortable. The garden at the side of the house is a welcome addition for most service users - as Woodcote House (their previous home) had little access to an outside ‘garden’ area. 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 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. Redecoration of bedrooms has taken place - the entire house was doubleglazed within a few days of the service users arriving in the home last July. A recommendation that net curtains be provided to ‘exposed’ bedroom windows – especially ground floor rooms at the front of the house, and those overlooking neighbours is made. Bedrooms seen were warm, well furnished and comfortable; each had its own character and reflected the occupant well. The single rooms clearly had more character – the service users having fully ‘taken them over’. 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. One double room was singly occupied at the time of the inspection, and the general manager confirmed that - in line with standard 23.6 7, the room would not be doubly occupied again unless the two service users have positively chosen to share or unless the present single occupant is offered the opportunity to decide not to share - possibly by moving into a different room if necessary. The prevalence of double-occupancy rooms is not ideal - especially as the standard expectation of learning disabled people in general is now set much higher. The home should put in place a written strategy concerning the future of the double rooms - so that both present and new service users can be appraised / reassured of the situation. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 18 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 the chair lift) - and a ‘custom-built’ shower facility on the ground floor to meet the varying needs of the service users. The home has now been formally assessed by a professional Occupational Therapist - the Lead Inspector has seen a copy of this report; issues arising have been addressed by the home. A stair / chair lift provides access to the first floor; there is an assisted bath, and an open shower facility for service user’s bathing needs; there are grab rails provided around the house. The small toilets now have a ‘safe door’ facility, to enable them to be opened outwards in an emergency. Thermostatic valves control hot water outlets - and radiator surfaces are covered, and have thermostatic controls to adjust the ambient temperature in separate rooms. The house is generally well maintained - it was clean and odour free on the day of the inspection. All bedrooms have external ventilation and access to natural daylight through windows. The main communal rooms are bright and 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 of the inspection visit. A single premises issue, arising from the previous inspection visit and report, relates to the rationalisation of two call points and indicators on the first floor – which must be ‘split’ to ensure that cancellation points apply to each room and are not shared, as is the present arrangement. A notice outside both bedrooms [placed, apparently, by the electrician] stating that the call bell may relate to either room is inadequate – from the perspectives of both service user’s privacy & dignity - and safety. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 19 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 & 30. Service users can expect that their needs will be met by suitably qualified and competent care staff, who are provided in sufficient numbers to provide for their assessed needs. Staff members employed at the home are encouraged to undertake training, and the home strives to ensure that relevant training is provided to ensure that the home meets its statutory obligations. EVIDENCE: Staffing at the home is provided at a minimum level of four staff in the morning, three staff on duty in the afternoon - and reducing to two into the evening, until two night staff, both awake throughout the night, come on duty. At weekends, three staff members are available throughout the day, with two on duty, awake, at nights. A cook undertakes catering tasks on a few mornings per week when there are sufficient service users ‘on site’ to justify this input. A training and staff development plan is in place at the home. This indicates a dedicated budget of £1,000 a year for training initiatives. Staff members are currently undertaking NESCOT training course in Food Hygiene and Safety. The majority of staff (nine out of fourteen) have been declared as being trained minimally in Basic / Emergency First Aid. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 20 Nine staff members also hold an NVQ at Level 2 in Care, or more. The home has, therefore achieved the national minimum standard - of at least 50 of care staff being trained to that level by the end of 2005 - in a timely manner. The home has introduced both Induction and Foundation training for staff - and it is planning to introduce the LDAF (Learning Disability Awards Framework) Units to ensure that the learning disability focus is also accommodated within this home. All staff members have completed the TOPSS induction process and many have completed the Foundation training. New staff contracts have been issued to all staff during this summer. The two proprietors provide regular supervision sessions. The General Manager undertakes Appraisals for all staff. Staff meetings are held at least every two months; minutes of such meetings were seen. Clearly the proprietors have their ‘finger on the pulse’ of the home. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 21 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. Service users can expect the home to be run efficiently and well, with the support and under the guiding eye of the proprietors. 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. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 22 EVIDENCE: Mrs Brook, co-proprietor, is present to manage the home, minimally, on three days each week - generally on Monday, Wednesday and Friday. The proprietor’s son, Jerry Brook - the company’s General Manager, also has his office ‘on site’ upstairs at the home - and is hence present on most days for some of the time. The Brook family have substantial backgrounds and experience in managing both care homes and nursing homes for various categories of service user. Jerry Brook is currently undertaking the Registered Manager’s Award at NVQ Level 4. An agreement made with the Commission - that the home would find a suitably qualified and competent manager to run the home on a long-term and full-time basis, has not been fulfilled, despite the proprietors trying to recruit a suitable person prior to Christmas 2004. Steps to commence this recruitment should be formally implemented again. The nominated manager must have, or be prepared to undertake, training to NVQ Level 4 in Management, as well as evidencing their care background through suitable qualifications. The General manager confirmed that service user surveys have now been undertaken; the requirement to survey other ‘professional stakeholders’ is yet to be undertaken – and remains an amended requirement brought forward from the last inspection report. 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 seen - presented by the organisation’s bookkeeper were well kept, with cross-referencing agreeing. Placing Local Authorities are the predominant agent for service users’ finances, with four service users having Mr Brook (senior) as Appointee. A single service user is currently having an application for Court of Protection status processed. Ongoing maintenance and servicing of equipment and the premises in general were well maintained – indicating that the safety of service users were protected, through the proprietors ensuring theses elements. Te house has more recently been registered for its new purpose; many checks and tests had been undertaken to satisfy the Commission Registration Teams’ requirements. Records of fire drills revealed a significant increase in the number undertaken – thus ensuring that all staff and service users are familiar with what should be done in such an emergency. Records of fire alarm tests were consistent and up-to-date; accident records were also clear and well maintained. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 23 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 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 24 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 OP3 Regulation 14(1) Timescale for action The suitability of all service users 01/12/05 placed at the home must be formally conformed with individual placing officers in writing, with a new agreed care plan being put in place to address any specific identified needs. Timescales of 30.01.05 & 01.07.05 not met. Requirement 2 OP15 16(2)(g) All foodstuffs must be carefully stored in sealed containers especially open packeting such as flour, mixes and spices, to avoid infestation. 01/12/05 Timescale of 01.07.05 not met. 3 OP22 23(2)(n) Rationalisation of the call points on the first floor must be effected to ensure that cancellation points apply to each room - and are not shared. Timescales of 30.01.05 & 01.07.05 not met. 01/12/05 4 OP31 8(1) (2) The home must employ and propose a long-term, full-time, suitably trained, qualified and competent manager to manage DS0000007171.V253722.R01.S.doc 01/12/05 Beeches House Version 5.0 Page 25 the home - as agreed recently at the time of registration of the service. Timescales of 30.01.05 & 01.07.05 not met – Mrs Brook, the proprietor, continues to provide management cover on three days a week - and the General Manager, Jerry Brook, is usually available on-site. 5 OP33 24(1)-(3) Independent quality assurance / satisfaction surveys must be undertaken with service users’ representatives to affect the way the service is delivered. Timescales of 30.01.05 & 01.07.05 not met – though service user surveys are now in place. 01/12/05 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 It is recommended that, wherever possible, medication stocks be obtained in a sealed ‘blisterpack’ style of dispensing format. OP9 2 3 OP16 OP19 That service user’s relatives and friends are given renewed information concerning the home’s Complaints Procedure. It is strongly recommended that service user’s bedrooms be provided with net curtains where the re is a possibility of being overlooked by neighbours – or in respect of ground floor rooms - where visitors / ‘strangers’ can see into the room as they walk by the house. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 26 4 OP20 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. 5 OP23 The situation concerning the future of double rooms and their occupancy at the home should be clearly stated in writing for the information of both current and possible new service users. Beeches House DS0000007171.V253722.R01.S.doc Version 5.0 Page 27 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. 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