CARE HOMES FOR OLDER PEOPLE
Beeches The - North Yorkshire County Council The Beeches Leeds Road Tadcaster North Yorkshire LS24 9JZ Lead Inspector
Kate Shackleton Key Unannounced Inspection 16th July 2007 09:15 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 The - North Yorkshire County Council DS0000034437.V343631.R01.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 The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beeches The - North Yorkshire County Council Address The Beeches Leeds Road Tadcaster North Yorkshire LS24 9JZ 01937 833603 01937 834772 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) www.northyorks.gov.uk North Yorkshire County Council Mrs Marie Denise Whitelock Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 26/07/06 Brief Description of the Service: The Beeches is a care home providing personal and social care for 33 older people. The home is located close to the centre of Tadcaster and service users can access the community amenities At the time of this visit the weekly charge is £381:41p. The home makes no additional charges. The Commission for Social Care Inspection reports are displayed in the home for anyone to read. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. • A review of the information held on the homes file since its last inspection. • Information submitted by the registered provider in the Annual Quality Assurance Assessment • Surveys received from six residents, one relative and one General Practitioner • An unannounced visit to the home, which lasted about seven hours. This visit included a tour of the premises, talking to residents, staff, and management. Examining some files, checking a small sample of health and safety records and observing staff working with residents. What the service does well:
Residents or their representatives are given enough information about the home before they move in. Someone from the home visits them prior to admission and they are offered the opportunity to visit the home for a look around and to ask questions about how the service is delivered. This enables them to make an informed decision as to whether the home is the right place for them to live. Comprehensive assessments are done from which a clear easy to understand care plan is developed. The resident is seen as a “whole person” and the service works well with other services to ensure that health needs are met. Residents are asked what they need and are actively encouraged to be involved in their care plans and reviews. This promotes the residents’ right to have a say in the care delivered and makes sure that all of their needs are considered. The home is clean, safe and comfortable. Staff are kind and helpful and make an effort to provide the service in the manner that residents want. Comments made by service users included “the staff are wonderful” and “everyone is very nice”. Emphasis is placed on maintaining the independence of people using the service and enabling them to exercise choice in key areas of their lives. Examples given included rising and retiring times, clothes, food and activities. This ensures that service users maintain some control. The safety of residents is an important aspect of the service delivered. It is demonstrated through good recruitment practices, risk assessments, staff training and the servicing of equipment and maintenance of the premises. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 6 A good choice of food and drinks are available. This ensures that service users receive a varied and nutritious diet. One service user spoken to said, “The food is very good.” There are various outings arranged and in house activities, which allow service users contact with the wider community and provide stimulation. Visitors are encouraged and made welcome. There is a clear and user-friendly complaints procedure and managers show a positive approach to complaints and ideas for improvement. There are clear ways in which quality can be measured which include feedback from residents. This ensures that the service continues to deliver care in the best interests of people who use the service. The staff are provided with comprehensive training to improve their knowledge and skills. This means that a well-informed staff team whose practice is up to date provides the care. The home is managed in a manner that is service user focussed. It concentrates on the needs, wishes and views of the people who use the service. What has improved since the last inspection? What they could do better:
The recording of the administration of prescribed skin creams must adhere to the homes policy and procedure on the safe administration of medication. This will ensure that skin creams are administered in line with the prescribers’ instructions. A way of involving residents wherever possible in the recruitment process would allow them the opportunity to have a say about the people employed in their home.
Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.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 The - North Yorkshire County Council DS0000034437.V343631.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to this service. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. To be confident that the service can meet all of the needs of prospective residents, comprehensive assessments are completed prior to admission. EVIDENCE: Examination of three resident’s files showed that comprehensive assessments are completed before anyone is offered a place in the home. A manager from the home visits prospective residents in their own home or in hospital to complete the assessment. Information is gathered from a range of sources including other relevant professionals. Relatives are involved where possible to find out more information that the prospective resident may not be able to provide. This meeting allows people the opportunity to ask questions about living at The Beeches. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 10 Everyone is offered the opportunity to visit the home prior to moving in. This provides another chance for prospective residents and their families to assess whether or not they want to go ahead with the admission. On admission a key-worker is allocated to each resident. On the day of admission a member of staff is allocated to help the resident settle in and find their way around. All admissions are subject to a trial period. After six weeks a review is held to decide whether the resident wants to live in the home permanently. The resident and their families are involved in this review. All of the residents spoken to, as far as they could remember, were satisfied with the way they were admitted to the home. One resident commented that she was “pleasantly surprised at how homely it felt and not at all like an institution” Resident’s surveys confirmed that people were given enough information about the home before they moved in which helped them to make a decision as to whether or not The Beeches would be the right place for them to live. Admission documents provided good information and included a copy of the care management assessment. The diverse needs of service users are identified. The information is available to staff to enable them to understand the social, personal and emotional needs of people who use the service. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users receive a care service that meets their needs. Care is delivered in a manner that respects residents’ wishes. EVIDENCE: The home has a strong ethos for involving residents in all aspects of their lives. Staff are expected to work in a manner that takes account of all of the residents needs and delivers the care in a dignified and respectful way. Files examined showed that resident’s care plans are comprehensive. Keyworkers work with residents to develop their plan. The plan is a working document. It contains sufficient detail to ensure that care staff knows the support they have to provide to meet the diverse needs of residents in a manner that promotes independence and respects privacy and dignity. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 12 Discussed with management that entries in some of the plans specifically relating to promoting residents independence were not being recorded properly. This is probably a training need for individual members of staff. Each plan contains a range of comprehensive risk assessments. Management of risks takes into account the needs of service users balanced with their aspirations for independence and choice. The plan is reviewed monthly and updated as changing needs dictate. Service users spoken to said that they received a very good service and are treated with respect. Comments like “the staff are wonderful” and “everyone is very kind” were heard. Feedback from residents surveys show that they always receive the care and support they need. A survey received from one General Practitioner commented “I am regularly struck by the high quality of cleanliness, courtesy and respect for residents”. One relatives survey shows that the resident usually gets the care and support that they need. Staff promotes the rights of residents to access the health care professionals that they need both within the home and in the community. Residents spoken to said that they can see the doctor and other health care providers as and when they need to. Staff training programmes show that training is provided on health care topics that relate to the health care needs of residents. Staff were observed delivering care in a kind and helpful manner. Residents looked clean and well cared for. There are medication procedures to guide staffs’ practice and training is provided on the safe storage, administration and disposal of medicines. Medication is stored and administered in a safe manner. However the application of prescribed skin creams are not recorded on the Medication Administration Record in the same way as tablets are. Creams applied are recorded in the residents daily log as part of the personal care delivered on each shift. Discussed with management that the application of prescribed skin creams must be recorded in the same way as any other prescribed medication. Service users assessed as being able are encouraged and facilitated to keep and take their own medication. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service Staff provides opportunities for stimulation and interest for people living in the home. Meals are nutritious and offer a varied diet. EVIDENCE: Residents say that the daily routines are very flexible and that they are able to make choices in key areas of their lives. Examples given included rising and retiring time, bath time, food and how and where to spend their time. Staff were observed communicating in a positive and friendly manner with residents. Staff training and the homes policies and procedures focus on residents being in control of their lives. The home employs an activities organiser and an activity assessment is kept about each resident. Residents form part of an entertainments committee. Weekly social evenings as well as regular group and individual activities are available. A monthly “Birthday Night” is held where all resident’s birthdays in that month are celebrated. The views of service users are also actively sought through surveys and at residents
Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 14 meetings. There are plans to introduce a gardening area so that residents who are interested can grow vegetables and flowers. Residents spoken to and feedback from surveys show that appropriate activities are arranged. Monthly religious services take place in the home and arrangements can be made for residents to attend church. Visitors are encouraged and made welcome. A room has been set-aside for visitors to use. The room is “child friendly” and has been very successful when grand children/great grand children have visited. Hot drinks machines and cold drinks are positioned around the home for anyone to help themselves to. Bar facilities are available. Menus are varied and nutritionally balanced. There is a choice of food at each mealtime and special diets are catered for. Residents mostly eat in the dining rooms but can have their meal in their bedroom if they prefer to eat alone. Dining room tables were set properly with tablecloths, appropriate cutlery and condiments. Staff served meals from a heated “hostess trolley” with discreet support being provided when needed. Mealtimes were relaxed and unhurried allowing residents as much time as they needed to complete their meal. Residents spoken to and surveys received all say that the food is very good. The catering staff and management have received specific training in the nutritional needs of older people. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service Residents are listened to. Robust procedures and staff training protect service users from abuse. EVIDENCE: The home has a clear complaints procedure that highlights the importance of complaining if people are not happy with the service. The procedure is given to every resident and is on display in the home. The procedure can be provided in a variety of formats on request. There is a visible suggestion box in the home inviting suggestions for improvement. A local advocacy scheme, which provides independent support for people, is displayed. Records examined showed that complaints are dealt with speedily. An analysis of complaints is done in order to “learn lessons” and thereby improve service delivery. Residents spoken to know how to complain and feedback from residents and one relative’s survey confirmed that they are aware of the complaints procedure and know who to talk to if they are not happy. Residents also confirmed that it would be easy to complain without fear of recriminations. They said they felt very safe living at The Beeches.
Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 16 The policies and procedures regarding the protection of residents are robust and in line with best practice. All staff including ancillary workers is provided with training and are made aware of the need to report any allegations or suspicions of abuse to their manager. Management know and are experienced in the measures to take in relation to safeguarding adults. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean safe comfortable home. EVIDENCE: The home is purpose built and meets residents’ personal and collective needs in a comfortable manner. Resident accommodation is arranged on the ground floor in four separate wings with an additional large communal sitting room. Each wing has its own bedrooms, kitchenette, sitting/dining areas, bathroom and toilets. There are additional sitting areas around the home where service users can get away from others without having to go to their bedrooms. The premises are easily accessible and provide a safe and well-maintained environment for the people who live there. Aids and adaptations are provided and regularly serviced. The home employs a handyman who is responsible for
Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 18 routine maintenance and the monitoring of some health and safety aspects of the premises. Information provided by the manager and the sampling of some health and safety records showed that every effort is made to provide a safe environment. Records show that the staff receives fire training and fire equipment is routinely serviced. A record of hot water temperatures is kept to ensure the delivery of safe hot water and prevent the risk of scalding. The gas installation is routinely serviced and maintained in a safe condition. A tour of the premises included all of the public areas, some bedrooms, bathrooms, toilets, and the kitchen. The home is very clean and smelled fresh. Systems are in place to prevent the spread of infection. One member of staff has had training on the prevention of infection and management of infection control. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The safety of residents is promoted through a robust recruitment process and a well-trained workforce. EVIDENCE: The home has a well - developed recruitment procedure that seeks to ensure that only suitable people are employed. Staff files examined showed that all appropriate and relevant pre employment checks are carried out before anyone is offered employment. All staff are recruited subject to a satisfactory probationary period. Discussed with the manager ways in which residents might be involved in the recruitment process. Staff training programmes are properly planned in order to provide staff with the skills and knowledge to deliver a good care service. All staff completes a proper induction training within the first few months of starting work. Further training needs are identified through regular formal supervision and annual appraisal meetings. Training is focused on improving the experiences for people who use the service. All staff are encouraged to complete National Vocational Qualifications training and a high percentage of staff have done so. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 20 Discussions with residents found that they felt that there is enough well informed staff in the home. They said that any requests for assistance were dealt with quickly. Staff was observed carrying out their duties in a calm and relaxed manner. Management said that staffing levels reflects the needs of people using the service. Rotas examined are flexible with part time staff picking up extra hours to cover sickness and leave. Agency staff is used sometimes. Rota’s are devised to ensure that appropriate numbers of staff are on each shift thereby ensuring the safe conduct of the home. Feedback from surveys confirm that staff are available when residents need them. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed and in a manner that promotes good service delivery in the best interests of residents. EVIDENCE: The Manager is qualified and experienced in managing services for older people. She keeps herself updated on current best practice through training opportunities. People who use the service say that they receive a reliable service from staff who are courteous, respectful, communicate well and deliver services in a responsible and professional manner. They also say that the management
Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 22 team are approachable and easy to talk to. Regular residents’ meetings, staff meetings and staff supervision promote an open and transparent management style that focuses on the needs of people who use the service. The home has sound policies and procedures in line with current thinking and practice. Efficient systems are in place to monitor staff adherence to policies and procedures in their practice. Monthly procedure awareness sheets are given to staff to help them maintain their knowledge and understanding. There is a Quality Assurance Scheme where audits of key aspects of the service are regularly monitored. Residents are surveyed about different aspects of the service to ascertain their views. The findings are analysed and wherever possible improvements made. A senior manager of the organisation visits the home at least monthly and completes a report. These visits include discussions with residents. A service improvement plan is developed to document, measure and monitor improvements. Residents are encouraged to manage their own financial affairs and spend their money as they wish. Staff provides support for people who require help in managing their finances and there is a robust procedure in place, which directs staff in their practice and protects residents from financial abuse. Management work in partnership with a range of other key people to ensure continuous improvement of the service. The home works to a clear health and safety policy and regular safety checks are carried out. Records are of a good standard and routinely completed. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 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 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 4 Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13(2) Requirement The application of prescribed skin creams must be recorded on the Medication Administration Record. Timescale for action 31/07/07 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 OP29 Good Practice Recommendations Where possible residents should be positively involved in the choice of staff. Beeches The - North Yorkshire County Council DS0000034437.V343631.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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