CARE HOMES FOR OLDER PEOPLE
Beechfield Lodge 232 Eccles Old Road Salford Manchester M6 8AG Lead Inspector
Ann Connolly Unannounced Inspection 29th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechfield Lodge DS0000067821.V337495.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. Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beechfield Lodge Address 232 Eccles Old Road Salford Manchester M6 8AG 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) 0161 707 6747 Margaret.thomas@anchor.org.uk sharon.blackwell@anchor.org Anchor Trust Ms Margaret Thomas Care Home 59 Category(ies) of Old age, not falling within any other category registration, with number (59), Physical disability (1), Physical disability of places over 65 years of age (59), Sensory Impairment over 65 years of age (59) Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of fifty nine (59) service users may be accommodated who are aged 60 years and over and require care by reason of old age (OP) and who may also have a sensory impairment (SI(E)) and/or a physical disability (PD(E)). One (person maybe accommodated who is under the age of 60 years in the category of Physical Disability (PD). 30th January 2007 2. Date of last inspection Brief Description of the Service: Beechfield lodge consists of 44 self-contained flats, which consist of a small kitchen, en-suite shower and toilet facilities. There are 12 en-suite residential bedrooms and the facility for 1 respite care place in a room, which is not ensuite. The home has a range of communal facilities, including a cinema room, courtyard and barbeque area with a patio and shrubs. The premises are specifically designed for people with visual and physical impairment and include a talking lift, textured floor coverings, tactile signs, entrance lighting and colour contrasting decoration to aid residents. Fees for accommodation at the home range from £364.41 to £400.00 per week. Fees do not include charges for hairdressing services, private chiropody and holidays. Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place on 29 June 2007 at 10:00a.m. over six hours. The manager was on leave during this visit, and a team leader had been designated as person in charge. During this visit, a selection of care plans, records, policies and procedures were examined. Discussion took place with the residents living in the home and the staff team. Twelve residents were spoken to during the visit and discussion took place with them to find out what they thought of the home and what they felt about the way the staff supported them. The manager completed a pre-inspection annual quality assurance assessment, which contained information about the way the home is run and managed. Some of the information in this documentation has been included in this report. Since the last inspection, which took place on 30/01/2007 the Commission for Social Care Inspection have not received any complaints about this home. There have been 6 complaints made direct to the manager in the last 12 months. There was evidence from records that even minor concerns are taken seriously and responded to within timescales set down in the complaints procedure. Complaints were fully investigated and recorded and five of the complaints were upheld. What the service does well:
Care plans are informative, and give staff useful background information about each resident. This is helpful for staff in assisting and supporting residents to maintain their personal preferred lifestyle. Activities offered in the home ensured that residents had access to a wide range of leisure opportunities. A number of activities were arranged with residents on a one to one basis, for example supporting a resident to attend swimming classes. One resident said, “ I like everything her, we have good entertainment, and I’ve just come back from a trip to Southport”. Standards of hygiene, and the maintenance of the building were very good. Residents had access to a number of lounge areas offering quiet relaxing areas. One resident said, “It’s lovely and clean here. I do a bit of my own cleaning, and the domestic helps me”. One visitor said, “ It’s my first visit here and I’m very impressed how nice everything seems to be”. During the day, staff were seen engaging with residents in a positive manner. Staff took time to actively listen to residents, and assist them with their
Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 6 queries. There seemed to be a good rapport between residents and staff, and staff were seen to participate in meaningful conversations with residents. All residents who were spoken to during this visit said that staff were very supportive. One resident said, “Staff do their job wonderfully. I have had a meeting about being here, and staff have told me it’s my home as long as I want”. One relative said that he felt that staff involved him in decision-making regarding his mother’s care needs. This home prioritises staff training and development. Since the last inspection a number of staff have attended a course in Adult Protection. There is a comprehensive National Vocational Training Qualifications training (NVQ) in place. The organisation supports the staff with training and has 5 assessors and an internal verifier. This means that staff receive training opportunities to help them develop their skills and practice, to improve the delivery of care services in the home. The manager and staff seem to work hard at involving relatives in the care planning. A number of relatives and visitors were spoken to during this inspection visit. All of them spoke highly about the staff and the way the home was managed. One relative said, “ the staff here are wonderful. I haven’t come across anyone who is not obliging. I am confident they are providing the right support and they always give me updates. The staff here treat people with respect”. What has improved since the last inspection? What they could do better:
Medication must be given as prescribed at all times, this includes having an adequate supply of all prescribed medications to make sure residents have continuous treatment. The records about medication must be clear and accurate and up to date so that they can show that residents are receiving their medicines properly and that they are safe from harm. The pharmacist inspector found unsatisfactory medication practises and issued immediate requirements at this inspection (these must be completed within 48 hours).
Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 7 There were sufficient staff on duty during this visit, however, on some occasions, residents in one lounge experienced difficulty in finding staff to support them. A recommendation has been made for the manager to review the deployment of staff in the home, so that more staff are present in areas in lounge areas, and available to support those with higher dependency needs. 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. Beechfield Lodge DS0000067821.V337495.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 Beechfield Lodge DS0000067821.V337495.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): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are given sufficient information about the home to help them in making a decision about their care arrangements. Residents’ needs are assessed prior to admission to the home so they are confident their needs will be met, and the home is sure it can meet their personal needs. EVIDENCE: The home had a detailed and comprehensive statement of purpose and service user guide, containing information to help prospective residents to make an informed choice about their care arrangements. A copy of these documents and the latest inspection report was also made available in the main reception/entrance hall for all residents and their relatives. Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 10 The team leader said that prospective residents were encouraged to visit the home before making a decision to move in. A resident who said she had visited a few homes prior to making a decision confirmed this. Her relative said that it had been an important part of the process and that staff really helped to allay any anxieties and provide support. There is an admission policy in place, which states that the manager or deputy manager would visit any prospective resident in his or her own home prior to admission to carry out a pre- admission assessment. This assessment, together with the care manager multidisciplinary assessment is used to develop the care plan. Beechfield Lodge DS0000067821.V337495.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans told staff how to care for residents in a way that promoted choice and respect, and ensured that residents had access to appropriate health care support. Medication is not handled well and residents are at risk from harm. EVIDENCE: Since the last inspection visit, improvements had been made to the care planning process and a new format had been implemented. The care plans are person centred, and they focus on identified individual needs, expected outcomes, and list the support required to meet needs. The care plans include information on the resident’s perception of their own needs, with a positive focus on what the individual can do. The care plans included a profile, which contained information about significant life events. This ensured that staff were aware of times when residents may need additional support, and provided information about the lifestyle that was preferable to the resident. Two good
Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 12 examples this were evidenced in the care plans. Staff had included important information about the resident’s lifestyle, and instructions for staff on how to support the resident in maintaining this lifestyle. There was evidence that there was a good system for carrying out regular reviews of the care plans. An evaluation sheet provided the opportunity for staff to monitor individual care needs, and record any significant changes in health care and social/emotional care needs, and amend the care plan appropriately. As part of this inspection the pharmacist inspector looked at the way medication was handled and if residents were given their medicines safely. Some of the records about medication were very good. There was a lot of information written on the back of the Medication Administration Record Sheets explaining why residents did not always take their medicines and when the prescribers changed residents’ medication the recording of those changes were accurate and clear, which made sure that residents received the correct medicines. It also was good that staff recognised that certain residents were able to look after some of their own medicines but there was no record of what steps they made to make sure people who did this were safe from harm. In general the records failed to show if residents had been given their medicines properly because there was no way of tracking exactly how much medication was in the home for each resident. In order to show that residents are receiving the correct doses of their medicines accurate and auditable records must be kept for all medication. An immediate requirement notice was issued at the end of the inspection to make sure this was done quickly There are serious concerns that residents are not being given their medicines as intended by the prescriber, it was noted that a number of medicines were not available for residents. For example one resident was currently prescribed medication for high blood pressure but the tablets were unavailable for 5 days and the records indicated ‘ awaiting delivery’ it was further noted that this medication was not signed for as being administered for a further 16 days and on the day of inspection no supply of these tablets were available. Another resident did not have a supply of eye drops for 3 days. An immediate requirement notice was issued at the end of the inspection to make sure this was done quickly and that all residents had a supply of medication to make sure they had the continuous treatment. It was also noted that on some occasions residents were not being given their medicines although the records were signed indicating that the medication had been administered. Residents’ health could be put a risk of harm if they are not given their medicines as prescribed. Beechfield Lodge DS0000067821.V337495.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to engage in the social activities, and daily life in the home. They are supported and encouraged to maintain links with their family and friends and exercise as much choice and control over their lives as they can. Mealtimes in the home were a relaxing and social occasion and the food served was appealing and well balanced. EVIDENCE: Routines in the home were flexible and designed to reflect individual needs and preferences. Residents spoken to confirmed that they were encouraged to have visitors and to pursue any interests. There were plans to organise one to one activities for residents. Attendance at a local swimming session was being arranged for one resident. There was a varied activity programme for residents to choose from. From discussion with residents it was evident that the home
Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 14 consistently offered daily activities and consulted with residents on their preferences and interest in order to develop the activities programme. One resident said, “I can have visitors when I want.” Residents confirmed that routines were flexible saying that they were able to go to their room at any time of day. One resident said, “I like to make my own bed, and I try to keep my room tidy. The domestic comes in to help me”. Visitors were seen coming and going throughout the day, and were made to feel welcome by staff. The lunchtime meal was a relaxed and social occasion. Table settings were pleasantly presented and set in small group settings. Residents said they were offered a choice of menu and were extremely complementary about the quality of the meals served in the home. One resident said, “The food is very nice, the staff always ask you what you want.” One visitor made comments about the meals and said, “The tables are set out like a hotel and the meals look really nice. The other day there was a lovely prawn salad, and something different for those who didn’t like it”. Beechfield Lodge DS0000067821.V337495.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies, procedures and training measures were in place to protect residents from neglect and abuse. EVIDENCE: The home used the Salford Multi Agency Policy for The Protection of Vulnerable Adults from Abuse. Since the last inspection visit 30th January 2007, the Commission for Social Care Inspection have not received any complaints about this service. In the last twelve months six complaints were made direct to the service and all of them investigated within 28 days. Five of the complaints were upheld. Records were in place, which demonstrated that the manager took all complaints seriously no matter how small. Records included details of the compliant, the investigation and the response to the complainant. In discussion with staff it was evident that they had a good understanding of issues surrounding abuse. Staff were aware of policies and procedures designed to protect residents from abuse and knew the procedures to follow in the event of any allegation of abuse. There had been one complaint that had been investigated under the Protection of Vulnerable Adults. The manager followed all the correct policies and procedures. This allegation was not substantiated.
Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents in the home are provided with a safe, clean and well-maintained environment. EVIDENCE: The environment is warm and welcoming, with a good standard of décor and furnishings throughout the home. Details provided by the manager in the pre inspection information showed that all health and safety checks had been carried out in the building ensuring a safe environment for residents, staff and visitors. Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 17 Residents appeared to access all parts of the building, taking advantage of large communal areas, and also the quieter areas of the building. Bedrooms had been personalised with items brought from residents’ homes. All residents who were spoken to expressed satisfaction about their personal environment, saying that they felt at home. A visitor commented on the generous sizes of the bedrooms, and said they seemed more like bed sitting rooms. Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were protected by the recruitment and training practices operated by the home. EVIDENCE: Policies and procedures are in place for the recruitment of staff. Staff files were examined and contained all the necessary documentation. The home experiences a low staff turnover, which provides continuity of care for those residents living in the home. All staff employed by the home have a Criminal Record Bureau (CRB) check in place. A recruitment officer, employed by Anchor, to manage the recruitment process, supports the manager. There was a good staff presence in the home, although in one of the large lounges there were occasions when it was difficult for residents to get the attention of staff. The residents in this lounge had higher dependency levels, and on two occasions, staff had to be made aware of a residents needs. It is strongly recommended that the manager reviews the staffing rota, to ensure that staff are deployed appropriately throughout the home, to ensure that the needs of residents are met on a consistent basis. Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 19 Training needs were identified through the staff supervision programme. All staff that were spoken to said they had plenty of opportunities to access ongoing training and development opportunities. One member of staff said she had recently received updated training in health and safety, and a wide range of care related topics. Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of residents and the health and welfare of residents, the staff team and visitors are promoted and protected by policies and procedures in the home. EVIDENCE: The residents in the home benefit from a committed staff team, and from the low turnover of staff. The manager operates an open management style, and encourages residents and staff to make use of the ‘open door’ policy. At the heart of this style of management is a person centred approach where the focus is on how the individual service user wants their care needs to be met.
Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 21 All residents spoken to during the course of this inspection expressed satisfaction on the way the home was run and the quality of the services delivered by the staff in the home. The manager supports staff, and there was evidence of an ongoing supervision programme for all staff. This ensures that the manager monitors the performance of staff and any training needs are identified. One member of staff confirmed that she received regular supervision, and that there was a rolling programme for training and development. She went on to say that she felt staff were supported and encouraged by the manager to maintain good practice, and work towards achieving positive outcomes for residents. One member of staff said, “ The manager spends a lot of time involving herself with residents and staff to ensure staff use the correct approach and appropriate methods of communication In cases where residents could not manage their own finances, systems were in place to record and document individual financial records. Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 22 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 X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13 Timescale for action The registered person shall make 01/08/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Specifically: • Ensure that all residents have a stock of all their currently prescribed medicines at all times to ensure continuous treatment. (2/07/07) • Ensure that all medicines are stock checked and an audit trail is available for all medicines. This includes all prescribed medicines and non-prescribed medicines (homely remedies) any food supplements and creams. In order to show that residents are administered the correct dose of medication. (2/07/07) • Ensure that all medication is administered as directed to make sure residents have the medicines as intended. (2/07/07)
DS0000067821.V337495.R01.S.doc Version 5.2 Page 24 Requirement Beechfield Lodge • Ensure that all records regarding all aspects of medication handling including risk assessments fro residents who are selfadministering are accurate and up to date, so residents are safe. (2/07/07). This requirement as a whole is unmet from 25/04/07. 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 OP27 Good Practice Recommendations It is strongly recommended that the manager reviews the staffing rota, to ensure that staff are deployed appropriately throughout the home, to ensure that the needs of residents are met on a consistent basis. Beechfield Lodge DS0000067821.V337495.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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