Inspection on 24/11/06 for Beechill Nursing Home

This inspection was carried out on 24th November 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beechill Nursing Home 09/02/09

Beechill Nursing Home 21/05/08

Beechill Nursing Home 09/05/07

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Clover House

Langrigg House

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

CARE HOMES FOR OLDER PEOPLE Beechill Nursing Home 25 Smedley Lane Cheetham Hill Manchester M8 8XG Lead Inspector Geraldine Blow Unannounced Inspection 20th November 2006 09:30 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 Beechill Nursing Home DS0000066845.V319998.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. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechill Nursing Home Address 25 Smedley Lane Cheetham Hill Manchester M8 8XG 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 205 0069 0161 205 0069 skolak@yahoo.com Skolak Homes Limited Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (12) of places Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users shall not exceed 31 older people aged 60 years or over. Twelve residents aged 18 - 60 who fall within the category of physical disability are currently accommodated. Should these residents no longer require the accommodation offered by Beechill Nursing Home the category will revert to OP (old age). The responsible individual must undertake Protection of Vulnerable Adult Training by 15 September 2006. 28th July 2006 3. Date of last inspection Brief Description of the Service: Beechill Nursing Home provides accommodation for 31 people. The home is registered to accommodate 12 residents aged between 18 and 59 years with physical disabilities and a further 16 residents aged 60 years and over who have been assessed as requiring nursing care. Since the last key inspection visit in April 2006 the home has been purchased by a new provider called Skolak Homes Limited. The home is located in the North of the City of Manchester and is situated within easy walking distance of local services and amenities. Limited parking facilities are available to the front and rear of the property. The home is a three storey purpose-built building. Bedroom accommodation for residents is provided on the first 2 floors and the third floor is used as office space. There are 23 single rooms and 4 double rooms. No en-suite facilities are provided but each room has a wash hand basin. There is one lounge, a smoking room, a small quiet room, a hairdressing room and a dining room. The home offers a small garden and patio area to the rear of the property. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the home was last inspected in July 2006. On the day of this inspection site visit the Pharmacist Inspector also visited the home to undertake a specialist pharmacist inspection. This visit was an unannounced site visit, which forms part of the overall inspection process, and was conducted by 2 inspectors. The visit took place on Monday 20 November 2006. The opportunity was taken to look at all the key standards of the National Minimum Standards (NMS) and the requirements made at the inspection in April 2006 and the random inspection visit in July 2006. This visit was also used to decide how often the home is to be visited and to make sure that it meets the required standards. During the visit time was spent talking with the manager, people who live at the home, observing how staff work with people and taking to staff on duty. Documents and files relating to residents and how the home is run were also seen and a tour of the building was made. The key inspection report of April 2006 and the random visit report in July 2006 highlighted a number of areas that the home needed to work on and improve. The home had addressed some of the changes needed from the last inspection report. However, some remain outstanding and have been repeated again in this report. What the service does well: What has improved since the last inspection? Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 6 Since the last inspection a new manager had been appointed and she had identified a number of areas that the home needed to improve on and was in the process of implementing the changes. The manager was able to demonstrate that a pre admission assessment is now carried out on all perspective residents to ensure the home is able to meet that persons needs and following the assessment a letter would be sent to the perspective resident stating that the home was able/not able to meet their assessed needs. The home has made many improvements in the way they handle medication. However, some shortfalls were noted which are detailed below. The last inspection report identified that the lift was out of order and appropriate arrangements had not been made for a number residents who were unable to access the ground floor as a result. An action plan had been submitted to the CSCI and the lift was now in full working order. Since the last site visit the entrance hall, ground floor corridor, the dining room and 5 bedrooms on the ground floor had been re-painted. Also, as required in the last inspection report the outside garden/patio area to the rear of building had been cleared of the inappropriate rubbish that was being stored there. As required in the last inspection report the owner of the home now undertakes a monthly unannounced visit to the home and completes the appropriate report, which is sent to the CSCI. A selection of 2 staff files were examined. The files inspected contained all the required information and safety checks on the staff employed. What they could do better: The newly appointed manager was in the process of reviewing and rewriting the resident’s individual plans of care. However a random sample of the care plans were examined and some shortfalls were found. For example specific care needs of residents had not been included in the plan of care. Although improvements were seen regarding the handling of medication the home still needs to make improvements in how they record how much medicine has been given to a resident. Also the home must ensure that medicines are stored at the correct temperatures. Although the manager said that it was her intention to employ a part time activity co-ordinator in the near future, at the time of this visit, the home did not have an activity co-ordinator and only limited activities were being provided. There was no evidence that residents were consulted about their social interests. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 7 As stated above some areas of the home had been re-painted and the manager said that new curtains and quilt covers were on order for those areas. However, shortfalls were seen in many areas of the home. It is therefore recommended that the owner of the home produce a detailed programme of maintenance and renewal of fabric and decoration with timescales attached. It was of concern that during a tour of the building dirty and soiled equipment was found on the floor in 2 bathrooms. The door of both sluice rooms, that contained cleaning products, was unlocked and therefore causing a potentional risk to residents. In addition, items such as bed rails and a TV were found stored on the main first floor corridor causing a potentional tripping hazard to residents. The last inspection report identified that staff were not receiving the training needed to assist and support them in their work with the residents living at the home. The new manager was in the process of looking at staff training needs. However, staff still have not received all the training needed to carry out their work. The training is necessary to ensure that the residents are assisted by staff who are competent, appropriately trained and qualified to enable them to provide care that meets the residents’ needs. In addition staff must receive formal supervision sessions on a regular basis. The systems for managing residents’ monies in the home were not clear and therefore, the registered person must ensure that this information is clearly recorded. 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. Beechill Nursing Home DS0000066845.V319998.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 Beechill Nursing Home DS0000066845.V319998.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&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home undertake an assessment of prospective residents’ care needs prior to their admission. EVIDENCE: The manager said that there have not been any admissions to the home since she took up post in October 2006. However, she had been out to assess 2 prospective residents and a letter was sent to 1 of the prospective residents stating that the home could not meet their assessed needs. Evidence was seen that the home had obtained a copy of the Care Managers Assessment for the 2nd resident. However, that person was not admitted to the home. The manager said that all prospective residents would have a pre admission assessment to ensure that the home could meet their assessed needs and for those residents who are referred through Care Management arrangements the home would obtain a summary of the Care Management Assessment. In Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 10 addition the manager said that following the pre-admission assessment the home will be confirming in writing to the prospective resident that the home was able/not able to meet their assessed needs. The service did not provide intermediate care. Beechill Nursing Home DS0000066845.V319998.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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Plans were in place but required further work to ensure residents’ health, personal and social care needs are fully met. The systems and procedures for dealing with medicines need some improvements in order to protect residents. EVIDENCE: A random sample of care plans was examined. The manager was in the process of reviewing and rewriting the care plans and some improvements with the contents and the lay out of the care plans were found. However, a number of shortfalls were found. Some parts of the assessments and personal detail forms had not be signed or dated by the person completing them. For example a ‘manual handling’ assessment had not been signed or dated and in one care plan the personal details of the resident had had not been signed or dated. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 12 It was of concern that specific care needs of residents had not been included in the plan of care. For example, one care plan identified that the resident “can become very aggressive when cleaning his peg”. There was no care plan on how to manage that resident’s behaviour. Another resident had lost 5kg in 4 months. The manager could verbally explain the action taken, however there was no documented evidence to support the explanation. There was no evidence that residents social and recreational needs and been assessed and therefore there were no plans of care relating to these specific needs. It was found that the plans of care were vague and did not set out in detail the actions which need to be taken by care staff to ensure that all aspects of residents health, personal and social care needs are met. For example, “assistance to be given to wash and dress” and “assistance to be given with oral care”. There was no evidence of resident/representative involvement in the development or reviews of the plans of care. Several residents had additional general and emotional health needs associated with their ongoing alcohol use. The manager was aware of these additional needs and the consequences of residents continued use of alcohol in terms of their behaviour and the impact on staff and other residents. She also acknowledged that the staff team had not received any specific training around working with residents who may misuse alcohol. In addition, there was no evidence that care plans or risk assessments reflected residents’ alcohol use and the affect this has on their behaviour, health, medication use, the support they require and the risks to other vulnerable residents. Again, the manager was aware of these issues and the need to develop and implement support strategies and challenging behaviour guidelines to meet residents’ needs. Several residents required their nutrition to be taken via a peg feed direct into the stomach. The residents’ care plans contained instructions for a peg feeding plan and records of the volume of food and liquids provided through the peg feed. However, it was not clearly documented that one the resident was nil by mouth. As already identified in this report many improvements had been made in the administration of medication. Most of the Medication Administration Record Sheets (MARS) were clear and accurate and provided evidence that medicines were being administered as prescribed. The records showed that most medications could be accounted for Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 13 by means of a clear audit trail. The home still needs to make improvements in how they record when creams are applied. They must also improve the way they record the administration of medicines, which are prescribed with a variable dose, so it is clear, how much medicine a resident has been given. The home had also made improvements in the way they administer medication to residents. During the visit three medicines were chosen at random and were audited. The check showed that all three medicines had been given exactly as the doctor had prescribed. However, there were some serious concerns surrounding the administration of Digoxin. The Nursing and Midwifery Council (NMC) guidance tells nurses they must take the residents’ pulse before giving this medicine to check it is safe for them to have it. Records indicated that nurses took the pulse twice out of a possible 30 occasions. This could potentially put residents’ health at risk. It was of particular concern that the nurses could not show that they were using the prescribed thickening agent to thicken fluids for people who have swallowing problems. This concern was identified on the previous inspection and little improvement had been made. By not thickening fluids and not knowing what consistency to thicken the fluids to places residents health at considerable risk. The home had made some improvements on the general tidiness of the medication storage room, but the room was still cluttered and dirty in places. There were safe levels of medication in stock and medicines that had limited lives once open were dated properly. There were concerns regarding the temperature of the medicines room and the fridge temperatures. The room temperature records showed that for most days the room was hotter than the manufactures guidelines and the fridge records showed that items in the fridge had not been stored within safe limits. If medication is not stored properly it could alter the way it works and potentionally harm the residents health. From observation on the day of this visit it appeared that the privacy and dignity of residents was protected. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Limited activities were provided for residents. Residents were supported to maintain some choices and preferences of lifestyles including choice of meals. EVIDENCE: The manager said that a member of staff had expressed an interest in becoming a part time activity co-ordinator and this appointment was due to take place early in the New Year. In addition the manager said she was in the process of arranging a number of activities for the Christmas period. There was no evidence that residents had been consulted about their social interests or that arrangements had been made to enable them to engage in any local, social or community activities. It was of particular concern that the social and recreation needs of the younger adults accommodated at the home had not been discussed or assessed with them. From observations it appeared that residents were able to exercise autonomy and choice around their day-to-day lives. Residents were seen freely moving around the home or sitting in the various communal areas. The manager had introduced the opportunity for residents to meet together and discuss issues Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 15 that affect their life at the home. Evidence was seen that residents raised issues such as the menu choices, the presentation of meals and social activities that they would like to participate in. The home supported a number of residents who had chosen to continue drinking alcohol. The home did work with those residents to try to respect their choice and to keep them and the other residents safe and healthy. However, the home does need to address the issue of alcohol use within the home and this issue is raised in the Health and Personal Care Section of the report. The menu appeared to offer a variety of wholesome meals. The cook on duty said that residents could request alternatives to the menu and a record was kept of the meals provided to individual residents. A tour of the kitchen was undertaken and was seen to be generally clean and organised. However, it was noted that the fly screen to one window was broken and missing from the other window. These must be repaired/replaced. Adequate supplies of food were seen which included fresh fruit and vegetables. All food was seen to be stored appropriately. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaint procedure was in place, however residents were not fully protected from abuse, as staff have not received the appropriate training. EVIDENCE: The previous inspection report highlighted the need for the home ensure that all complaints were fully investigated and recorded. The manager had introduced a new system for recording residents concerns and complaints, the investigation, the outcome and the actions to be taken to resolve the issues raised. An example of how the manager had undertaken an investigation into a resident’s concern was seen and found to be detailed and clearly showed the actions taken by the home to resolve the issue. This action met the previous requirement. The home had a standard formal complaints policy and procedure setting out the process to follow and the timescales for responding to formal complaints. However, the policy and procedures were not dated and there was no evidence that the policy had been reviewed. In addition, it is recommended that the policy be reviewed to ensure that it contains details of all the other agencies that residents can contact if they want to raise a concern. The manager was aware of the action to follow in response to an incident or allegation of abuse involving residents at the home. Information for making a Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 17 referral was posted in the office. The manager and deputy manager were available ‘on-call’ to provide guidance if an incident or allegation occurs. She had access to the contact information needed to contact the relevant local authorities in response to incidents and allegations. This met the requirement made at the previous inspection. The home had a written Adult Protection policy. However, it was noted that the policy was not dated, had no evidence that it had been reviewed, still referred to the National Care Standards Commission and did not contain any procedures or guidance for how the home and staff must respond to allegations or incidents of abuse. The policy to be reviewed and updated to reflect local and national guidance. Evidence was seen that some staff members had attended POVA training and the manager had identified those staff who still require the training. In order to protect the residents accommodated all staff must receive POVA training, which includes the actions to be taken in the event of an allegation of abuse. At the time of this visit 2 allegations of abuse were in the process of being investigated. All appropriate action had been taken by the home. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some areas of the home were not safe, clean and some furnishings were not well maintained. EVIDENCE: As already referenced in this report some improvements had been made to various rooms on the ground floor. However, numerous shortfalls were identified in the decoration, furnishings and cleanliness of the home. For example the majority of bedroom and corridor carpets were stained and in a poor condition, armchairs in various bedroom were found to be stained and in a poor state of repair and bedroom furniture was generally damaged and in a poor state of repair. It is was recommended in the last inspection report that the registered person produce a programme of maintenance and renewal of fabric and decoration of Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 19 the premises based on his own audits and the comments contained within the report. This was not met and has been reiterated in this report. During a tour of the building a number of concerns were raised directly with the manager, which potentionally put residents at risk. Some of these include: • A dirty pressure relief cousin was found stored on the floor in one bathroom and in another bathroom there was a soiled and stained overlay under the sink. • What appeared to be communal toiletries were found in the shower room. • A TV and 2 dirty bed rails were found on the corridor on the first floor. • Both sluices, which contained cleaning fluid, were found to be unlocked and accessible to residents. Three bottles of salad cream were found stored in the sluice. • Aerosols and cleaning fluid were stored in the same room as the electrical fuse box. • A liquid that smelt like cleaning fluid was found in a plastic milk carton. • There was a hole in the ceiling in the toilet opposite bedroom 6. • There was no carpet strip at the entrance to bedroom 6, which could present as a potentional tripping hazard. • The toilet seat in the toilet opposite bedroom 7 was loose. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home appeared to employ sufficient numbers of staff to meet the needs of the residents accommodated. However, the home was unable to demonstrate that its staff had completed the required training to meet residents’ needs. EVIDENCE: On the day of the visit the staffing numbers appeared appropriate to meet the needs of the residents accommodated. The manager said that home employs 14 carers, 5 of those have successfully achieved NVQ level 2 and a further 3 members of care staff were waiting for the results from the provider college. A random sample of staff files were examined and were seen to contain all the appropriate documentation as required by Schedule 2 of the Care Homes Regulations 2001 and the appropriate safety checks had been undertaken. The home’s Induction Programme consisted of a one-day event that covered topics such as Moving and Handling, Fire Safety, Health and Safety, First Aid, the Aims of the Home, Basic Food Hygiene and relevant policies and procedures. It was not clear if the Induction Programme had been reviewed and updated to reflect the Skills for Care Induction Modules that are now mandatory for all Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 21 care workers. This was a recommendation made at the previous inspection and was reiterated. The home had begun to put in place a series of training events. These include moving and handling, fires safety and adult protection. The manager stated that a number of staff had attended these events with further staff still to attend. The home are supporting residents who have additional needs and behaviours associated with their alcohol use. The manager acknowledged and was aware that staff needed to be provided with training and knowledge around these issues. The manager was making progress in identifying staff training needs, however, the staff files contained a ‘Training Profile’ that should list the training that staff have participated in. Of the sample of files seen the majority of the Training Profiles had not been completed or updated to reflect training the manager stated had been carried out. Although the home had begun to address the issue of staff training it could not provide sufficient evidence to show that staff had participated in the necessary mandatory training for example, the topics covered in the Induction Training in more depth. This would include Moving and Handling, Infection Control or refresher training required to undertake their role. The previous inspection report highlighted the need for the home to ensure its staff received the training required and so the requirement was reiterated. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 22 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, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management practice of the home had improved but still did not fully maintain the health, safety and welfare of residents and staff. EVIDENCE: A new manager took up post in October 2006. She has submitted her application form to apply to the CSCI for registration. As already stated in this report she has identified some areas that require improvement in the home and is in the process of implementing changes. The manager was aware of the need to review the quality of care being delivered at the home, however there were no systems in place to do this. In addition it is recommended that following a quality review an annual development plan is developed reflecting aims and outcomes for the residents. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 23 The previous inspection report highlighted the need for the home to implement formal staff supervision. The manager had started to undertake formal supervision with the qualified staff every 8 weeks. She has developed a system of supervision with the non-qualified care staff but this has not yet started. The home had a policy and procedure folder, which was kept in the managers office so that it was easily accessible to staff. However it was noted that they had not been dated and therefore the home could not evidence that they had been regularly reviewed in light of changing legislation or good practice advise. During the site visit a resident asked a member of staff to go to the shops for them to purchase some personal items. It was found that this was a common practice for residents to ask staff to help them in this way. However, there was no record maintained of this support, the amount of money given or the goods purchased. This practice made the resident and the staff vulnerable to accusations and financial abuse. The home must ensure that all financial support for residents is clearly recorded. The manager stated that the registered provider has applied to carry on the appointee role for a number of residents. In addition a number of residents have their local authority acting as their appointee. At the time of the site visit there was no available information as to who acted as individual residents appointees. In addition, there was no clear evidence of how residents’ money and spending was being recorded. The home does keep a record of residents’ money and spending who require additional support. However, the records showed that not all transactions are signed by the resident, the details of the transaction lack detail and evidence was seen of errors being corrected with tippex. It was also unclear whether the home’s insurance covered the amount of residents’ money kept at the home. There was no evidence of a policy and procedure for how the home supports, records and manages residents’ finances. Therefore, the home must ensure that it has the policy, procedure and practices to support, record and manage safely resident’s personal finances. The manager provided written evidence that the home’s maintenance certificates and records were up to date. Evidence was provided that fire awareness training was being delivered on an ongoing basis, which meets the requirement, made in the last inspection report. The requirement made in the last 4 inspection reports, that the proprietor must conduct a monthly unannounced visit to the home and complete a report, had been met. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x X 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 1 2 x 2 Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 13 (4) (c) 15 (1) Requirement 1. Each resident must have a written plan of care setting out how individual resident’s needs in respect of their health and welfare are to be met. This must be undertaken in consultation with the resident or their representative. 2. The resident’s plan of care must include detailed risk assessments to ensure that unnecessary risk to the health of service users are identified and so far as possible eliminated. (The previous timescale of 31/1/06, 31/05/06 & 18/8/06 had not been met). The registered person must ensure that the home promotes and make proper provision for the health and welfare of residents in particular those needs associated with ongoing alcohol use. 1. The registered person must ensure that all medication is stored at the correct temperatures to ensure the DS0000066845.V319998.R01.S.doc Timescale for action 30/01/07 2. OP8 12 (1) 30/01/07 3. OP9 13 (2) 18/12/07 Beechill Nursing Home Version 5.2 Page 26 safety of residents. 2. The registered person must ensure that all nurses follow the correct procedure when administering Digoxin taking into account the NMC guidelines. The registered person must ensure that: 4. OP12 16 (2) (m) 30/01/07 5. OP15 16 (2) (g) 6. OP18 13 (6) 7. OP19 13 (4) (a) 23 (2) (b) (d) Residents are consulted about their social interests and make arrangements to enable them to engage in local, social and community activities. The registered person must 18/12/06 ensure that the fly screens in the kitchen are repaired/replace to ensure the home is providing safe and adequate facilities for the preparation and storage of food. The registered provider must 30/01/07 make suitable arrangements to ensure that all staff receive training on how to protect and keep residents’ safe from harm and abuse or being placed at risk of harm or abuse. The registered person must take 30/01/07 action to ensure that: 1. All parts of the home to which residents have access are free form hazards to their safety. 2. All parts of the home are reasonably decorated. 3. The premise are kept in a good state of repair internally (The previous timescale of 28/07/06 had not been met). The registered person must ensure there are systems in place to maintain the cleanliness of the home to maintain DS0000066845.V319998.R01.S.doc 8. OP26 23(2) (d) 18/12/06 Beechill Nursing Home Version 5.2 Page 27 9. OP30 18 (1) (a) residents health. 1. Evidence must be provided that all staff have undertaken appropriate training, as detailed in main body of the report. This training is necessary in order for the home to ensure that it provides suitably qualified, competent and experienced staff to ensure the health and welfare of the residents are met. (The previous timescale of 28/07/06 had not been met). 2. To ensure the home are meeting the specific needs of the residents who have additional needs associated with alcohol use staff must receive the appropriate training. The registered person must establish and maintain a system for reviewing the quality of care provided at the home. 1. The registered person must ensure that residents monies is managed inline with Regulation 17 (2) Schedule (4). 30/01/07 10. OP33 24 (1) (a) (b) 17 (2) Schedule 4 9 (a) (b) 01/03/07 11. OP35 31/12/06 Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 OP7 Good Practice Recommendations The registered person should ensure that staff who use prescribed thickening agents when preparing residents’ fluids have specific details of how each residents fluids are to be thickened. The information should be obtained from the speech therapist. It is recommended the home employ the services of an activity co-ordinator. 1. It is recommended that the complaint policy be reviewed an updated to ensure that it contains details of all the other agencies that residents can contact if they want to raise a concern. 2. The complaint policy should be dated and evidence provided that the policy has been reviewed. It is recommended that the Protection of Vulnerable Adult policy be reviewed and updated to reflect the name of the current registering body and reflect local and national guidance. It is recommended that the updated policy contain the date of implementation. It is recommended that the registered provider produce a programme of maintenance and renewal of fabric and decoration of the premise, with timescales attached, based on the homes own audit process and the comments contained within this report. Skills for Care have introduced requirements for staff induction and training. It is recommended that the home take account of the new requirements and include them in their induction programme. 2. 3. OP12 OP16 4. OP18 5. OP19 6. OP30 Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 29 7. OP33 1. It is recommended that a system for reviewing the quality of the service being provided be implemented and that the results of such a quality review are analysed and a report is produced and published based on the results. 2. It is recommended that the home can evidence that policies and procedures are regularly reviewed and updated inline with changing legislation and good practice advise. 8. OP36 The manager should continue to ensure that all care staff working in the home are appropriately supervised. Beechill Nursing Home DS0000066845.V319998.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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