Inspection on 15/09/09 for Beechlands

This inspection was carried out on 15th September 2009.

CQC found this care home to be providing an Poor service.

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

Beechlands 01/07/08

Beechlands 05/02/08

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Beechlands 54 Church Road Huyton With Roby Liverpool Merseyside L36 9TP Lead Inspector Mrs Margaret Van Schaick Key Unannounced Inspection 15th September 2009 08:30 DS0000070530.V377114.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechlands Address 54 Church Road Huyton With Roby Liverpool Merseyside L36 9TP 0151 489 0598 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) sharon.skelhorn@blueyonder.co.uk Beechlands Care Home Ltd Miss Madeleine Ward Care Home 21 Category(ies) of Dementia (21) registration, with number of places Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - code PC, to people of either gender whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of people who can be accommodated is 21. Date of last inspection 1st July 2008 Brief Description of the Service: Beechlands care home is registered to accommodate 21 older people who experience dementia. The premises comprises of 18 single and 3 double bedrooms, 5 of which have en-suite facilities. Accommodation is provided over 2 floors the upper floor being accessible via a passenger lift. Ramp access is available at the side entry to the service. A call bell system is fitted throughout. A variety of lounges and sitting areas are available together with a dining area and secure rear gardens. The home is located close to public transport facilities to include rail travel and is within easy reach of local shops and amenities. Fees are between £415 and £450 per week. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. A site visit took place as part of the unannounced key inspection. It was conducted over one day with one regulatory inspector and lasted 9.5 hours. 16 residents were accommodated at the time. As part of the inspection process a tour of the service took place including residents’ bedrooms. Care records and other documentation was viewed. Discussion took place with residents, staff and their families. The inspection was conducted with the registered manager Madeline Ward and the registered provider Mrs Bhairvi Patel. During the inspection three of the residents were case tracked (their care files were looked at and their views of the service were obtained). Other residents care documentation was looked at also. All of the key standards for older people were inspected. Some of the previous requirements and recommendations made at the previous key inspection in 2008 have been met. Satisfaction forms ‘Have your say about….’were distributed to staff prior to the inspection. A number of comments included in this report are taken form the surveys and interviews. An AQAA (Annual Quality Assurance Assessment) has been completed. The AQAA consists of two self assessment questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. What the service does well: Residents interviewed liked living at Beechlands. Families interviewed told us that staff were caring and provided their relatives with good care. The atmosphere in the service is relaxed and friendly. Residents were at ease in their surroundings and staff interacted in a respectful manner. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 6 Residents interviewed told us they were happy with the care and support provided. One resident interviewed stated, “We do get asked every day if we are alright and I’m always alright”. Relatives interviewed about the care told us they were happy with the care provided. Relatives interviewed stated, “The care staff are very caring” and “Mum loves it here, she is dead happy”. Relatives were also pleased with medical input in the service and stated, “Mum has seen the Dr and they keep us informed” and “Mum sees the Dr, they usually phone us”. Residents interviewed told us they enjoyed their meals and had sufficient to eat. Families confirmed this. One resident interviewed stated, “The food is very nice, I have never asked for anything different as I always like what I have Relatives interviewed about food served stated, “The food is lovely, they get fed really well, Mum is really happy with the food” and “We have been a few times during meals and have noticed a good variety of food, Mum is well fed”. What has improved since the last inspection? Daily resident records have improved in the past weeks. This now gives a clearer picture of how residents care is managed. Some of the service has benefited from physical improvements such as new wood effect flooring in all the public rooms and bedrooms. New carpeting has been fitted to the hallways, stairs and landings. New dining room furniture has been provided and new comfortable looking armchairs have been provided in the sitting rooms. The public rooms are being decorated at present with one sitting room already complete to a good standard. This has improved the environment for the residents and provides a pleasant room for residents to spend their time. A new call bell system has been fitted and was working well during the visit. A new electrical system has been fitted throughout. A staff training programme has commenced with some of the staff having attended training sessions as confirmed through staff interviews. A registered manager has been appointed since the last inspection visit. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 7 What they could do better: Pre admission assessments need to be dated and evidence sufficient detail about the prospective resident so that a clear decision can be made as to whether the service can meet their needs. Residents’ health and welfare are at risk as they do not have care plans identifying their care and support needs. Residents and their families need to be involved in setting up the care plan so that it is person centred and specific to their needs. The care plans also need to be written up by a member of staff who has knowledge of the residents’ individual needs. Residents who are nutritionally compromised need to have weekly weight checks and have their diet closely monitored with specialist input accessed at an early stage. Their care plan needs to reflect regular reviews. Residents who are at risk of falls need to have risk assessments in place and the management of the risks clearly identified in their care plan. Care plans need to be audited on a regular basis to ensure clarity and reviews are recorded. The management of medication needs to be improved so that we can be sure that residents are receiving their prescribed medication at the right time. Medication audits need to be carried out regularly to ensure residents medication is managed well. Staff who administer medication need to be assessed for their competency before being allowed to administer medication to residents. There is no documentation in relation to what type of activities would be suitable for the residents. The service could appoint someone to organise this area. It would benefit the residents if their individual preferences were taken into account. Residents are at risk as safeguarding procedures were not followed following recent concerns raised. The service need to ensure that any safeguarding concerns raised have to be recorded and forwarded on to the safeguarding team. It would benefit the residents if all staff employed fully understood this area so that residents would be protected. A complaints log needs to be in place so that all other concerns or complaints raised have to be recorded, investigated and outcomes documented. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 8 The refurbishment of the service needs to continue so that residents can be provided with a comfortable and pleasant environment that is suited to their needs. The service need to have robust pre employment checks carried out for all staff so that residents are protected. Staff induction and additional training provided needs to be evidenced in staff files so that we know the training has been attended. The service has not been very well managed in the past months and residents may be at risk because of this. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 9 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 Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Op 3 was assessed. Op 6 is not applicable. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments need to be dated and evidence sufficient detail about the prospective resident so that a clear decision can be made as to whether the service can meet their needs. EVIDENCE: Three of the residents were case tracked and all three assessments were viewed. It is not known if all of the residents were assessed prior to admission. Only one assessment was dated prior to admission. There was no recorded date for the assessment of the second resident and the third assessment was dated one month after the resident was admitted. Therefore Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 11 staff would not have the necessary information in place so that they would know what the individual residents needs were. The assessment documentation that is in use covers a wide area. The assessment information collated does not give sufficient knowledge with regard to the individual prospective residents needs. There is not enough detail recorded to enable staff to make a decision as to whether or not the prospective residents needs can be met effectively. The service need to have more information so that they know they can meet the needs of the individual or their care may be compromised. A relative interviewed about the admission process stated, “Mum was assessed by the manager in hospital. I came and had a look around the home, I spent an hour here, and I found the care staff very caring”. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP7,8,9,10 were assessed. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ health and welfare are at risk as they do not have care plans identifying their care and support needs. EVIDENCE: Recent concerns were raised about the care of residents in the service and following this social workers have been reviewing all of the residents care. Since their visits the service is in the process of commencing care plans for residents. Relatives interviewed stated, “My mum did have a care plan, I saw it, I don’t know if it has been updated or not” and “We have not seen the care plan yet”. Of the three residents we assessed only one had a care plan in place. Care plan headings identified some of the assessed needs of residents. There were no care plans in place to address the residents varied needs including, challenging behaviour, personal hygiene, angina, weight loss, Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 13 aggression, dementia, hearing problems, incontinence, pain, oral care, mobility, chronic obstructive airways disease and serious visual impairment. The new care plan viewed had recently been commenced this month. The new care plan documentation form is satisfactory but the information recorded does not identify all of the residents care needs as identified in their assessment documentation. Areas missed include significant weight loss and communication. There is also insufficient detail in the care plan. One care plan heading is named communication, then they go on to record mobility under the same heading. We have told the manager that the care plan needs to be written by staff who know the individual needs of the resident with input from the residents’ family where they are able to. The care plan needs to be person centred and agreed by the resident. Residents interviewed told us they were happy with the care and support provided. One resident interviewed stated, “We do get asked every day if we are alright and I’m always alright”. Two of the residents have documented weight loss yet no one has picked up on it to produce a care plan on how staff will manage this. One resident has lost a significant amount of weight over the past few months and is nutritionally compromised yet there has been no referral to the Dietician or Gp for advice on how to manage this resident. A new food intake chart has now commenced this month, which will help monitor residents diet. One risk assessment in place for a resident with challenging behaviour has not been completed it is just a statement. Accident records viewed showed that four residents were recorded to have occasional or regular falls but no risk assessments were in place nor was there a management plan formed for any of them. Two residents suffered fractured bones following a fall and medical help was not requested until several hours later. The safeguarding team are carrying out an investigation into this. Daily records in the past couple of weeks have improved and now provide more relevant information specific to the individual resident. Relatives interviewed about the care told us they were happy with the care provided. Relatives interviewed stated, “The care staff are very caring” and “Mum loves it here, she is dead happy”. Relatives were also pleased with medical input in the service and stated, “Mum has seen the Dr, they keep us informed” and “Mum sees the Dr, they usually phone us”. The management of medication was reviewed by the PCT (Primary Care Team) pharmacy technician this month. The report highlights many serious concerns. Some of their concerns were being addressed. Medication records and storage was looked at during our visit. One of the residents prescribed strong pain relief was given their dose prematurely by one day on two occasions. The Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 14 controlled drug register did not evidence the dose of sleeping medication prescribed although it was recorded on the daily medication record. The manager told us that she had assessed staff carrying out medication rounds but there is no documented evidence of this. Medication received into the service is recorded with amounts, strength and signature of staff. There were one or two missing signatures on the medication records, therefore it is not known if the residents received their medication or not. Blister packs checked showed no gaps. Medication was stored in a locked room and the trolley was secure to the wall. The manager held the keys. Medications viewed were in date. A fridge is in use to store medication and a controlled medication cabinet is in use. A document is in place to agree that one of the residents has their medication given covertly. This has been agreed and signed by health professionals, the relative and manager. The manager told us that the monthly prescriptions are ordered by the pharmacist and prescriptions are then checked by the manager before being formally ordered. The manager and one other staff check in the medication. A returns book was in evidence with lists of medication returned to the pharmacy. All staff who administers medication were booked to go on a medication course in October. The manager needs to assess staff for their competency before confirming they are competent at administering medication. Documented evidence needs to be in place to confirm the audits take place. The manager also needs to carry out regular audits of medication and records to ensure safe practice, which is also to be documented. Residents were observed to be well groomed and dressed appropriately during the visit. Finger nails were clean and manicured. Staff were observed to be respectful and friendly in their interactions with residents. A relative interviewed stated, “Residents are always nicely dressed and groomed, Mum chooses her own clothes. She is constantly encouraged to change her clothes by staff, when they are stained. Her key worker helps with her grooming”. Screens were in place to provide privacy in the double rooms. Due to the problems with the laundry service personal clothing of residents is sometimes mixed up with other residents. One relative interviewed stated, “She sometimes gets someone else’s clothes”, therefore this needs addressing. None of the residents has a telephone but there was a call phone in the hallway. The provider told us that residents and families who wish to can use the office telephone, which has an additional line for them to use and can be portable”. A relative interviewed confirmed she was able to maintain contact with her mum and stated, “I ring every night and say goodnight to her”. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP12,13,14,15 were assessed. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents need to have a more structured activity programme. It would benefit residents if their individual preferences were taken into account when planning activities. EVIDENCE: The service does not have an activities organiser. A list of barge trips arranged for residents were on display in the front hall. Relatives interviewed confirmed residents went out and stated, “The residents go out a lot in the summer, barge trips, to Otterspool and the river front or just out in the bus” and “They take residents out on trips, the barge, Harry Ramsdens, theatre, Christmas pantomime and parties”. The manager told us that the following activities were also arranged for residents including, bus trips, aromatherapy, painting, balloon exercises, pamper days sing along and occasional parties to celebrate residents’ birthdays. There was no weekly record of activities on display. An activities programme needs to be implemented following Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 16 consultation with residents. A record needs to be kept of activities provided and list the residents who take part. This list of activities needs to be displayed in a format that is easy for residents to understand. Where residents are reluctant or unable to participate then further research needs to be taken to find out what sort of activity would be suitable for them. Visitors were observed to come into the service when they wished to see their relatives. All of the visitors told us that they could visit when they wished to. All of the residents were relaxed and calm in their surroundings. None of the residents were restricted to a particular area and all were able to walk around or relax in the public areas on the ground floor. Many of the residents took part in a singing group in the afternoon. There were no other activities going on with the remaining residents. Staff were noted to chat with the residents who were at ease in their company. Residents are asked about their preferences during the pre admission process. Some of these were recorded, but there was not sufficient detail recorded. There was no evidence of a social history record. It would be of benefit to the residents for information to be gained about their previous lifestyles. This information could then be used to help put together their individual care plan and show staff how the resident also sees themselves being involved in making decisions about how they spend their time. Residents told us they were able to get up and go to bed when they wished to. One relative interviewed stated, “Staff fit around mum’s routine”. We spoke with several residents during our visit. All of the residents seemed to be relaxed and comfortable in their surroundings. Residents’ religious beliefs were asked about on the pre admission document. The service does have regular visits from the local clergy for the residents who wish to continue to practise their religion. Residents were observed to be eating their meals in the conservatory dining room. The dining tables and matching chairs were spaced out to give residents enough room to enjoy their meals. The tables did not have table cloths or table mats. Food served looked appetising and residents were given time to enjoy their food and not rushed. The menu evidences choices for some meals and not for others. Residents and staff told us that choices were available at mealtimes. Residents interviewed told us they enjoyed their meals and had sufficient to eat. Families confirmed this. One resident interviewed stated, “The food is very nice, I have never asked for anything different as I always like what I have Relatives interviewed about food served stated, “The food is lovely, they get fed really well, Mum is really happy with the food” and “We have been a few times during meals and have noticed a good variety of food, Mum is well fed”. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP16,18 were assessed. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are at risk as safeguarding procedures were not followed following recent concerns raised. EVIDENCE: A complaints procedure is in place and was on display in the front hallway. Copies were available for people to use. Residents and families spoken with told us they would speak to senior staff if they had any concerns. Some of the relatives spoken with told us they were aware of the complaints procedure but have not used it. During discussions with families it became apparent that there were problems with residents’ laundry. One relative interviewed stated, “I know about the complaints procedure, we have a form to fill in. I have only complained once, it was about a clothes mix up I didn’t complete a complaints form but B….. (provider) sorted it”. Some residents were being given the wrong clothing to wear. This has been an ongoing problem. There is no record of these issues being raised although the manager did confirm that there was ongoing problems with personal laundry. The service did not have a complaints log. Both the manager and the registered provider were advised they need to have a log book for complaints Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 18 to be recorded. The complaints log should also evidence the investigation and outcomes for the complainant. The service does have a copy of the adult protection procedure. Some staff did tell us that they had attended adult protection training in the past but following discussion with the staff and how recent concerns raised have not been acted on, it is clear that their knowledge of the adult protection procedure is insufficient, non existent or not being followed. All sixteen residents have been placed on safeguarding following concerns raised recently. During the unannounced visit, residents care files were found lying around in the conservatory/dining room for anyone to view. When staff were asked why they were not locked away we were told that social workers were looking through them and night staff would have been writing on them. Residents care documentation needs to be secure and not left lying around for anyone to pick up and read through. Residents’ information needs to be stored in a secure facility when not in use. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP19,21,26 were assessed. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The refurbishment of the service needs to continue so that residents can be provided with a comfortable and pleasant environment that is suited to their needs. EVIDENCE: The public rooms are in the process of being redecorated. One of them has been completed and looks pleasant in light colours. All ground floor public rooms have new wooden effect flooring fitted. The other two public sitting areas have their wallpaper stripped in preparation for redecoration. The dining room/conservatory had light wood dining furniture in place suitable for residents. The activities room roof and conservatory/dining room roof both Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 20 needed cleaning. There were sufficient comfortable looking armchairs in place but some of them were torn and needed repair. The registered provider told us they were only two years old but had been damaged by a resident. The lift was in working order and the call bell system worked when we tested it. There were two bathrooms for residents. The provider told us that the top floor bathroom, with a bath and fixed chair seat, which we viewed, was not in use. This means that residents only have the use of one facility. This facility is a medi bath with shower attachment. The provider and manager told us that residents use the shower facility only. One of the residents case tracked is documented that they prefer a bath and refuses the shower facility. This was confirmed by their daughter. At present this residents personal hygiene is maintained by a daily wash therefore they are not given the chance to choose a bath as the facility is not in use. This area needs to be improved so that residents can choose an alternative method of maintaining their personal hygiene. Residents who wish to have an en-suite facility should be offered one when one becomes available as one relative told us their parent was a very private person and would prefer this facility. Some of the service is in need of further decoration and refurbishment including residents’ bedrooms. Some of the residents’ bedrooms are nicely decorated and furnished. Double bedrooms have a screen facility in place for privacy. All of the bedrooms have wood effect flooring and new carpets have been fitted to staircases, hallways and landings. Specialist beds were in place for one or two residents and bed rails were attached with comfort bumpers in place to protect residents whilst they are in bed. Some of the bedrooms were personalised with resident’s belongings on display. One relative interviewed stated, “Mum’s bedroom is lovely”. The external storage rooms for the kitchen were viewed and showed fridges and freezers that stored food. There was no uncovered food stored in the fridges. There was plenty of fresh eggs, bread, fruit and vegetables in store and a supply of tinned and dried foods. The temperatures of the fridges and freezers have been maintained daily. Hot food temperatures were not recorded therefore the cook was advised this needs to be done prior to any hot food being served with a record kept. Menus are changed seasonally. Lunch today was liver and bacon or corn beef hash. The menu does not always offer an alternative therefore this needs to be changed, so that residents have a choice. Residents spoken with did tell us that they could have something else if they did not like what was on the menu. The cook told us that the service does not provide a cooked breakfast but porridge and various cereals with toast is provided. There was no written schedule of cleaning the kitchen therefore this has to be implemented. However the kitchen was clean, although cluttered due to lunch Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 21 being in progress. The kitchen walls were tiled and an intact waterproof floor was in evidence. The laundry facility was not organised and was messy. Tiled walls and linoleum on the floor makes it easier to clean. There was one washing machine, two driers and a sluice facility. There were no individual baskets for residents’ personal clothing and there is no laundry assistant. Care staff manage the laundry. Externally there are level gardens to the rear with some suitable garden furniture in place. There is ramp access at the side of the building. The service provider has improved the premises since the last inspection visit but there are still areas that need attention. Decoration and refurbishment of the premises continues but it was clear that there are some areas that still need work. Discussion took place with the provider during the tour of the service where she highlighted her plans. Improvements need to continue to ensure it is a pleasant and comfortable environment for the residents to live in. The provider told us that the service does not employ a maintenance person, although the mini bus driver does carry out some work. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP27,28,29,30 were assessed. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service need to have robust pre employment checks carried out for all staff so that residents are protected. Staff induction and additional training provided needs to be evidenced in staff files so that we know the training has been attended. EVIDENCE: The rota was viewed and evidenced sufficient care staff were on duty. The manager was not on the rota therefore she was advised that all staff including her have to be entered on the duty rota. Staff surnames and position need to be recorded. A cook and domestic were on duty during the visit. There is no laundry assistant employed and this was evident when we looked at this facility. It was disorganised and messy. The service needs to look at managing this facility better and possibly providing some staff so that residents can have an improved laundry service. Staff interviewed confirmed there were sufficient staff on duty and one stated, “We have enough staff on duty”. The AQAA states that 60 of care staff has the NVQ Level 2 qualification and staff interviewed confirmed that they had the qualification although there was Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 23 no evidence of copied NVQ certificates in the care staff files looked at during the visit. There was a NVQ Level 2 in catering certificate displayed in the kitchen to confirm that the chef had this qualification. Some of the staff interviewed confirmed they had an NVQ qualification in care. Three staff files were viewed. Staff files evidenced application forms with school and colleges attended and previous employment, copies of birth certificates and driving licence, contracts, date of commencement of employment, references and police checks. One of the staff files did not have any police check carried out prior to commencing employment. They had been employed six months prior to the police check being confirmed. This employee has no references in place either. One of the two references for another employee was verbal and not followed up by a written reference before starting work. The manager and provider were advised that all verbal references need to be followed up with a written reference before the employee commences work. One of the staff files evidenced that they had their first supervision this month. One of the files evidenced the employee had attended Dementia training. There was no other record of any training that staff may have attended. There was no evidence of induction in staff files although staff interviewed confirmed they had an induction when commencing employment. One of the staff interviewed stated, “I had an induction over 3 months, my first day we went over the call system, residents and a fire drill. I did not sign any induction forms”. The provider and manager were advised to audit all staff files to ensure all pre employment checks are in place. Staff interviewed confirmed that they had attended training arranged by the service although this is not evidenced in staff files. Staff interviewed stated, “I have had first aid, manual handling, medication and health and safety in the past few months” and “I did manual handling two months ago, no abuse training here recently but in the past”. A training and development programme needs to be in place for each staff member and a record kept of their individual training plans and certificates of any training or induction attended. We spoke with the manager who told us what training had taken place in the last year. Training provided included, safeguarding, first aid, manual handling, infection control, health and safety, basic food hygiene, continence, cosh (Control of Substances Hazardous to Health), medication, Diabetes, Dementia, adults eating and drinking, epilepsy, fire and soon to be commenced report writing. Not all of the training is up to date and not all staff has attended mandatory training. Staff spoken with confirmed that a handover took place. One staff interviewed stated, “We have a handover at the beginning of each shift”. Staff employed in the service told us that the service provided good care for the residents and Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 24 that they were happy in their work. Staff interviewed stated, “I think the residents get the best care they can, residents get good medical care and the chiropodist comes quite often” and “I like it”. Families interviewed told us they were happy with the staff that cared for their relatives and stated, “The carers are fantastic, they really do care, Mum has a key worker that she really likes” and “Staff have been brilliant with Mum”. One of the residents interviewed stated, “I like everybody here, staff are nice and great, we have a lot of fun”. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP31,33,35,38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has not been very well managed in the past months and residents may be at risk because of this. EVIDENCE: The registered manager has been in post from December 2008. She has the Registered Managers Award (RMA), NVQ Level 4 and has attended various other courses in the past year. We are concerned following this inspection about the manager’s ability to manage this service. When asked why she had not been able to manage the service effectively she stated, “I hold my hands Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 26 up, I don’t know why, I think it’s because it’s so relaxed here”, to each of our concerns. There are many areas of concern where she has not put procedures in place or dealt with the management of residents care, including care plans, risk assessment and medication. The lack of effective and robust management has resulted in residents living in the service being placed at risk. The provider is keen to improve the standards and has already brought in additional management support to help implement care plans. Surveys have been issued to families to canvass their views on how the service has been run. Surveys viewed showed positive feedback about the care provided but negative feedback with regard to the laundry service and physical surroundings. There are no residents meetings. Staff meetings are held as confirmed by staff with minutes published. A relatives meeting had been arranged for the evening of the visit and many families turned up for the meeting. The registered provider lives on the premises on the weekdays therefore does not do provider visit reports. We advised the provider that it would benefit the service if she were to audit the premises on a regular basis including speaking with staff, residents and their families and record the information. This could be used to inform her of how the service impacts on the residents who live there. The provider manages the financial records of two residents. We looked at the records kept and found very good record keeping of all financial transactions with detailed records and receipts kept. The files were well organised and documentation was easy to follow. There is no valuables book in place therefore this needs addressing. A carbonated copy needs to be available for residents or their families to evidence any valuables held or returned. The AQAA stated that all safety checks for all appliances in use in the service including electricity, gas and boilers were serviced and up to date. A selection of the servicing certificates was viewed at random including, electric testing, lift, boiler and hoist and these confirmed that all were up to date. Fire checks are carried out weekly with various points tested and this is recorded. Fire drill training has been held in December by an external trainer for day and night staff with records kept of all who attended. The service also have regular fire drills for staff at 8am. Emergency lighting is checked monthly. The call bell system was in working order during the visit. Liability insurance is in place and up to date. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 27 Accident reports were viewed and all were completed correctly. Some of the residents have had several falls and this has not been highlighted or risk assessed. The manager is aware of RIDDOR (Reporting of Injuries, Diseases, Dangerous, and Occurrences Regulations) and we viewed a copy of a report forwarded to them when a resident broke her wrist. Not all mandatory staff training is up to date nor do staff files evidence staff induction therefore this needs addressing to ensure that staff employed have the training and induction needed to provide safe care for the residents who live at Beechlands. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 28 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 1 X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The registered provider must ensure that the pre admission assessments must be more detailed so that a clear decision can be made as to whether or not the service could meet their needs. The registered provider must ensure that all residents have a care plan in place that addresses all of their assessed needs and be person centred. The care plans must be agreed and reviewed on a regular basis to ensure the planned care reflects the up to date needs of the resident. This is an outstanding requirement The registered provider must ensure that were residents are nutritionally compromised that specialist advice is sought without delay and care documentation details the management of this. The registered provider must Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 30 Timescale for action 01/11/09 2 OP7 15 01/11/09 3 OP8 12, 13 01/11/09 also ensure that residents at risk of falls have a detailed risk assessment in place and the care plan evidences the management of this. The registered provider must ensure that risk assessments are completed in particular with regard to residents with challenging behaviour. The registered provider must 01/12/09 ensure that the management of medication is improved to ensure that residents are given their medication at the correct time. Documented audits must take place to monitor this. The registered provider must ensure that staff who administer medication have been assessed as competent in this area. Documentation with regard to training and competency checks must be evidenced. This is an outstanding requirement. The registered provider must ensure that residents wear their own clothing. This will ensure residents maintain their dignity. The registered provider must ensure a structured activity programme is in place that reflects the needs of the residents. The registered provider must ensure that residents are able to choose how they wish to maintain their personal hygiene. The registered provider must ensure that a complaints log is in place and that this evidences the complaints made, the investigation and the outcome for the complainant. DS0000070530.V377114.R01.S.doc 4 OP9 13 5 OP10 12 4 (a) 01/11/09 6 OP12 16 2 (n) 01/12/09 7 OP14 12 1 (a) 01/01/10 8 OP16 22 01/11/09 Beechlands Version 5.2 Page 31 9 OP18 13 (6) 10 OP19 23 2 (b d) 11 OP21 23 2 (j) The registered person must ensure that any allegations of abuse are documented and referred to safeguarding and the local procedures are followed by all staff. The registered person must ensure that the refurbishment of the service continues so that residents can have a comfortable environment. The registered person must ensure that a bath facility is included in the refurbishment so that residents have a choice. This is an outstanding requirement The registered person must ensure the laundry facility is cleaner and better organised. The registered person must ensure that sufficient staff are employed in the service to ensure all areas are better managed including the laundry. The registered person must ensure that robust pre employment checks are carried out before staff commence employment. 01/11/09 01/02/10 01/01/10 12 13 OP26 OP27 23 2 (d) 18 1 (a) 01/11/09 01/12/09 14 OP29 19 1 (a,b,c) 01/11/09 15 OP30 18 1 (i) 16 OP31 9 17 OP33 26 This is an outstanding requirement The registered person must 01/12/09 ensure that staff induction and additional training provided needs to be evidenced in staff files so that we know the training has been attended. The registered person must 01/12/09 review the failings in practice of the registered manager in line with the services own policies and procedures regarding competency and effective performance. The registered person must 01/12/09 DS0000070530.V377114.R01.S.doc Version 5.2 Page 32 Beechlands ensure that regulation 26 ‘visits’ are undertaken and a report written of their findings. A copy of the report must be forwarded to the Commission. This will demonstrate that the quality of the service is being checked and monitored. The registered person must ensure that all staff are up to date with their mandatory training and that staff induction is evidenced in staff files. This ensures that staff have the skills and training needed to care for the residents. 18 OP38 18 1 (c) i 01/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 33 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Beechlands DS0000070530.V377114.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!