Inspection on 21/12/05 for Beechlands

This inspection was carried out on 21st December 2005.

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

Beechlands 10/01/08

Beechlands 06/10/06

Beechlands 28/07/05

Beechlands 05/01/05

Beechlands 24/08/04

Beechlands 11/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Beechlands 42 Alderton Hill Loughton Essex IG10 3JB Lead Inspector Kathryn Moss Unannounced Inspection 21st December 2005 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 Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 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. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beechlands Address 42 Alderton Hill Loughton Essex IG10 3JB 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) 0208 508 5808 0208 508 1484 Southend Care Limited Mrs Amanda Jayne Austin Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who only fall within the category of old age (not to exceed 28 persons) 28th July 2005 Date of last inspection Brief Description of the Service: Beechlands is a detached property, located in a residential area a short distance from local shops and facilities. Accommodation is on two floors, accessed by a through floor passenger lift. The home is divided into four units, each with its own lounge/dining area and bathroom facilities, and each accommodating seven service users. The home has 24 single bedrooms and 2 double rooms, all with ensuite toilets. The home has appropriate aids and equipment (e.g. mobile hoist, assisted bathing facilities, hand rails, etc.) to assist residents with limited mobility. Beechlands is registered to provide residential care for 28 Older People (i.e. over the age of 65), and provides 24-hour personal care and support. There were 27 residents living in the home on the day of the inspection. There are currently a few residents who have developed dementia since coming to live at Beechlands, but the home is not registered to admit people with dementia. The home is owned by Southend Care, and the current registered manager is Amanda Austin. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 21/12/05, lasting five and a half hours. The inspection process included: discussions with the manager, 6 staff, 4 residents, and 1 relative; an inspection of communal areas and laundry; and inspection of a sample of staff and resident records. 14 standards were inspected, and 3 requirements and 6 recommendations have been made. Information on key standards not covered on this inspection can be found in the report of the unannounced inspection that took place on the 28/7/05. What the service does well: What has improved since the last inspection? Whilst there were no specific areas of significant improvement since the last inspection, the home had maintained consistent good practices in relation to the support and daily lifestyle offered to residents, and the maintenance of the environment (which residents reported was always kept very clean). It was noted that there had been several significant activities or events since the last inspection, including a summer fete, an outing to Southend, a theatre trip and a Christmas party with entertainment. Residents had clearly enjoyed these. It was noted on this inspection that the home had good recording systems in place to evidence that certain practices within the home were being regularly monitored (e.g. medication procedures, and falls and accidents). These provided good evidence that issues relevant to the safety of residents were being regularly checked and reviewed. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 7 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 DS0000017764.V274556.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 The home ensures that new residents’ needs are assessed, and that the home can meet their needs, before they move into the home. Residents were confidant that the home was able to meet their needs. EVIDENCE: The manager confirmed that she or a senior carer always visit prospective residents prior to their admission to assess their needs; they also receive a care management assessment if a person is referred through social services. An example of a care management assessment and of the home’s preadmission assessment were seen for a new resident; the home’s pre-admission assessment had been well completed. New residents confirmed that although they had not been able to visit the home themselves prior to admission, a friend or family member had visited on their behalf. They felt confidant that staff were able to meet their needs, and were positive about the care and support being given to them. Staff spoken to were knowledgeable about residents, and were able to describe the action being taken to meet specific needs. The home’s environment and facilities were suited to the needs it aims to meet. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 Residents’ personal care and health needs appeared to be well met at the time of this inspection. However, documentation (care plans) did not satisfactorily describe all of the assistance required by staff to meet key care needs. Medication practices were well maintained and protected residents. EVIDENCE: Residents seen appeared well cared for, and residents and a relative spoken to were happy with the level of support given by staff. No residents were bed bound or had pressure sores at the time of this inspection: two were at risk of developing pressure areas and staff were able to describe appropriate action being taken to prevent this (use of pressure relief cushions and mattresses, periods of bed rest, encouragement to eat and drink, etc.). However, this action was not fully documented in the residents’ care plans. Two sample care files were viewed: these contained good evidence that relevant assessments were being updated regularly, and there were a range of care plans that were similarly being reviewed monthly. Some care plans contained some appropriate and useful information on the person’s needs. However, in one instance the care plans had not been updated to show Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 10 significant recent changes to the assistance the person required, and in the other file there were insufficient details of the action required by staff to meet key needs (feeding, continence, pressure area preventative care, dressing, etc.). Medication practices were inspected on just one unit. Medication was appropriately stored: tablets dispensed to the home in a monitored dosage system were stored in a locked cabinet on the unit; other medication (e.g. liquid medication and tablets in bottles) was stored in a locked medication trolley; bottles of liquid medication had been dated on opening. Medication administration records (MAR) were printed by the pharmacist, and were well maintained, showing medication received by the home and medication administered. A separate record of ‘as required’ medication was maintained to show the quantity of tablets remaining in the home. Records were maintained of all medication returned to the pharmacist. The home had a controlled drugs cabinet and record book available for use when required. The home’s medication policy and staff training records were not inspected on this visit. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Residents were happy with the lifestyle they were experiencing at Beechlands. Practices and routines within the home supported residents to exercise control over their lives. EVIDENCE: Daily routines in the home appeared flexible, with residents reporting that they could chose where to spend their time, whether to join in activities, what time to get up or got bed, etc. It was good to see one resident being served breakfast when they got up mid morning, and another said that they could stay up late and there was always someone around to help them. Staff were observed offering residents a choice of food for the following day, and there were hot and cold drinks regularly available throughout the day. Activities were not inspected in detail on this occasion, but an activities programme was displayed in each unit, and a senior carer said that they felt the home had arranged more activities this year, particularly reporting a trip to the theatre, a trip to Southend, and a fete in the garden. Residents spoke very positively about the Christmas party and entertainment that had taken place on the day before the inspection, which they had clearly enjoyed. Staff were putting a lot of effort into Christmas arrangements, with Christmas trees and decorations on each unit, and laminated menus on each dining table Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 12 showing an appealing and varied range of meals planned for Christmas Day and Boxing Day. Advocacy information was seen displayed on a notice board in the hallway: no residents were currently receiving any advocacy support, but an advocate had been accessed previously when required by someone. Bedrooms were not specifically inspected on this occasion, but on previous visits it had been noted that residents could bring their own possessions into the home with them, and that bedroom furniture contained a lockable drawer so that residents were able to keep valuables safe and in their control if required. Residents were able see their own records, and information on Access to Records was covered in the home’s Resident’s Handbook. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents were confidant that they could raise concerns and that they would be listened to. EVIDENCE: The home’s complaints procedure was clearly displayed on a notice board in the hallway. The home had not received any complaints since the last inspection, and residents’ spoken to stated that they had no concerns about the care provided to them at Beechlands, and would be happy to speak to the manager or a senior if they had any concerns. Protection of vulnerable adults procedures were not reviewed on this occasion, but training was briefly discussed: two staff spoken to said they had attended a recent in-house abuse workshop; training records indicated that seven care staff (mainly night staff) and the domestic staff had not yet attended POVA training, and this should be arranged. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 25 and 26 Residents have access to an appropriate range of comfortable communal space. The home is warm and well lit, making it safe and comfortable for residents. The home is clean, pleasant and hygienic. EVIDENCE: The home has a good range of communal space that can be used by residents, with lounge/dining areas on each unit and with seating also in the entrance hall and activities room. The communal areas were all well maintained on the day of the inspection, with entrance hallway and lounges all clean, warm and homely and attractively decorated for Christmas. A resident and a relative both felt that the home had a warm and welcoming atmosphere. Garden areas were not inspected on this occasion. Rooms were naturally ventilated and lit, and also had suitable lighting and heating. There was emergency lighting throughout the home, which was checked regularly. There were also systems in place to regularly monitor that hot tap water remained close to 43°C, and to prevent risk of Legionella. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 15 Bedrooms were not inspected on this occasion, but the manager confirmed that action had not yet been taken to address an issue highlighted at the last two inspections relating to residents not being able to control the temperature of the radiators in their rooms. If design features to not easily enable this to be resolved, the provider should ensure that this is clearly identified to prospective residents (e.g. recorded in the service user guide and statement of purpose). Infection control policies were not inspected on this occasion. On the day of the inspection, areas of the home viewed (communal areas) were clean and tidy, and free from any unpleasant odour. The laundry was inspected on this visit: his was located away from areas where food was stored or prepared, and had washable floors and walls. It was equipped with two washing machines, both of which had sluice wash cycles and programmes to wash items at 65°C or 71°C for infection control purposes. There was a separate hand wash sink, with liquid soap and paper towels. Sluice rooms were not inspected on this occasion. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29 Staff recruitment practices included appropriate checks that protected residents. Levels of NVQ training did not currently provide sufficient evidence of the competence of staff. . EVIDENCE: Agreed staffing levels were being maintained on the day of the inspection. Excluding bank staff, at the time of this inspection the home had 24 care staff, and of these the manager confirmed that three staff had achieved NVQ level 2, and two seniors had completed NVQ level 3 and were waiting for their work to be assessed. The home does not therefore currently meet the standard of 50 staff trained to NVQ level 2. It was noted that four other staff had started NVQ level 2 training since the last inspection; a further four staff had previously started this training, but their training was on hold due to issues with the training provider, and had not progressed since the last inspection. One new carer had been recruited since the last inspection, and their recruitment documentation showed that the home had carried out appropriate checks to meet regulatory requirements and to protect residents. The manager was reminded to ensure that applicants fully complete a declaration of criminal record prior to recruitment. The registered person had not yet obtained CRB checks on all of the staff that were working in the home prior to April 2002, and must do so. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 38 The home is run in the best interests of residents, with systems in place for monitoring this. Practices in the home promote the health and safety of residents and staff. EVIDENCE: Staff spoken to felt well supported, were positive about working at Beechlands, and felt that they were offered plenty of training. The atmosphere in the home on the day of the inspection was relaxed, and staff were clear about their roles and responsibilities. The manager provided evidence of a quality assurance survey carried out this year: questionnaires had been sent to a sample of relatives and residents, and twelve responses had been received back and had provided positive feedback. A report had been produced summarising the responses, and identifying some recommendations, and the manager stated that she was due to do an action Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 18 plan to address these. The home did not currently have an annual development plan: it was recommended that the home should have an annual plan that reflects aims and objectives for residents. The manager stated that she had recently identified premises issues for action next year. A representative from the organisation regularly visits the home to audit a range of issues and records, and there was good evidence of a variety of internal monitoring regularly taking place within the home (e.g. records showing monitoring of medication records, falls, health and safety checks, and accidents). The home’s policies and procedures on health and safety were not inspected on this occasion. The manager maintained a clear record of all checks and servicing carried out on equipment and utilities, which provided evidence that the equipment and premises were regularly maintained. The manager was advised that Gas Safety Record certificates do not show whether equipment was serviced, and it was recommended that the engineer be asked to provide evidence of this in future. There were records of regular internal checks on hot water temperatures (re risk of scalding and to prevent risk of Legionella), and also evidence of regular fire drills, and of checks on fire alarms, emergency lighting, and fire equipment. Accident records were maintained, and there were good systems in place to monitor these (an accident summary form, and also individual monitoring forms per resident). The home had a risk assessment relating to safe working practices, which briefly addressed most core areas of the home. It was recommended that this include a risk assessment in relation to the use and storage of chemicals within the home. There was evidence that some training in health and safety issues had taken place this year, including moving and handling, fire safety, and infection control. Staff training records showed some gaps in relation to health and safety training: according to records, although most staff had current moving and handling training (five staff needed to attend an update), seventeen staff needed basic food hygiene training, and ten staff needed fire safety training. Additionally, only four staff had first aid training, and the manager was advised that there should be at least one person on each shift with this training. Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 19 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 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X 3 X X X X 3 3 STAFFING Standard No Score 27 X 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 2 Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15 Requirement It is required that care plans provide detailed information on the action required by staff to meet each identified need. This is a repeat requirement for the second time (previous timescale 31/10/05). Care plans must be updated when residents’ needs change. The registered person must ensure that all staff employed at the home prior to April 2002 have evidence of a CRB check obtained through the provider. The registered person must ensure that all staff have attended current training in relevant health and safety issues (including fire safety). Timescale for action 28/02/06 2. OP29 19(5) and (6) 31/03/06 3 OP38 13, 18 and 23(4)(d) 31/03/06 Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 21 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. 2. Refer to Standard OP18 OP25 Good Practice Recommendations The registered person should ensure that all staff have received appropriate training on the protection of vulnerable adults. This should include domestic staff. The registered person should make appropriate arrangements to ensure that heating can be controlled in residents’ own rooms. If this cannot be achieved, this should be clearly identified to prospective residents (e.g. noted in the service user guide and statement of purpose). It is recommended that the registered person ensure that training is provided to ensure that at least 50 of care staff have achieved NVQ level 2. The home’s quality assurance processes should include an annual development plan that reflects aims and outcomes for service users and is based on a systematic cycle of planning, action and review. It is recommended that there is at least one person on each shift who is trained in emergency first aid. It is recommended that the home’s risk assessments of safe working practices include use and storage of chemicals in the home. 3. 4. OP28 OP33 5. 6. OP38 OP38 Beechlands DS0000017764.V274556.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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