Inspection on 05/02/08 for Beechlands

This inspection was carried out on 5th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beechlands 15/09/09

Beechlands 01/07/08

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

CARE HOMES FOR OLDER PEOPLE Beechlands 54 Church Road Huyton With Roby Liverpool Merseyside L36 9TP Lead Inspector Mrs Lynn Paterson Key Unannounced Inspection 05/02/08 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 DS0000070530.V354743.R02.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. Beechlands DS0000070530.V354743.R02.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 (temp email address) Beechlands Care Home Ltd Vacant Post Care Home 21 Category(ies) of Dementia (21) registration, with number of places Beechlands DS0000070530.V354743.R02.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 New Service 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. 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 £399.91 to £473.37 per week Beechlands DS0000070530.V354743.R02.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 1 Star. This means the people who use this service experience adequate quality outcomes. The inspection of Beechland’s care home was unannounced and was carried out over a one -day period. During the inspection a number of documents were examined including care files, staff files, maintenance logs and medication records. Discussions were held with staff and people living in the home and a tour of the building undertaken. Observations were made of staff carrying out their duties and their interactions with people living in the home. Fieldwork included case tracking three residents, which involved reading all documentation relating to the residents daily living and speaking with the residents and staff who were associated with their care. Beechlands has been registered as a care home for several years however it changed ownership in October 2007 and does not currently have a registered manager. The acting manager and registered provider were in attendance for most of the inspection and provided useful information about policies and practices and how they were beginning to introduce changes to the environment by updating the fabrics and furnishings in the home. What the service does well: The home arrange monthly meeting for the people living in the home and their families and friends to enable them to voice any concerns or pass on suggestions or ideas to make life better for the people living there. Observations of staff interactions with the residents of the home revealed atmosphere of calm and contentment. People living in the home said they were happy with their daily life and they were observed singing and dancing and chatting amongst themselves appearing to be totally at home with their surroundings. Staff training records show that they receive on going training in both mandatory and specialised dementia care and staff spoken with demonstrated total commitment to providing needs led care and maximising the daily life of the people living in the home. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Whilst all policies, procedures and other information were available they were not all easy to access. Filing systems would benefit from an update to ensure that documentation is easily accessible when required. It was noted that care plans held signatures of each resident/residents representative however records showed that monthly review of care was inconsistent and monitoring and reviewing processes not carried out on a regular basis. Medication records were well managed however records of the number count of controlled drugs was incorrect. Whilst this error was accounted for at the time of the visit the home must ensure that a quality audit of medication records is in place to ensure any errors can be checked upon as and when they occur. Staff were provided in more than sufficient numbers to meet the needs of the people living in the home. However staff advised that the home provides a day care service but does not provide nominated staff for this service. As a consequence staff provide services to all people in the home whether permanent residents or day visitors. Whilst this was not seen as a shortfall as only 2 day care residents were in the home and the home did not have more than its registered number of residents on the premises, it should be noted that the staff rota should identify staff roles and staff should be aware of their areas of responsibility and extra staff should be on a rota to provide any day care support within the home. Staff recruitment and selection policies were in place however staff had recently been employed without the full procedures being undertaken. Three staff files were without Criminal Records Bureaux (CRB) checks and written references and this was contrary to the system of recruitment as stated in the home policy. Staff should not be appointed to commence work within the home Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 7 until all the necessary checks have been completed to ensure the safety and wellbeing of the people living in the home. 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. Beechlands DS0000070530.V354743.R02.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 Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1.3.Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. All new residents receive full information about the home and services provided and have a comprehensive pre admission assessment of need prior to a placement being offered. Standard 6 was not inspected, as there were no people in the home receiving intermediate care. EVIDENCE: Care files viewed showed that thorough pre assessments of need were carried out for all prospective new admissions to the home. It was noted this process was carried out in the prospective residents own home and followed by the person visiting Beechlands Care Home for a further assessment of need. Records showed that trial visits were also offered to people to enable them to see if they felt at ease in their surroundings and the care home could meet assessed need. The homes statement of purpose was viewed and it was noted that recent changes to the staffing and ownership of the home had been recorded. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 10 Care files held information to show that residents and their representatives had been provided with full details of the care provision of the home to ensure that they could make informed choices about their future care. The acting manager said that the pre assessment process incorporates issues relating to equality and diversity such as resident’s age, disability, mental capacity, gender, race, religion or belief and sexuality to ensure a holistic package of care can be provided. Beechlands DS0000070530.V354743.R02.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 adequate. This judgement has been made using available evidence including a visit to this service. Care plans are in place for all the people living in the home however they do not contain full details about reviews of care. Medication practices do not fully safeguard residents. EVIDENCE: Care plans were looked at in general and three were examined in detail to gain information about the health and social care provision in the home. The care information was detailed in a booklet form. However the information detailed in the care plans was inconsistent and although they held sufficient information to advise about personal care planning and personal care delivery daily records were inconsistent. Care plans viewed did not hold information about how they were reviewed or identified changing needs. Care plans held signatures of all the people who were involved in the care planning process and staff advised that all care plans were discussed with the resident and their representatives to enable plans to be developed to ensure they were fully person centred. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 12 Daily records were clear however information about aspects of daily life are recorded using three different systems and it was noted that staff use correction fluid to rectify any errors in recordings. Discussion with the registered provider and acting manager enabled them to make the decision that in the future they would use only one recording system to enable all information to be available in one place. They advised that they would also ensure that staff had refresher training in recording of information to include not using correction fluid on any records in the home. Health care needs were recorded on file and all health -care appointments, district nursing and General practitioner notes were held on file. General medication records had improved greatly since the last inspection and records seen were clear and held staff signatures to show if a resident had been given prescribed medication. Staff said they had received medication refresher training and medication records are now double -checked daily to ensure that medication was managed as per the training and guidance provided. However it was noted that 2 tablet counts in the controlled drug book were incorrect. Whilst the error was identified, explained and rectified at the time of the visit the home must also have a quality audit in place in respect of controlled drugs to ensure full compliance with their policies and procedures. Staff spoken with and observed carrying out care practices and support with residents revealed they carried out their practice with sensitivity and respect and fully understood the needs, capabilities and preferences of all the residents living in the home. Residents were observed interacting with staff and were seen to be totally at ease in their company. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff arrange activities and encourage community involvement for the residents. Choices of meals are provided and the dining arrangements are tailored to specific individual need. EVIDENCE: Visitors were observed coming and going from the home throughout the day to meet with residents and spend time with them. People living in the home were also observed being escorted to visit areas of interest within their local community. The home currently do not have a designated activities co-ordinator and staff revealed that they take it in turns to arrange activities to suit the interest and capabilities of the people living in the home. Staff said that care plans clearly identify what would be suitable for each individual and staff, say the activities programme supports people in their social interest and needs. Observational practices identified that people living in the home were able to have their breakfasts at times to suit them. Breakfast food provision was also a matter of individual choice. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 14 Lunch -time was seen to be a similar set up in which residents were provided with their meal and sat in areas of their choice to eat their meals, some not choosing the dining area, preferring to sit in the comfort of the lounge to enjoy their food. Staff and visitors were observed assisting the residents during mealtimes in a discreet way but ensuring each person was able to enjoy food of their choice. It was noted that staff wore aprons when handling food and discussions with staff revealed they were fully aware of the methods to control and limit the risk of infection. Staff carried out their care and support duties in a way that enables residents to maintain choice and control over their daily lives wherever possible. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a procedure for dealing with complaints information of which is provided to all residents and their representatives. Protection of vulnerable adult training is provided however not all staff have full awareness of what constitutes abuse. EVIDENCE: The complaints procedure is available in the main entrance of the home for all visitors to see and the procedure is also provided to each resident on admission. Visitors spoken with said they knew of the complaints procedure but had not had any occasions to use it. They said that staff, were approachable and if they had any concerns they would speak with staff. Records show that most of the staff have received training in the protection of vulnerable adults, however some of this training is not recent. The home does have information available for staff in what to look for and how to recognise abuse and what actions to take if they suspect potential or actual abusive situations. However daily records revealed that a potential financial abusive situation had already arisen and staff had not taken appropriate action to deal with this issue. More training and refresher training needs to be put in place to ensure that staff have full knowledge and understanding of their responsibilities in the protection of vulnerable adults. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19.26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, safe, environment for people to live in. EVIDENCE: The home has an ongoing refurbishment programme in place to ensure the comfort of the people living therein. The home maintenance records were clear and information provided by the home revealed that all essential services checks and updates were in place. The home presented as clean and free from unpleasant smells and the fabrics and furnishings were adequate. The physical environment meets the individual needs of the people living in the home and staff advised that the refurbishment programme would include re design and redecoration to reflect the preferences of the people living in the home. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 17 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 number of staff employed is sufficient to meet the needs of residents however recruitment and selection processes do not fully ensure that people living in the home are in safe hands. EVIDENCE: Staff files viewed varied greatly. Three files examined in detail for newly appointed staff did not hold the necessary documentation to include Criminal Records Bureaux (CRB) enhanced disclosures, two written references, interview information records or contract of employment. A random sample of other staff files revealed they were fully complete. The acting manager and registered provider said that they were awaiting the references and CRB record to be returned and other documentation had not been filed in the appropriate place. However they revealed that although the three staff members had been appointed they had been placed to work alongside other staff until all the checks had been received. It was agreed that the acting manager would refresh her knowledge of the recruitment and selection process to ensure that staff appointments would only be made in accordance with the protocols as directed. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 18 Staff training is an ongoing process of the home and staff displayed good knowledge and understanding of all aspects of dementia care. The staffing numbers are good and staff say they work hard but are able to manage to provide quality care for the people living in the home. It was noted that day care is provided. Staff advised that the home provides a day care service but does not provide nominated staff for this service. As a consequence staff provide services to all people in the home whether permanent residents or day visitors. Whilst this was not seen as a shortfall as only 2 day care residents were in the home and the home did not have more than its registered number of residents on the premises, it should be noted that the staff rota should identify staff roles and staff should be aware of their areas of responsibility and extra staff should be on a rota to provide any day care support within the home. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 19 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 adequate This judgement has been made using available evidence including a visit to this service. The acting manager is not registered with The Commission but has relevant qualifications and experience in dementia care. Whilst the homes philosophy is for it to be managed in the best interests of the people living therein some working practices need to be updated to ensure residents rights and best interest are fully met. EVIDENCE: The acting manager is newly appointed to her management role but has many years experience in caring for people who experience dementia. The home has a quality assurance system to determine the standard of care provision and hold monthly meetings with residents and their families and Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 20 friends who are encouraged to give suggestions and ideas about how to improve services. The finances of people living in the home are managed by their families, some of whom have power of attorney others who do not. The acting manager advised that the home do not have any responsibility for managing residents money but they will utilise a billing system in which they will hold a small amount of money for each person to enable them to purchase small items and pay for outings etc. She said that resident’s representative’s who wish this to happen, leave small cash amounts for this purpose. Discussion about finances in general revealed a concern about external potential mismanagement of a residents finances and it was agreed that the home had a duty to disclose information to the placing authority as a matter of urgency. Records show training for staff in health and safety, infection control, fire awareness, food hygiene, first aid and moving and handling are up to date. Staff supervision has fallen behind allocated timescales, however staff advise that they have informal supervision any time needed. Discussions with the acting manager revealed that she is unable to receive professional supervision, as she does not have a line manager who has any knowledge of care management issues. This has impacted unfavourably upon the acting manager as she is in a position in which all the responsibilities are left in her hands and as she is knew to this role she too needs guidance as to her roles and responsibilities. It is recommended that this situation be resolved to ensure that she can have professional support to enable her to carry out her demanding role. The laundry has recently been updated and all staffs are aware of the systems in place in respect of infection control. Health and safety practices were well managed. Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 2 X 3 Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? New Service 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 Residents care plans must be consistent in their recording and contain all aspects of information about individual need, choice and capability and how these needs will be met. Regular reviews of care should be held and records kept on file. Records should be clear and not be obscured by correction fluid. Medication must be managed as per the homes policies and procedures and audits must be in place to ensure that all medication is provided as recorded on the medication record sheet. In this instance: The controlled drug book medication record count was incorrect. Quality audits must be used to ensure medication records are accurate at all times. All staff of the home must be provided with training in the protection of vulnerable adults to ensure they fully understand what constitutes abuse. A copy of Knowsley’s Local Authority Adult protection procedure must be in place to ensure allegations DS0000070530.V354743.R02.S.doc Timescale for action 05/05/08 2 OP9 13 05/05/08 3 OP18 13 05/05/08 Beechlands Version 5.2 Page 23 4 OP28 18 5 OP29 18 6 OP31 18 7 OP35 18 8 OP36 18 or concerns re abuse are managed properly. The forthcoming years staff training programme and the induction training needs to be developed to include training on recording of information and the protection of vulnerable adults form abuse. The homes recruitment and selection procedures must be followed at all times to ensure the safety and well being of the people living in the home. All the necessary information must be gathered about staff before they are employed to ensure they are suitable to work with vulnerable adults. In this instance staff have been employed without all information being provided. The home must employ a registered manager who is qualified and experienced to run the home. The home must utilise systems to ensure that the finances of the people living in the home are safeguarded. The home must ensure that suitable supervision arrangements are in place for all staff members. 05/05/08 05/05/08 05/05/08 05/05/08 05/05/08 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.V354743.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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. Extracts may not be used or reproduced without the express permission of CSCI Beechlands DS0000070530.V354743.R02.S.doc Version 5.2 Page 25 - 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. 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