Inspection on 16/11/05 for Beechmore Court

This inspection was carried out on 16th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Beechmore Court 15/07/08

Beechmore Court 06/07/06

Beechmore Court 07/06/05

Beechmore Court 01/12/04

Beechmore Court 15/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Beechmore Court 267 Southlands Road Bickley Bromley Kent BR1 2EG Lead Inspector Monica Hanscomb Unannounced Inspection 16th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 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. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Beechmore Court Address 267 Southlands Road Bickley Bromley Kent BR1 2EG 020 8468 7778 020 8295 0596 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) Cedarmore Housing Association Limited Julia Isaacson Care Home 36 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (20) of places Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2005 Brief Description of the Service: Beechmore Court is a purpose-built two-storey home providing care for older people. The upper floor is accessed via a lift. The home is generally well maintained and each resident has his or her own room, which is centrally heated. The resident can control the central heating in their rooms. Residents are able to personalise their rooms. There is access to a telephone and residents are able have their own telephone in their room at their own expense. For safety purposes all the radiators and hot pipes are guarded. There are grab and hand rails on stairs and passageways. Toilets, showers and bathrooms have specialised bathing, toilet equipment and lifting aids. All toilets, showers, bathrooms and bedrooms are accessible from the outside in case of emergency. Service users can also have a radio, television and video in their room at their own expense. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was carried out over a period of four and a half hours in the presence of the manager, Julia Isaacson. A tour of the building was made and the environment is comfortable and well maintained and free from odours. The inspectors spoke with a relative, residents and some of the staff who were on duty to gauge the level of understanding of their role and level of competency of the staff team in ensuring the welfare of the service users What the service does well: What has improved since the last inspection? 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. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 6 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 Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 7 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): 1,2,3,4,5. Residents and their relatives have all the information to make the decision whether they wish to live in the home. EVIDENCE: The home gives all prospective residents a copy of the home’s Statement of Purpose and the Service Users guide to help them make a decision whether to live in the home. Prospective residents are welcome to visit to meet the staff and look around the home before making their decision. The home always undertakes a full assessment of needs carried out by the manager or her deputy before offering a placement to the prospective resident to make sure the home is able to meet the needs of the each individual. Residents are issued with a contract and terms and conditions of the home. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 8 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): 6,7,8,9,10,11. Residents’ health and social care needs are met to a high standard of care. EVIDENCE: All residents have a care plan which reflect the assessment of need and the pre-admission questionnaire undertaken by the manager and/or deputy manager and this underpins a person-centred approach for all care given. The care plans are regularly reviewed and they also contain physical and mental health risk assessments, personal risk and behaviour assessments, pressuresore assessments and nutrition screening. A number of staff has undertaken training in the administration of medication and they are the only staff administering medication. The home has a policy and procedure for the care of the dying and what to do in the event of a death of a resident. Staff were seen to be knocking at residents doors before entering their rooms and talking to residents in a respectful manner. Residents’ relatives were spoken with and they stated the care their relative received was “wonderful” and they were always treated with respect and made to feel welcome. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 9 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): 12,13,14,15. The routines of daily living and activities made available to residents are flexible and varied to suit the residents’ expectations, preferences and capacities. EVIDENCE: At the time of the inspection groups of residents were seen to be chatting to their peers, some were reading their papers and/or books. Relatives visiting were welcomed and offered refreshment. The home does not handle any residents’ monies; this is undertaken by relatives, solicitors/appointees. The home has an activities co-ordinator who has responsibility for the daily activities in the home. Residents are encouraged to attend these activities, however, the element of choice is always taken into consideration and it is the residents’ choice if they wish to participate. The local vicar visits the home on a weekly basis to hold a service for those wishing to participate. The food is prepared daily and the home has a varied choice of meals, which showed a balanced and varied menu. The tables were attractively laid and the meals are unrushed and residents were full of praise for the meals. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 10 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): 16,17,18. Residents are safeguarded from abuse by the policies and procedures of the home and the training received by all staff. The complaints procedure has time limits for investigating a complaint and every complaint is thoroughly investigated and the outcomes acted upon. EVIDENCE: The home has a complaints policy and procedure, which is clear and easily understood. A copy of the procedure is displayed on the home’s notice board near the entrance. A record of complaints and compliments is kept and the outcome recorded. All service users who wish to participate in the elections have a postal vote. The residents needing an advocate have access to one and there are leaflets in the home about the service in the home. The home has a written policy and procedure on abuse which all staff receive training to help them understand and act upon if they see any abuse taking place. Staff, also receive training in whistle blowing. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 11 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): 19,20,21,22,23,24,25,26. The home provides a pleasant and safe environment for all residents. EVIDENCE: The home was clean and tidy at the time of the unannounced inspection and the inspectors were welcomed on their arrival. The home is well maintained by the handyman who deals with the general repairs. The grounds were in good order for the time of year. The residents have access to all parts of the communal area and their private part of the home by the provision of lifts, ramps and handrails. The toilets and bathrooms have grab rails for those needing to use them. The residents’ bedrooms seen were domestic in character and personal items displayed e.g. photographs and their own easy chairs. There are no shared bedrooms in the home. Nineteen bedrooms have en-suite facilities. A loop system provided for those residents who wear a hearing aid. There are hoists available for those residents who have a need to use one; these hoists are regularly serviced every six months Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 12 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): 27,28,29,30. Staff with the appropriate qualities are recruited and trained to enable them to have the skills to undertake their roles. EVIDENCE: The staff receives a high standard of training to give them the understanding and skills to care for some highly dependant residents. The care given to residents suffering from dementia is especially commended and the staff working in those units ware seen to be very caring, as were all the staff working at the time of the inspection. The rotas seen during the inspection provide the home with enough staff to meet the assessed needs of all residents. The manager was advised to provide all members of staff with the General Social Care Council’s Code of Practice. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 13 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): 31,32,33,34,35,36,37,38. The home is run with the safety and interests of the residents as a priority. EVIDENCE: The Registered manager of the home is a Registered Nurse, holds a Level 4 NVQ in Care Management and has completed and passed the Registered Manager’s Award. The home has a Quality Assurance System, which reflects the views of the residents and their relatives/advocates on the care they receive in the home. The inspector advised a copy of the published outcome of the survey should be sent to all those completing the questionnaire. A copy of the results could also be displayed in the entrance hall. The company accounts were not inspected at this inspection but are audited by Mr. J. Hovey of the Cedamore Housing Association. The home’s set of policies and procedures, which are regularly reviewed, were found not to be dated. The certificates of service for the safety systems e.g. gas appliances, the fire alarms and the gas and electric systems were seen and found to be up-to-date. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 14 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 3 3 Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 15 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard OP29 OP33 OP33 Good Practice Recommendations All staff should be given their own copy of the GSCC Code of Conduct. The Policies and Procedures of the home should be reviewed and date annually. A copy of the results of the Quality Assurance Survey should be given to all those who completed the forms. Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 16 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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. Extracts may not be used or reproduced without the express permission of CSCI Beechmore Court DS0000006912.V265620.R01.S.doc Version 5.0 Page 17 - 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. 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