Inspection on 19/02/07 for Beechtree House

This inspection was carried out on 19th February 2007.

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

Other inspections for this house

Beechtree House 19/11/08

Beechtree House 20/05/08

Beechtree House 03/12/07

Beechtree House 06/01/06

Beechtree House 29/04/05

Beechtree House 20/10/04

Beechtree House 23/06/04

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

CARE HOMES FOR OLDER PEOPLE Beechtree House Beech Tree House 62 Buckland Road Maidstone Kent ME16 0SH Lead Inspector Michele Etherton Key Unannounced Inspection 10:00 19th February 2007 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 Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechtree House Address Beech Tree House 62 Buckland Road Maidstone Kent ME16 0SH 01622 752047 01622 752047 kupendrarajah@aol.com 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) Beechtree House Ltd Mrs Pauline Peters Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Shared rooms to be occupied by married couples, siblings or those where it is evidenced that it is in their best interest to share. 6th January 2006 Date of last inspection Brief Description of the Service: Beechtree house is a care home for 24 service users. The home’s registration has changed to one offering a service to older people with dementia. As a consequence there is at present a mixed group of both elderly frail and elderly people with dementia. The property is a Georgian house that has been extended and adapted to become a residential home. The accommodation is arranged on three floors and is mechanically accessible by way of a passenger lift. The majority of bedrooms are single occupancy, there are two shared bedrooms and most rooms have en-suite facilities. There are three bathrooms with one having an assisted bath. There is also a wheel-in shower facility. The home has a garden and limited parking facilities. Street parking is available but limited to two hours. The home is within walking distance of amenities such as a shopping centre, post office, railway and bus station and river walks. A copy of the inspection report is available to read at the home on request. Fees for this service range between £400 and £450 (price increase pending) depending on status and assessed needs. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of this service has taken account of information received by CSCI and feedback from a range of stakeholders including service users, relatives, health and social care professionals. All key standards have been inspected in addition to others where previous requirements or recommendations were in place or feedback received has raised issues of concern. A site visit of the home was undertaken on 19th February 2007. The site visit commenced at 10.00 a.m. and finished at 16:10 p.m. The site visit comprised time spent speaking with some service users, relatives, the manager and staff. A tour of the premises was undertaken and a review of documentation including samples of user plans, medication records, staff personnel and training records, accident reports, the fire book, menus and activity information were also viewed. Owing to difficulties in engaging with some service users because of their needs and communication issues, judgements as to their quality of life were made from observations, speaking with staff and relatives, assessing feedback from other stakeholders and looking at records. What the service does well: The owner is continuing to invest in improvements within the home and in the development of the staff team. The home is committed to the training and development of staff and has implemented good systems for the supervision and assessment of staff competency. The manager is well informed and aware of changes in legislation and guidance. The manager ensures that pre-assessment of prospective service users are supported by joint assessment information and that the home is suitable to meet assessed needs. The home offers a friendly and homely environment to service users. Relatives and visitors are made welcome. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Omissions of required information within the Statement of Purpose that would be informative to service users are still outstanding. Cleaning schedules need reviewing to ensure the home is kept clean, hygienic and free of unpleasant odours. The home must actively promote good hand washing and infection control by ensuring service users, visitors etc are routinely provided with adequate supplies of toilet rolls, paper towels and liquid soap. Improved detail within user plans is needed to inform staff of how care, health and behaviour needs are to be supported. The development of user medication profiles and individual PRN guidelines would improve current medication arrangements. The development of agreed behaviour guidelines for some service users would ensure consistent and approved practice by staff and safeguard those users affected. Some staff practice fails to demonstrate a full understanding and awareness of individual user needs and the support required. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 7 The home has been asked to review the current fire risk assessment and fire arrangements within the home with reference to the Fire safety Reform order 2005. A review of the provision of ancillary staff, and those tasks currently undertaken by care staff that impact on time spent with service users, has been recommended 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. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, 4,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users have access to information about the home, this would benefit from improved detail in parts. Prospective service users can feel confident that their care needs will be assessed prior to admission to the home. EVIDENCE: The home has an outstanding requirement in respect of the Statement of Purpose and user guide information available to prospective service users. This information has been revised, however, omissions of information required by schedule 1 of the Care Homes Regulations 2001 remain and will need to be addressed. Service user documentation viewed during the site visit provided evidence that the home is undertaking pre-admission assessment of prospective service users. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 10 The Home has its own assessment tool and this was evident within the file, however information recorded on this was insufficient in itself to enable the home to make an informed decision that it can meet users needs. The manager is aware of this and has advised that she ensures that this information is now routinely supported by a professional joint assessment from the funding authority prior to any decision being made to admit. As a consequence of this decision it is unlikely that the home would be able to admit emergency placements and this should be reflected in the statement of Purpose. The manager also meets all prospective service users. In the case of privately funded service users who may not be in receipt of a professional joint assessment of their needs, the home will need to ensure that they complete fully their own assessment information in order that an informed judgement can be made as to whether assessed needs can be appropriately supported within the home. The home does not provide an intermediate care service and is not resourced to do so. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care and healthcare needs of service users are not always met. Service users can however be confident that their privacy and dignity are upheld and supported by staff. EVIDENCE: In response to a previous recommendation the home manager advised that further improvements have been made to the individual service user plans, including the development of person centred planning. A small sample of plans were viewed during the site visit, these highlighted that detail around the support required from staff in respect of care, health and behavioural needs of service users, is still insufficient to adequately inform staff of the support they need to provide. There is still some reliance on verbal information around individual routines being passed between staff. The home is required to ensure that all information relating to health and care needs and the support to be provided are clearly recorded in the user plans. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 12 Feedback received from Social Care and health professionals supported concerns that health care advice is not being incorporated routinely into user care plans, and that staff are not always aware of how individual service user needs are supported. “A carer was observed putting sugar into a client with diabetes tea, they should have known this was wrong and were surprised when this was pointed out to them” “The staff member at the review was telling me something quite different from the manager about how this persons finances are managed, I found it very confusing” Feedback from the majority of service user and relative’s responses indicated overall satisfaction with the home. “I can’t find a fault about this place, If I had to go anywhere I would choose this place 100 no doubt about it” “She has been well looked after so far and staff are very caring” Service users and relatives confirmed access to routine health care appointments, appropriate assessment of risks in respect of nutrition, moving and handling, mobility and skin integrity were also noted in user plans. Weights are being recorded regularly. Whilst there are no indications that health care needs are not being met, feedback from a range of health care professionals has highlighted concerns at the ability of some staff to put into practice effectively what they have learned through training and from awareness of individual user health care needs, and as such the welfare of service users may be compromised. The manager has introduced competency assessments for some care practice and will need to ensure that the concerns raised by health professionals, are addressed within these. The home is committed to ensuring all care staff are trained in the administration of medication and there are plans that staff will also undertake a more advanced training course. At present only senior staff are administering medications. Staff competency assessments are planned for medication administration following training. Storage arrangements for medications are appropriate. A sample of medication records were viewed at the site visit and were found to be completed correctly. It is recommended that the home develop individual medication profiles for service users, and individual PRN medication guidelines should the use of this increase. Feedback received from a visiting GP indicated that medication is being administered appropriately in the home. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 13 Discussions with staff indicated an awareness of privacy and dignity issues and how this is incorporated into care routines within the home. Shared rooms now have ceiling track screens for added privacy. Relatives confirmed that service users wear their own clothes. On the day of the visit all the service users observed and spoken with were dressed appropriately and by choice and their personal appearance was good. Feedback from some health care professionals indicated this is not always their experience when visiting the home, although they have not raised these concerns with the manager and need to do so. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported and enabled to exercise choice and control in their daily routines and maintain links and contacts with family, friends and the local community where these exist. EVIDENCE: An activities list is displayed in the home. Staff supported activities are arranged three days per week. Staff were observed during the site visit facilitating a bingo session for residents and this was in keeping with the activity list. Staff reported that they have access to a range of activity materials, and have sought advice regarding appropriate activities from a Care professional specialising in Dementia care. Participation is by choice, residents spoken with stated that they are content with the things they do at present, with some also maintaining their own interests and hobbies in addition to activities within the home. “I’m quite happy day and night” The girls are good here on activities all the time” Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 15 “ I enjoy being her and the staff are really nice” Feedback from some relatives and social care professionals expressed concerns as to whether there is enough stimulation within the home. Observation of residents indicated that many remain in their arm chairs for lengthy periods and it is strongly recommended that activities are reviewed and consideration given to providing more opportunity for mild physical exercise within the activity programme either on an individual or group basis. Service users and relatives spoken with were happy with the visiting arrangements, which they found flexible. “Whenever I visit the home has a friendly family atmosphere with residents and staff appearing happy” Residents have access to the local priest for religious services and support. Service users are encouraged to participate in their daily routines and are encouraged to make choices. None of the present residents manage their own finances or medication. Whilst many residents within the home do have the onset of dementia and are disorientated some of the time, diagnosis does not determine capacity. The home must ensure that in respect of determining whether a service user is competent to manage money, finance, keys etc they must make reference to the Mental Capacity Act 2005 and assessment of capacity. Service users and relatives reported that they are generally satisfied with the variety, quality and quantity of food provided. The chef was observed speaking individually with residents to get their preferred choice of meal and has an awareness of individual preferences and dietary needs. The lunchtime meal was taken in the dining room, which is accessed by a lift. Portion sizes observed were good. Service users and a relative spoken with were particularly happy with the provision of little cakes and snacks provided by the chef in the afternoons. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and relatives feel listened to and that their concerns will be acted upon. Service users are protected from abuse and exploitation through the implementation of policies and practices within the home EVIDENCE: There is a complaints procedure. This is referred to within the Statement of Purpose and user guide information pack but would benefit from providing a copy of the full procedure. Feedback from service users and relatives indicated that the majority were aware of the complaints procedure. Pre-inspection information received from the home indicates that no complaints have been received by the home; this was still the case at the site visit as advised by the manager. Relatives indicated that the home was responsive to any issues of concern they raised, and concerns were normally addressed promptly at an early stage. Two adult protection alerts were raised and closed last year. Two staff members spoken with had an awareness of adult abuse issues and had received training. The training matrix indicates that all care staff receives POVA training, and the manager confirmed this is provided annually. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 17 The home has established behaviour guidelines for one client and it is strongly recommended that the home consider developing them for other users where sexualised or aggressive behaviours are exhibited from time to time. In those cases where staff are using techniques to diffuse situations for specific users, this should be clearly recorded in user plans. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and safe environment that will benefit from the planned programme of upgrading. Improvements are needed to existing cleaning schedules and infection controls. EVIDENCE: Décor and furnishings within the home are worn and in need of replacement and upgrading. The manager advised that a planned programme of upgrading is due to commence in April 2007 and will address many of the current shortfalls in the standard of accommodation. The home has a maintenance man two days per week who undertakes minor repairs. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 19 The manager demonstrated an awareness of recent changes in fire legislation and was recommended to discuss the current fire risk assessment and evacuation plan with the fire officer. Requirements issued by the fire officer last year have been completed as advised by the manager. Fire equipment and testing are well maintained; the manager was advised to ensure all staff participate in at least two fire drills annually. Communal areas were comfortably furnished, providing a range of seating. These areas have a pleasant atmosphere but will benefit from redecoration and refurbishment, with some furnishings needing replacement. There is a patio and lawn area to the rear of the home that has recently been updated. Aids and adaptations were noted in the home and these are being serviced appropriately; the home should ensure that wheelchairs are also serviced on a regular basis. The home has adequate lavatories and washing facilities, providing walk in shower and assisted bath facilities. Bedrooms viewed with resident’s permission were furnished in accordance with standard 24 although it was noticeable that the quality of furnishings and personalisation was dependent on whether families are actively involved. Where this is not the case the home should make greater efforts to help service users to personalise their bedrooms. Service users do not routinely hold keys to their bedrooms, the reasons for this are not clearly recorded in user plans. In shared rooms, ceiling tracks have now been fitted for curtain screening to allow greater privacy. The choice and colour of curtains has impacted on light levels in these rooms, and when these are due for replacement the home should consider choosing lighter colours. Occupancy of shared rooms is now discussed with the GP to ensure compatibility of needs. The home has now completed a programme of guarding all radiators in the home. On the day of the site visit the home was clean but there was an underlying unpleasant odour throughout the home and this was discussed with the manager. Feedback from service users and relatives has not indicated any concerns re overall cleanliness in the home, although one relative did comment on the odour. Feedback from health professionals has indicated a concern at the standard of cleanliness within the home and there was a view by some that this has deteriorated. A tour of the premises highlighted that toilet rolls and hand towels were not in evidence in client bathroom and wash areas, and liquid soap was not available Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 20 in one. It was made clear these would not usually be provided until the cleaner had visited these areas. It is a requirement that the home reviews current cleaning schedules and cleaning hours available to ensure that the home is kept clean, hygienic and free from offensive odours. The home must ensure that service users and visitors have access to toilet rolls, paper towels, and liquid soap routinely to promote good hand washing and infection control. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 21 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. Staffing levels are inadequate for the current number and dependencies of service users; insufficient ancillary staff compounds this. The home has a commitment to the training of staff, but must ensure that all staff put into practice the knowledge and skills they have learned. Service users are protected by the home’s implementation of a robust recruitment procedure. EVIDENCE: Feedback from some health professionals has expressed concerns as to whether there are always an adequate number and competency of staff on duty. Feedback from relatives and service users has highlighted no issues in respect of staffing levels. Discussion with the manager and staff indicated that at weekends care staff have additional cleaning responsibilities as well as laundry duties, and on Sundays this also means additional cooking duties. The manager felt that staffing levels were sufficient for the number and dependency of service users, staff spoken with felt that staffing levels were better than previously. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 22 A calculation of staffing hours using the residential forum staffing guidance, and taking account of the nature of the environment and the dependencies of the service users as advised by the home, indicates the home to have less care staff hours than it should. The home is required to review care and ancillary staff hours. Clearly concerns by health professionals about availability of staff may be linked to their need to undertake other ancillary roles within the home and the deployment and supervision of staff generally. The home has demonstrated a commitment to the training of staff and has now achieved more than 50 of staff trained to NVQ2 and above; further staff are registered to undertake the course. Clearly the staff’ are being provided with training opportunities and competency assessments are being undertaken by the manager and deputy, however, there are issues as to whether some staff are able to put into practice what they have learned. Experiences reported by some health professionals is that this is not the case. The manager must undertake to communicate with health professionals and encourage feedback from them to improve the quality of support provided to service users A sample of staff files were viewed and documentation within them was in keeping with schedule 2 of the Care Homes Regulations 2001. Discussion with a new member of staff regarding the recruitment process and a review of files confirmed that appropriate vetting and checks are carried out. The manager had an awareness of the skills for care training programme and has appropriate work books for use with existing staff and those new to care. All care staff are currently undertaking a college VRQ course in Dementia, infection control and medication. The manager is also undertaking competency reassessments of staff. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 23 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health safety and welfare of service users is not always protected and promoted by the home. EVIDENCE: The manager was up to date and well informed about recent changes in legislation and care staff training. She was well organised and able to respond knowledgeably to all questions. The manager demonstrates a commitment to the training of staff and was supportive of their efforts with service users. She had a good awareness of the needs of all the service users. The manager must however, ensure that information about the needs of the service users is fully Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 24 recorded and the reliance on verbal information should cease, as this practice does not ensure that the needs of the residents are being met. The manager has introduced staff competency assessments and supervisions that have recorded observation of practice incorporated into them. The manager needs to ensure that staff maintain ownership of supervision and that they feel supported by the process. The manager also needs to ensure that staff put into practice the training they have received and that there are adequate numbers of staff on duty to meet the needs of the service users. Staff reported that they felt supported; they confirmed access to staff meetings and those minutes are available to them. Whilst they may not have influence on overall service development, one reported that they felt that issues that had been raised by staff e.g. staffing levels had been taken on board by the home provider and manager. Two residents spoken with confirmed that they have attended resident meetings from time to time but could not recall the frequency; they felt they were asked about activities. The home undertakes quality assurance questionnaires and analysis of these is undertaken by the manager. Evidence of analysis and outcomes was not available. The manager advised that an annual development plan is in place but this was not available to view. This information should be available for inspection. Regulation 26 visits are undertaken. The majority of residents have their money managed on their behalf by relatives, social services representatives or legal representatives. The home invoices for any additional expenditure incurred by residents for hairdressing, chiropody etc. The home manages personal allowance monies for two service users currently and records of income and expenditure are maintained with two staff signatures recorded for all expenditures. Receipts are kept for these outgoings. The current balance held for one service user was checked for accuracy and found to be correct. A good system of supervision and appraisal of staff performance and competency is in place. The manager has indicated within the Pre-Inspection Questionnaire that servicing of equipment and services within the home are all current; a sample of these were viewed at inspection and were found to be up to date. An updated electrical installation certificate could not be found and the home has been requested to provide a copy to CSCI following this visit. As previously mentioned in the report there are concerns that infection controls within the home are inadequate. The underlying odour and reported deterioration in cleaning standards also needs to be addressed. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 25 A current certificate of insurance was on display. Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 26 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 2 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 3 2 2 3 3 3 2 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 2 2 Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4(1)c Sch 1 5(1)b c Requirement The statement of purpose and serviced users guide shall consist of items listed in Schedule 1 and as detailed in the text. (Not met within timescale of 17/2/06) Timescale for action 17/04/07 2 OP7 , 8 15 Service user plans must 17/04/07 accurately and in detail record the health, care, and behaviour needs of individual users and the support to be given by staff The home to review current cleaning schedules and cleaning hours available to ensure that the home is kept clean hygienic and free from offensive odours. The home must ensure that service users and visitors have access to toilet rolls, paper towels, and liquid soap routinely to promote good hand washing and infection control. 17/04/07 3 OP26, 38 16(2) j, K 4. OP27, 37 18(1)a The home is required to review care and ancillary staff hours. 17/04/07 Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that the home develop individual medication profiles for service users, and individual PRN medication guidelines should the use of this increase. Activities programme to be reviewed in respect of activities offered and frequency, consideration also to be given to providing more opportunities for mild exercise It is strongly recommended for the safety and well being of service users and staff that the home consider developing behaviour guidelines for staff to follow for all service users who exhibit sexualised or aggressive behaviours from time to time, and that where staff are using techniques to diffuse situations for specific users this should be clearly recorded, and referred to within user plans. It was recommended that the manager discuss the current fire risk assessment and evacuation plan with the fire officer with reference to the Fire safety reform order 2005. And to ensure all staff participate in at least two fire drills annually. 2 OP12 2 OP18, 38 3 OP19,38 Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beechtree House DS0000050691.V321068.R01.S.doc Version 5.2 Page 30 - 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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