Inspection on 20/05/08 for Beechtree House

This inspection was carried out on 20th May 2008.

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

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

Other inspections for this house

Beechtree House 19/11/08

Beechtree House 03/12/07

Beechtree House 19/02/07

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Beechtree House Beech Tree House 62 Buckland Road Maidstone Kent ME16 0SH Lead Inspector Gary Bartlett Unannounced Inspection 20th May 2008 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 Beechtree House DS0000050691.V363532.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.V363532.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@btconnect.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 Manager post vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Beechtree House DS0000050691.V363532.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. 28th January 2008 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. It is a detached property 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 £326.33 to £455.00. Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This key unannounced inspection was conducted by Gary Bartlett and Wendy Mills, Regulatory Inspectors, who were in Beechtree House from 9.30.m. until 5.00 pm. Due to the nature of the service provided, it is difficult to reliably incorporate accurate reflections of some residents’ views of the service in the report. Judgements about quality of life and choices were taken from direct observation and by discussion with the owner and staff, inspection of records and a tour of the building and grounds. The home had completed an Annual Quality Assurance Assessment as requested prior to the site visit. This was not completed in detail and was of limited value in informing the inspection process. Assessment was made of progress made in meeting requirements and recommendations made at a random inspection conducted on 28th January 2008. The report of the random inspection can be made available on request to the provider or the Commission. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as “service users”. People living at Beechtree House prefer to be referred to as “residents”. Accordingly this shall be done in the text of this report. What the service does well: What has improved since the last inspection? Staffing levels are appropriate for the current number of residents living at the home. There are better contingency plans to maintain staffing levels in the event of emergencies. An Activities Co-ordinator is employed for 15 hours per week. A maintenance person is now employed for 20 hours per week. Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 6 The dining room has been redecorated. Most staff have had POVA training. The acting manager has had training in staff supervision. The office is more organised. Residents are offered a more appropriate choice of meals and it is better understood how those choices are made. The kitchen has been equipped with a new steriliser. 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 Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechtree House DS0000050691.V363532.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.V363532.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): 3, 4 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Beechtree House has a pre-admission procedure so that appropriate people are admitted to the home. EVIDENCE: It was established at the last site visit that there is a procedure for making assessments of prospective residents. This is necessary to be sure the needs of the prospective residents are likely to be met. Prospective residents and their supporters are welcome to visit the home, meet staff and other residents and view the proposed bedroom and facilities. The procedure remains untested as the local authority contract with the home is suspended and no new residents have been admitted. As detailed later in this report, entries made in care records demonstrate that staff do not have a detailed understanding of dementia. This is not the Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 10 situation that would be expected in a residential home registered to provide specialist support. Intermediate care is not offered at Beechtree House. Beechtree House DS0000050691.V363532.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): Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans must be more comprehensive and consistently maintained to promote residents’ health and welfare. Residents are put at risk by the unsafe management of residents’ medicines. It is not evident the home always obtains professional health care support for residents when needed. EVIDENCE: Each resident has a care plan. Four plans were inspected in detail. Since the last inspection the plans have been developed to identify care needs but the information is generally not very detailed or specific. Work has been done in obtaining some good life histories but the information is not used in the planning of care. For example, the life histories of two residents showed they Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 12 had held strong religious beliefs. There is not evidence the home has sought spiritual support for these people. Indeed, one part of the care plan notes “No interest”, which contradicts the life histories. The life history written by a resident’s relative clearly notes his military background. However, no reference is made to this in other parts of his care plan, including the activities plan, where at the very least one would expect to see suggested conversation prompts. The care plans are a composite of parts gathered from different sources and do not present a cohesive document. Consequently, information is fragmented and is not presented in a readily available format. Some records indicate a there is a lack of understanding of dementia throughout the staffing group of the home. For example, competent management would have addressed deficits in entries in a resident’s behaviour monitoring charts where staff have not identified the antecedents and not recorded adequate assessments and forward plans. More care needs to be taken in the completion of care records. Some entries are not dated or signed. Some care plans do not have a photograph attached, even on the missing persons form. It is evident from the care plans the home is monitoring that residents’ weight and food intake but there is poor recording of action taken when needed. The weight-monitoring forms used do not prompt staff to do this. During the inspection, it was apparent that one resident did not eat breakfast or lunch but there was no evidence to suggest management of this situation. This particular resident’s nutritional monitoring form was missing on the day of inspection. Whilst there is evidence of good basic personal care and records indicate residents are registered with GPs, there is not much evidence of other health care professionals such as dentists, psychologists and psychiatrists being involved. The multidisciplinary review sheets in the care plans seen are blank. There is little evidence that risk assessments are written or reviewed as a result of incidents or changes in residents’ welfare. At the Random Inspection conducted on 28th January 2008, the Inspector recommended the time as well as dates should be noted on falls monitoring charts so that patterns could be established. This is still not being done. Most daily records are not informative and included repeated negative statements such as “no behavioural problems” and “no health issues”. (The latter entry was used for a resident whose other records indicate there was an issue at that time). There is poor and subjective recording of incidents of challenging behaviour. Daily records rarely make positive comments about residents’ experiences. A cross-check between the daily records and the Medication Record Administration Record (MAR) sheets reveals contradictions. The MAR sheet for one resident shows they refused their medication on 12th May 2008. The daily care record for this date states all medication taken this Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 13 morning. There are other examples of inconsistent and contradictory recording. Residents’ medicines that are not in included in the monitored dosage system are stored together in a cardboard box in a room that is also used for keeping cleaning materials and foodstuffs. The temperature of this room is not being monitored. These arrangements do not comply with current Royal Pharamaceutical Society guidelines and puts residents at risk. Some Medication Record Administration Record (MAR) sheets were inspected. Where there are changes to prescribed medication, for example, four times daily altered to PRN, these changes are not being signed or dated in most cases. This is generally around the administration of laxatives and pain control. On some records “R”, (refusal), is noted consistently for pain-relief and laxatives. There is not always clearly recorded pain monitoring that is should be done with the regular refusal/non administration of pain control. Nor are there risk assessments or guidelines/strategies in regard to the refusal of medication. This could mean that residents requiring pain control are not getting the help they need. The acting manager was unable to produce a clear record of which staff had been trained and authorised to dispense medication or a specimen signature book. This places residents at risk. From observation, residents are treated with respect and staff talk with them in a kindly manner. Beechtree House DS0000050691.V363532.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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides some activities for residents. More meaningful activities must be provided so residents are able to maintain the abilities they still have and do not lead boring and uninteresting lives. Residents enjoy the meals which are of good quality. EVIDENCE: Beechtree House cares for people with varying degrees of dementia and lifestyles can be very challenging for some. Residents are offered choices where practical. When choice is not possible, support given should take into account each resident’s known preferences and sensibilities. As mentioned previously in this report, information contained in residents’ life histories are not being used to do this. Since the last key inspection, the owner has appointed his daughter as activities co-ordinator for 15 hours per week. The activities co-ordinator is enthusiastic, clearly enjoying the work and is kind and caring towards the residents. Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 15 The acting Manager stated there are now more activities in the home and lots of resources (books, puzzles etc). These were not seen in use on the day of inspection. There has been an outing to Folkestone, for which the home hired a mini bus. To date, there has not been specific training in providing meaningful activities for people with dementia. As detailed later in this report, it is very difficult for residents to wander independently around the home. This increases the necessity for the provision of appropriate activity and stimulation. The hairdresser was in the home on the day of inspection and several residents were enjoying the “hair do” sessions. One resident has religious support and receives communion in the quiet room where there is a small statue of the Virgin Mary and a New Testament. Records indicate that at least two other residents might benefit from this. The acting manager says visitors are welcome at any time. A notice in the lobby states that normal visiting hours are from 9:00 am until 8:00 pm unless other arrangements are confirmed in writing by management. A less rigid policy would better promote individual independence. The home has a new cook who used to be the laundry assistant/carer. She clearly enjoys her new role and engages well with the residents. There are four weekly menus and are varied. Residents are offered a more appropriate choice of meals and it is better understood how those choices are made. There is plenty of fresh produce in the refrigerators and freezer. Bills from a local butcher indicate purchases of good quality meat. The dry food store has variety of tinned goods and preserves. The meals seen were well presented and looked appetising. Two residents spoken with said the food in the home is “very good” and “it is just like being in a club here, I wouldn’t want to go anywhere else”. Meal times would be more relaxed and pleasurable occasions for residents if staff do not vacuum-clean in the vicinity of residents whilst they are eating their meals. The owner and acting manager expressed surprised when told this is happening. Beechtree House DS0000050691.V363532.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 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable those living and those visiting the home to raise concerns or complaints. Inadequate safeguarding adults procedures and practices place residents at risk. EVIDENCE: It was established at the last key inspection that the home has a complaints procedure with an appropriate recording system. The Annual Quality Assurance Assessment indicates there have been two complaints received by the home in the last twelve months. One was not upheld and the other is still being investigated. The acting manager said any complaints received would be recorded along with the outcome of investigation and a record of any resultant action taken. These records were not inspected on this occasion. The home’s policy on adult abuse and protection could not be found on the day of inspection. Since then, it has been forwarded to the Commission as required. It makes no mention that the local authority is the lead agency in safeguarding alerts and does not demonstrate a sound understanding of procedures by the author. The document is not dated or signed. Most staff have had POVA training recently and the acting managers says it is arranged for the remaining staff. There are currently Safeguarding Adults alerts open in Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 17 respect of Beechtree House. Discussion with the owner does indicates he does not have a sound understanding of good safeguarding adults procedures. It is evident there has been undue delay in initiating formal disciplinary action in respect of a staff member. Some staff have expressed a lack of confidence in being listened to and feel they can not complain. Residents are placed at risk through these paucities in practice. Beechtree House DS0000050691.V363532.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 and 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 generally comfortable environment that would benefit from a planned programme of refurbishment and redecoration. Residents’ quality of life would be improved if they had safe access to the garden and space to wander independently. EVIDENCE: Beechtree House is built on two levels with a shaft lift. The lift has been problematic. Indeed, one of the Inspectors became stuck on top floor when the lift door would not open. Records confirm that the lift was out of action for a significant period over the Christmas period. This is clearly detrimental to the welfare of residents reliant on the lift to get around the home. Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 19 A maintenance person is now employed for 20 hours per week and there have been some environmental improvements since the last inspection. For example, the dining room has been redecorated. There is not a written development plan for the redecoration/refurbishment of the home and there are a number of areas in the home where the décor is tired, the furniture and carpets are stained and the lighting poor. Some window frames are looking shabby and in need of painting/replacement. Access to outside space and small rear garden is unsafe. It is steeply sloping with a very narrow concrete path. Consequently, residents are not able to get fresh air or go out independently. Had it been possible for a resident to gain ready access to the garden it may have assisted attempts to de-escalate a situation in which physical restraint was used. Mr Kupendrarajah has obtained quotes for a stair lift to allow access to the rear garden. He says that this will be in situ by end of June 2008. The hairdresser visits regularly and the home makes the bathroom close to the lounge available to her to use. Whilst this is conveniently close to where most residents spend their time and facilitates some friendly chat, it means residents’ cannot readily access the toilet in the bathroom at such times. It is recommended an alternative room is provided for use by the hairdresser. Staff say that bathing facilities are adequate. The “main” bathroom is the only one fitted with a lifting hoist. The side-panel of the bath has some sharp edges where it has been damaged. This must be replaced to avoid the risk of injury. Infection control is generally better maintained in the home but would be further enhanced if all staff observed good practice guidelines in regard to wearing appropriate protective aprons when entering the kitchen. Mr Kupendrarajah undertook to ensure staff followed procedures and that this did not happen again. This negated the need to issue an Immediate Requirement Notice. Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are caring but there is not evidence they have the skills to deliver specialist dementia care, this compromises the care of residents. EVIDENCE: Recent months have been unsettled for the staff with there being some staff turn-over. Consequently, the home is reliant on day staff and agency staff to fill the gaps in the staffing roster. There are improved contingency plans to ensure there are satisfactory staffing levels in the event of staff sickness and other unforeseen circumstances. People applying to work at the home have to complete an application form, attend an interview, provide references and satisfactory POVA and CRB checks. The files of the most recently recruited staff show that appropriate checks are made prior to them commencing duties. The owner was advised that the staff application form should be updated to comply with current employment legislation and facilitate the recording of a full employment history as required by Regulations. New staff are required to undertake an induction programme. Agency staff are given an induction when they first work at the home but it is not recorded. Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 21 Since the last inspection, some training has been made available to staff, for example POVA. Staff confirm they have received “quite a lot of training recently” and say they feel there are adequate staffing levels in the home. However, as stated earlier in this report, it is not always evident from records that staff have the skills to meet residents’ more complex care needs. The staff rosters seen indicate staffing levels are geared to peak times of activity. The staff rosters do not indicate a nominated person in charge each shift when a senior is not on duty. This should be done to clarify lines of responsibility. Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ best interests, safety and care are seriously compromised by the home’s poor management and administration. EVIDENCE: Beechtree House is presently without a manager, the last manager having left in June 2007. An acting manager is in post. This person is currently undertaking the NVQ at level 4. It is recorded in recent Kent County Council Adult Protection minutes that some health care professionals and some of the home’s staff do not have confidence in the current management arrangements. Specialist healthcare advice has not always been sought when required and advice given has not always been followed. Relevant agencies have not always Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 23 been kept informed of incidents at the home. This inspection does not dispel those views, identifying deficits in care planning and record keeping, a lack of evidence of proper reviews, a lack of action where required, a propensity to blame staff and an apparent limited understanding of dementia care. The home had completed an Annual Quality Assurance Assessment as requested prior to the site visit. This was not completed in detail and was of limited value in informing the inspection process. The owner said nobody working at the home is an appointee for any resident and the home holds small amounts of cash for two residents. There have not been any concerns raised about the home’s handling of residents’ monies. The last key inspection identified there are adequate quality assurance systems in the home. The standard of cleanliness in the kitchen and surrounding area is satisfactory. The kitchen has been equipped with a new steriliser. Plated meals should be covered when carried from the kitchen to promote food hygiene and to keep the meals warm. Staff spoken with have a sound understanding of emergency procedures. However, records indicate that staff have not had the required fire training/drills since 1st April 2007. Mr Kupendrarajah said a Fire Safety Advisor is due to visit Beechtree House on 24th May, 2005 to review fire safety systems and to write a fire-risk assessment. Staff files are being updated to ensure they comply with Regulations and are well organised. Criminal Record Bureau (CRB) checks are not filed in accordance with recommendations, the owner was advised to obtain guidance from the CRB. website. Some personal information about residents is recorded collectively in the home’s communication book, thereby potentially compromising confidentiality. The acting manager has recently undertaken training in supervision and is implementing arrangements to ensure all staff receive the supervision necessary to ensure good standards of care practice. Mr Kupendrarajah stated that all records of maintenance and safety checks are up to date. These were not inspected on this occasion. Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 2 2 X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 3 2 2 2 Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14(2)(b), 15(2), 17 Schedule 3, Schedule 4 Requirement The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review in that: 1. Service users’ care plans must be must up to date and based on assessments. 2. Service users’ care plans and records must be specific in detail of information required to show what their care needs are and how they are met. 3. Service users care plans must be regularly reviewed with emphasis being placed on high-risk areas. All service users must have an accurate care plan by the given timescale, if not sooner, which is thereafter maintained. 2. OP7 13(4) The registered person shall ensure that unnecessary risks to the health and safety of service DS0000050691.V363532.R01.S.doc Timescale for action 30/10/08 30/10/08 Beechtree House Version 5.2 Page 26 3. OP8 12(a) users are identified and so far as possible eliminated in that risk assessments, including falls monitoring charts, must be more comprehensive and recorded in response to incidents and changes in residents welfare. Comprehensive risk assessments must be in place by the given timescale, if not sooner, and maintained thereafter. “The registered person shall 30/06/08 ensure the care home is conducted so as to promote and make proper provision for the health and welfare of service users” in that the home’s records must give clear evidence that residents are given the all the support they need from health care professionals such as dentists, opticians, psychologists etc. To be completed by the given timescale, if not sooner and maintained thereafter. “The registered person shall 20/06/08 make arrangements for the recording, handling, safekeeping, safe administration of medicines” in that: 1. The home must ensure all medicines are stored in accordance with current Royal Pharamaceutical Society guidelines. 2. The Medication Administration Record charts must be a true and accurate copy of the prescriber’s intentions and must be a true and accurate record of the medication administered to the service users. 3. There must be recorded risk assessments and DS0000050691.V363532.R01.S.doc Version 5.2 Page 27 4. OP9 13(2) Beechtree House guidelines/strategies for the refusal of medications. 4. The home must have a clear record of which staff had been trained and authorised to dispense medication and a specimen signature book. To be completed by the given timescale, if not sooner and maintained thereafter. “The registered person shall make suitable arrangements to ensure the home is conducted with due regard to the sex, religious persuasion, racial origin, and cultural and linguistic background and disability of service users” in that meaningful activities must be provided by staff trained to do so. 5. OP12 4(a) 30/10/08 6. OP18 13(6) To be done by the given timescale, if not sooner and maintained thereafter. “The registered person must 31/07/08 ensure that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance” in that the adult protection policy must be further developed to ensure all staff must have clear guidelines of the procedure to follow and that the procedures are consummate with the local authority protocols. To be completed by the given timescale, if not sooner, and maintained thereafter. The registered person shall ensure that all parts of the home DS0000050691.V363532.R01.S.doc 7. OP19 13(4) 31/08/08 Beechtree House Version 5.2 Page 28 to which service users have access are so far as reasonably practicable free from hazards to their safety in that the garden and grounds of the home must be accessible to service users and safe for them to use. To be completed by the given timescale, if not sooner and maintained thereafter. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety in that the damaged side-panel of the bath in the main bathroom must be repaired or replaced. 8. OP19 13(4) 31/07/08 9. OP19 23(2)(c) To be completed by the given timescale, if not sooner. 31/07/08 “The registered person shall having regard to the number and needs of the service users ensure that equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order” in that the lift must be repaired so as to function properly and safely. To be completed by the given timescale, if not sooner, and maintained thereafter. “The registered person shall, having regard to the size of the care home, the statement of purpose and numbers and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured DS0000050691.V363532.R01.S.doc 10. OP30 18(1)(c) 30/07/08 Beechtree House Version 5.2 Page 29 induction training” in that the home must be able to produce evidence of an induction programme undertaken by agency staff working at the home. To be completed by the given timescale, if not sooner and maintained thereafter. “The registered person shall, having regard to the size of the care home, the statement of purpose and numbers and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training” in that the home must be able to produce evidence that staff have the necessary skills to provide good care for people with dementia. To be completed by the given timescale, if not sooner and maintained thereafter. The registered provider shall appoint an individual to manage the care home To be completed by the given timescale, if not sooner. “The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users”, in that all records must be made in a manner that preserves confidentialty. To be completed by the given timescale, if not sooner and maintained thereafter. Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 30 11. OP30 18(1)(c) 30/08/08 12. OP31 8(1)9 31/07/08 13. OP37 12(4)(a) 20/06/08 14. OP38 23(4)(d)( e) “The registered person shall 30/06/08 after appropriate consulation with the fire and rescue authority make arrangements for persons working at the care home to receive suitable training in fire prevevtion; and to ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home and, so far as is practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life” in that the home must be able to produce evidence that all staff are attending fire drills/training at least at the frequency required by the Fire Safety Officer. To be completed by the given timescale, if not sooner and maintained thereafter. 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 OP13 Good Practice Recommendations It is recommended the home reviews its visiting policy whereby visitors must have written authorisation by management to visit outside of the “normal” visiting hours are from 9:00 am until 8:00 pm, to be more flexible and promote individual independence. It is strongly recommended staff do not vacuum-clean in the vicinity of residents whilst they are eating their meals so as to make meal times more relaxed and pleasurable occasions. It is strongly recommended the home has a recorded programme for the redecoration and refurbishment of the DS0000050691.V363532.R01.S.doc Version 5.2 Page 31 2. OP15 3. OP19 Beechtree House 4. 5. OP21 OP37 6. OP38 premises. It is strongly recommended an alternative room is provided for use by the hairdresser, to avoid restricting residents’ access to the toilet sited close to the lounge. It is strongly recommended the staff application form is updated to comply with current employment legislation and facilitate the recording of a full employment history as required by Regulations. It is strongly recommended plated meals are covered when carried from the kitchen to promote food hygiene and to keep the meals warm Beechtree House DS0000050691.V363532.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone 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. 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