Inspection on 29/04/05 for Beechtree House

This inspection was carried out on 29th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Beechtree House 19/11/08

Beechtree House 20/05/08

Beechtree House 03/12/07

Beechtree House 19/02/07

Beechtree House 06/01/06

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 62 Buckland Road Maidstone Kent ME16 0SH Lead Inspector Maria Tucker Unannounced 29 April 2005 09:40 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 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 H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Beechtree House Address 62 Buckland Road Maidstone Kent ME16 0SH 01622 752047 01622 752047 Telephone number Fax number Email 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 Miss Pauline Atkins Care Home 24 Category(ies) of Old age (24) registration, with number of places Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Old age not falling within any other category (14). A maximum of 10 with dementia. Date of last inspection 20 Otober 2004 Brief Description of the Service: Beechtree house is a care home for 24 service users, 14 of whom are elderly frail and 10 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 home provides individual care and supervision within their twin and single accommodation, with most rooms having 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 it is within walking distance of amenities such as shopping centre, post office, railway and bus station, and river walks. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The inspection lasted from 9.40am until 1.15pm. Time was spent meeting the manager and responsible individual and going through various records and documentation. About one hour was spent meeting service users. Three staff on duty were spoken with. A partial tour of the premises was undertaken. Due to the nature of some of the service, it is difficult to reliably incorporate accurate reflections of the service in the report. Some judgements about quality of life and choices were taken from direct conversation with service users and observation followed by discussions with staff and evidencing from records held in the home. What the service does well: What has improved since the last inspection? What they could do better: The home must produce a full Statement Of Purpose and Service Users Guide that takes into account the changes made to the home and includes all items required in the Standard, Regulations and Schedule. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 6 Specialist advice for service users who present challenging behaviours needs to be sought on an individual basis and this information must form part of the overall care plan. Continued work on the environment needs to be carried out to ensure and maintain health and safety this includes the laundry floor and finishes, the garden area made safe and accessible and mixer valves on all taps accessible to service users. The home would benefit from a stable support staff team. 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. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 6. Service users do not have all of the information they need to be able to make an informed decision to live at Beechtree house. Service users are offered a placement following assessments, which enable the service users and the home to determine if the home is suitable. EVIDENCE: Service users and their representatives do not have to a copy of the Statement of Purpose and Service Users Guide, as they are not fully completed. A care plan contained a copy of joint health and social care assessment for a recently admitted service user and an assessment conducted by the home, which details the assessed needs prior to service user being offered a placement. The home does not provide intermediate care. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Service users individual general health care needs are monitored and advice sought for support. EVIDENCE: Through discussion with individuals and sharing of care plans, it is clear that service users are given support in accessing health care professionals, including the residential care team and the GP to maintain good standards of health. Not all of the relevant information in the pre assessment has been detailed into the service users care plan. Specialist advice to support staff in managing behaviours for service users with dementia was not contained within care plans. Medication was overall managed well; the metal cabinet used for storing was not fixed to the wall. Staff were seen to be giving out mail unopened to service users, to knock on doors before entering and offering support in a positive respectful manor. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 10 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 standard(s) 12, 15 Service users are encouraged to choose from planned activities or to relax watching the television or listening to music. Regular refreshments are provided offering variety and choice to encourage service users to drink plenty. EVIDENCE: A service user spoken with stated that they had a cup of tea in bed at 6am; another stated that they did not, they had a lie in. Staff support with afternoon activities comments from service uses included “…does a good job”, “Bingo yesterday afternoon, snakes and ladders”. A pictorial activity board with future planned activities and outings were on display to support service users. A dedicated staff member is situated in one of the lounges / dinning area to support service users who require extra assistance. Staff stated that the cook and manager devise the menu. Service users generally agreed that the food was okay, that “it is fish today, it is Friday”. Snacks and hot and cold drinks including milk, squashes and juices are offered at regular intervals service users commented that “supper, chocolate and biscuits”. Service users did not remember if an alternative meal was available. A service user who staff stated was allergic to fish was given sausages. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 11 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 standard(s) 16, 18 Service users and their representatives can feel confident and supported to complain. Protection from abuse is promoted through staff understanding of the adult protection policy and procedures. EVIDENCE: A copy of a complaint made by a relative was received by the CSCI. This was in the process of being fully addressed by the manager, a meeting had been arranged with the manager and registered provider to discuss the issues raised with the complainant. A copy of the Kent and Medway adult protection procedures was on display in the staff area. The home has had an adult protection alert raised since the last inspection that is in the process of being managed by the adult protection coordinator. The manager and the coordinator have made the CSCI fully aware. Following discussions with the adult protection coordinator, given the circumstances and presenting evidence the inspector has made the judgement that the CSCI do not need to become involved. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 12 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 standard(s) 19, 22, 24, 25, 26, Service users live in a warm, clean home that has had many areas improved for their comfort. Individual safety would be greatly enhanced with access to the garden, mixer valves and the laundry floor and finishes impermeable. EVIDENCE: The home has had considerable improvements including the decorating of some areas; a wheel in shower; carpets and curtains. A service user commented that a bathroom that has been painted with a sea creatures “grows on you, you can sit on the loo and meditate”. A quote for work to be undertaken to make the garden area safe and fully accessible was shown to the inspector. A service user stated that “nice to sit outside”. A quote for mixer valves to be fitted was seen. The laundry room floor and finishes are not impermeable. The laundry floor and finishes are not impermeable. A suitably qualified person has not made an assessment of the disability equipment and the environmental adaptations. Advice given by the local social services occupational therapy bureau is that, private care homes are directed to seek a qualified private OT facility through the, College of Occupational Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 13 Therapists, 106 – 114 Borough High Street, Southwark, London, SE1 1LB, telephone, 02073576480. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, Service users benefit from the extra staffing support provided, allowing a higher level of individual attention. EVIDENCE: The home has a 4 staff in the morning and 3 staff in the afternoon with 2 waking night staff. Extra staffing for house keeping and cooking is employed. A dedicated staff member remains in the lounge to support service users who require extra support and monitoring. A staff member conducts activities in the afternoon, service users detailed some of these activities. The home has had a high turn over of staff in the last year. The staff rota did not accurately reflect all of the exact hours worked. Training has been booked to ensure that the skill mix of staff supports those service users with dementia. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 38, Service users support and care needs are encouraged through the registered managers open leadership and the continued promotion of a safe home and working environment. EVIDENCE: The manager has completed NVQ level 4 and is awaiting verification. The home has a head of care who supports the running of the home. Since coming into post the manager has demonstrated her commitment to ensuring that the home is run and managed effectively and transparently through the implementation of policies and procedures and in working with the registered provider and outside agencies such as the CSCI and health professionals. A letter from the quality support advisor (Kent Care Homes Association) following a visit to the home in respect of the home application for membership of Kent Care Homes Association stated that “speaking with the manager I feel confident that, given time, this will become a home in which residents receive an excellent level of care from a well trained and motivated staff group” and commented that they would be happy to offer advice concerning quality Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 16 assurance. The home has consulted the Environmental Health Officer regarding the re-designing and new equipment in kitchen. Systems were in place to prevent the spread of infection, this included wall mounted hand hygiene gel, gloves and aprons and a sink in the dinning area. Maintenance work continues to be undertaken to provide a safe secure environment. As stated earlier the home would benefit from an assessment by a suitably qualified person such as an occupational therapist so that guidance and support can be offered to ensure that the home is tailored for the specific needs of the service user group. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 3 2 x 2 x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 2 x x x x 3 Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 18 Yes Are there any outstanding requirements from the last inspection? 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 OP 1 Regulation 4 (1) (a) (b) (c) (2) 5 (1) (a) (b) (c) (d) (e) (f) 2 Requirement The registered person shall compile in relation to the care home a written statement (in these regulations referred to as the statement of purpose) which shall consist of, a statement of the aims and objectives of the care home;a statement as to the matters listed in Schedule 1. The registered person shall produce a supply a copy of the Commission and shall make a copy of it available on request for inspection by every service user and any representative of a service user. The registered person shall produce a written guide to the care home. The registered person shall make arrangements for the safe keeping of medicines received into the care home. The registered person shall ensure that all parts of the home to which service users have access is as far as reasonably practicable free from hazards to their safety, in that mixer valves are fitted and that further radiator guards are to e Timescale for action A full version to be received by the CSCI by July 30th 2005 2. OP 9 13 (2) 3rd June 2005 3rd June 2005 3. OP 25 13 (4) (a) Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 19 implemented. 4. OP 26 13 (3) The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infections in the care home, in that the laundry floor and finishes are impermeable and these and wall finishes are readily cleanable. A copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked. In that all hours worked must be recorded. Advice sought by the EHO by 3rd June 2005. 5. OP 27 17 (2) Schedule 4 3rd June 2005 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 OP 7.2 Good Practice Recommendations It is strongly recommended that the care plans be more specific in detailing the service users individual needs, which relate to the assessments, to ensure that all aspects of the health, personal and social care need of the service users are comprehensive for staff able to follow. It is strongly recommended that specialist advice be sought to enable staff to support service users with dementia in managing some behaviours such as wandering; verbal agression and refusing personal care. It is recommended that the garden area is made safe and fully accessible. It is strongly recommended that the home has an assessment by a suitably qualified person and that the recommended disability equipment has been secured or provided and enviornmental adaptations made to meet the needs os the service users. It is strongly recommended that in the absence of service users own provision, furnishings for individual rooms are provided as listed in standard 24.2 and that each room is assessed as fit for purpose and that this be clearly recorded in the care plan. It is strongly recommended that freestanding screens be replaced with over-head tracking H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 20 2. OP 8 3. 4. OP 19 OP 22 5. OP 24.2 Beechtree House 6. OP 33 screens. It is recommended that the home develop further their quality assurance and quality monitoring systems based upon seeking the views of the service users and to measure suscess in meeting the aims, objectives and statement of purpose of the home. Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Beechtree House H56-H06 S50691 Beechtree House V223841 290405 Stage4.doc Version 1.30 Page 22 - 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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