Inspection on 03/12/07 for Beechtree House

This inspection was carried out on 3rd December 2007.

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

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

Other inspections for this house

Beechtree House 19/11/08

Beechtree House 20/05/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beechtree House Beech Tree House 62 Buckland Road Maidstone Kent ME16 0SH Lead Inspector Sue Gaskell Key Unannounced Inspection 9:00 3rd December 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.V346922.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.V346922.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 Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Beechtree House DS0000050691.V346922.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. 19th February 2007 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 £326.33 to £455.00 depending on status, assessed needs and the service to be provided. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 3rd December between 9.00am and 3.00pm. There were 19 residents living in the home and there are five vacancies. I spoke with 2 residents, the acting manager, the recently appointed head of care (deputy manager) and a senior care assistant. I toured the building and looked at bedrooms and all communal areas. The inspection process also consisted of information collected before and during the visit to the home, including the home’s annual quality assurance assessment. 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 informal observations of residents, speaking with staff and relatives, assessing feedback from other stakeholders and looking at records. The home has been subject to an investigation under the “Kent County Council Safeguarding Adults procedures” since the last inspection and the home has been unable to admit Kent County Council funded clients. This should be resolved in the near future. Whilst there has been a significant improvement in the home recently there are five requirements as a result of this current inspection. What the service does well: What has improved since the last inspection? The statement of purpose, service user guides and contracts have been reviewed. Care Plans and risk assessments have been extended. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 6 Staffing levels have increased and there has been further staff training in dementia awareness and safeguarding adults. The home has commenced a programme of refurbishment and redecoration. There has been a change of manager and management style. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use the service experience good outcomes in this area. The statement of purpose and service user guide says what service will be offered. Prospective residents can expect that their needs will be met This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose and Service User Guide are reviewed and amended regularly and provide residents, prospective residents and their relatives with information about the home. There is currently no information regarding the fees but the registered owner has agreed to amend this immediately. Copies of these two documents are available in large print and are on display in the main hallway. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 9 Six care plan files were examined, including three referring to residents who have been admitted recently since the last inspection. All files inspected include basic pre-admission assessments carried out by the home, some with supporting information from health care professionals or care managers. Several residents relatives confirmed that the residents had visited the home prior to admission and that the manager had also visited them in their own homes or in hospital. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 10 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. The lack of sufficiently detailed daily records may affect the home’s ability to meet residents’ needs. Residents are generally protected by the home’s policies and procedures for dealing with their medication. Residents are able to make choices and are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has a care plan that includes personal and healthcare needs, likes and dislikes, moving and handling assessments and some risk assessments. There has been a considerable improvement to the care plans but they still lack detailed risk assessments and guidelines around specific needs. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 11 Although the daily records are sometimes lengthy, eg because they refer to “care needs 1-5 have been met” , they actually provide little information on what the residents have actually done during the day. Residents have access to local health care services. The local District Nurses and Diabetic Nurse call regularly. Residents are able to choose their own GP and all have access to dentists, opticians and other community services. Residents’ healthcare needs are generally monitored and appropriate action taken. The acting manager said that she seek professional advice on health care issues and on the day of the inspection the paramedics had been called for one resident with a heart condition who had been obviously unwell. There is also evidence in the care plan of monitoring residents’ health care needs and general well being, eg some residents are weighed weekly. The home has a medication policy which is accessible to staff. The medication records are up to date for each resident. There are appropriate records for the receipt, administration and disposal of medication. The place of storage is not ideal but is adequate. The home has carried out risk assessments to judge whether residents may administer their own medication but there are currently no residents where this would be appropriate. There is a training matrix which indicates that staff have received training in administering medication, and staff confirmed that they have attended this training. One member of staff spoke of the need to treat residents with respect and to consider dignity when delivering personal care and staff were seen to assist residents with great sensitivity. Two residents said that they like living care in the home and three residents’ relatives said that the care is good. Although there is an outstanding “safeguarding adults” investigation, local care managers who have regular contact with the home said that there are no other current complaints or issues regarding the home. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 12 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. Daily life generally meets the residents’ lifestyle preferences and expectations. Residents’ choices are respected. Residents have regular contact with their families and friends. Residents receive a nourishing and balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans contain a list of residents’ needs, likes and dislikes and preferences. There was evidence in the residents’ daily records to show that families, and other visitors are encouraged and welcomed. I also spoke with three relatives who visit on a very regular basis. They all said that they are always made to feel welcome and offered refreshments and meals. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 13 Staff said that residents generally get up and go to bed at the time they choose although this is not always possible if they require assistance. One member of staff said that they try to bear in mind which residents like to get up early and which like to stay in bed later when they need to help those residents who require a greater degree of assistance. Residents may take meals in the dining room or in their own rooms. On the day of the inspection one resident was having her meal in the lounge as she prefers this because it is quieter than the dining room. The food served on the day of the inspection appeared appetising and wholesome and the residents said that it tasted good. The manager said that meals provided are mainly based on what residents like, but the home also takes into account the need for a reasonably balanced diet. The store cupboard contained a wide range of food including fresh fruit and vegetables. Nutritional assessments are carried out and residents are weighed monthly. The home employs an activities co-ordinator who works in the afternoons but she said that she is leaving in the near future. Although she keeps a record of the activities offered, such as art and craft, cookery etc., there was no evidence of any supplies or equipment necessary to provide a variety of activities. The manager said that the home currently has no involvement in any residents’ finances as they are dealt with either by families or the local authority finances officers. The acting manager and head of care said that there are no residents at present with different ethnic or cultural needs but some residents have been assisted in following their religious beliefs, The manager also said that residents would be supported with personal relationships whatever their gender or choice of lifestyle. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. Residents’ complaints are recorded and dealt with appropriately and they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of staff have undertaken training in the area of ‘safeguarding adults’ either through attending a specific training course or/and as part of NVQ training. The member of staff spoken to showed a good awareness of adult protection issues. Although the home has started completed “ABC” charts (ie antecedents, behaviours and consequences), in order to record and monitor certain incidents, there are lack of guidelines on how to recognise and deal with the particular issues. The home has a complaints procedure with an appropriate recording system. Relatives said that they would feel comfortable mentioning any problems to the manager or and one relative said that there has been a noticeable improvement recently in getting any issues resolved speedily and without fuss. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 15 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, 24 & 26 Quality in this outcome area is adequate. Residents live in a comfortable environment but there is still an inadequate odour control routine and a need to maintain the programme of refurbishment and redecoration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The building is on two levels and there is a lift and an alarm call system. The home is suitable for people with impaired mobility. All residents but two are in single room accommodation, some of which have en-suite facilities. The shared room is provided with curtain style screening. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 16 The service provides a homely environment and residents said they are comfortable. Residents can personalise their rooms and choose where they sit in the communal areas. The garden is not large but is usable and residents and their relatives were invited to a bar-b-que in the summer. The cleanliness, decoration and maintenance of the home have improved generally since the last inspection. Although all parts of the home appeared clean, there are still areas where there is a noticeable odour. Further areas have been redecorated and re-carpeted since the last inspection and the mis-matched and worn furniture is gradually being replaced. However there are some items of furniture, such as the chair in room 16, which is worn and stained and requires re-covering or replacement. All of the radiators have been fitted with protective covers and windows are fitted with restrictors. The acting manager said that there are currently no residents who have asked for keys, although some relatives have expressed a wish for this. However, all of the bedroom doors are fitted with door locks of a type that would not allow staff access in the event of an emergency. Therefore is any residents do require keys to give them control of access to their rooms, the locks would have to be changed. Although some of the rooms have en-suite facilities not all of the residents make use of them as they require the assisted bathing facility. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. Residents are cared for by a competent staff team. Residents are protected by the home’s recruitment and training procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection there were four staff on duty, namely the acting manager, head of care (ie deputy manager), three care assistants, a cook, a laundry assistant and two domestic assistants. An activities co-ordinator works five afternoons a week but she is leaving shortly. The laundry assistant has been re-deployed to make residents’ beds which apparently provides care staff more time for assisting residents. This staffing level appears adequate to meet the current number of residents’ needs (ie 19 residents) in terms of their daily care and the home’s domestic needs. Two recently employed members of staff confirmed that staff must complete application forms, and that the home has obtained references, CRB checks, and evidence of identity on all staff. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 18 There appears to have been a high level of turnover of staff recently. However the acting manager said that this has improved standards and attitudes and that staff training is not an issue and some of the staff have an NVQ. The recent training programme has included dementia awareness, diabetes awareness, health and safety, infection control. There is further training in the very near future on safeguarding adults and dementia care. Staff confirmed that there is induction training and regular formal or informal supervision. A professionally qualified and very experienced consultant and trainer spent time in the home last October and is providing ongoing training and advice. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. The record keeping, and health and safety systems are sufficient to safeguard residents’ welfare, rights and best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home currently has no registered manager and this should be addressed as soon as possible. Until a registered manager is in place and able to take legal responsibility the management standards can only be judged as adequate. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 20 The acting manager showed a good awareness of the running of the home and the needs of individual residents She is currently working towards recognised care and management qualifications. The management of the home and completion of records are generally of a good standard but would benefit from daily records being regularly monitored and reviewed by the acting manager to ensure clarity. The issues affecting the home since the last inspection were discussed in detail. Staff said that residents are regularly asked for their views and feelings about activities, meals and how things are done. This is either through talking to residents or through questionnaires for residents, and/or their families, and staff. The questionnaires include questions on satisfaction with personal support, the quality and quantity of the meals, staff attitudes, complaints and the comfort and cleanliness of the environment. The acting manager said that she is looking at preparing a newsletter to provide feedback to residents and their relatives. Residents’ relatives confirmed that there has been an improvement in the way that suggestions or feedback are acted upon. Other quality assurance methods include the monthly reports and an annual business plan. There were no obvious hazards around the home and there was evidence to show that health and safety issues are taken seriously such as staff ensuring that personal items were appropriately disposed of and warning signs in place for wet floors. The maintenance file contains current certificates to show that regular checks eg gas, electricity, are carried out. Risk assessments on the environment, and for activities involving residents have been prepared but would benefit from more detail. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 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 2 3 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X 2 Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The daily health, care, and behaviour needs of individual residents must be recorded clearly. Residents must be provided with the opportunities for stimulation and equipment necessary to provide leisure and recreational activities. Behaviour guidelines must be provided for staff to follow for all residents users who exhibit inappropriate behaviours. The home must maintain the programme of redecoration and renovation or renewal of worn furniture. Timescale for action 31/01/08 2 OP12 14 31/03/08 3 OP18 13 31/01/08 4 OP19 23 31/03/08 Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 23 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 OP26 Good Practice Recommendations The home should find a way of eradicating the unpleasant odours in the home. Beechtree House DS0000050691.V346922.R01.S.doc Version 5.2 Page 24 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.V346922.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!