CARE HOMES FOR OLDER PEOPLE
Beechtree House Beech Tree House 62 Buckland Road Maidstone Kent ME16 0SH Lead Inspector
Maria Tucker Announced Inspection 6th January 2006 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Beechtree House Address Beech Tree House 62 Buckland Road Maidstone Kent ME16 0SH 01622 752047 01622 752047 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Beechtree House Ltd Mrs Pauline Peters Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Old age not falling within any other category (14) . A maximum of 10 with dementia. 29th April 2005 Date of last inspection Brief Description of the Service: Beechtree house is a care home for 24 service users, 14 of who 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 DS0000050691.V265348.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The inspection lasted from 11.00am until 16.10pm. Time was spent meeting the manager responsible individual and staff going through various records and documentation. About one hour was spent meeting service users individually and as a group. Two staff on duty was spoken with. A partial tour of the premises was undertaken. Due to the nature of some of the service users, it is difficult to gain a full picture of their quality of life, this was made through judgements from observations, speaking with staff and looking at records. 7 comment cards were received from service users, all of whom had ticked to say that they felt well cared for; treated well; liked the food; felt safe and had no complaints. This was reconfirmed during the inspection during observations and discussions. The pre inspection questionnaire was received by the CSCI. It is recommended to gain a full picture of the home that this report is read in conjunction with the previous inspection report, as some standards inspected at that inspection have not been inspected during this inspection. What the service does well:
The owner, manager and staff are committed to continuing to improve the service offered through environmental improvements, staff training and general management. The home continues through the pre admission assessments that are conducted to ensure that the home is suitable and can meet the service users needs. Beechree House is a small family type home that provides an individual service in a homely comfortable way. There is a small staff team including the manager who work closely together providing care and support. Relative and visitors are made very welcome and are encouraged and supported to be included in the well being of their loved one. The management is open and transparent with the CSCI and other agencies. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 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.V265348.R01.S.doc Version 5.0 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 the following standard(s): 1, 4, 5, standard 3 was met during the last inspection. Service users are supported to decide if the home is suitable for them and can feel secure that their needs will be assessed and met. EVIDENCE: An updated version of the statement of purpose / service users guide was given to the inspector. This document contains most of the items listed. Omitted are the experience of the manager and provider; the terms and conditions in respect of accommodation to be provided for service users including as to the amount and method of payment of fees; a standard form of contract for the provision of services and facilities by the registered provider to service users; service users views of the home. The care plans were drawn together from the assessments made prior to service users being offered a place, these were viewed and found to be very comprehensive although it was discussed for service users who have dementia the care plans need to be more detailed and specific and include more details on behaviours. Service users are invited to visit the home and are offered to move in on a trial basis. The home does not provide intermediate care.
Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 11 standard 10 was met during the last inspection. Service users can expect a good standard of care, which supports them in promoting and maintaining good health and well being. EVIDENCE: The care plans contained a lot of information that had been gathered during the assessments and had been detailed within individual care needs. It was discussed that the specific details of how the care is to be delivered and the support with behaviours needs to be expanded upon especially for service users with dementia. In a group discussion with service users mixed reactions were received while discussing care plans and reviews. Some service users remembered having discussions about their care while others were not sure or did not know. They all felt and expressed that they were well cared for. The home seeks specialist support and advice through referrals to health professionals. The health and well being of the service user are promoted and maintained through regular visits and appointments with health professionals.
Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 10 The medication cabinet has been fixed to the wall as identified during the last inspection. Service users are supported to remain at the home for as long as the home can meet their needs for the rest of their life. Good practice was evidenced in supporting a service user who had health needs who chose to remain at the home with support from their general practitioner. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 standard 15 was met during the last inspection. Service users have a relaxed comfortable lifestyle and the pleasure of home cooked meals and snacks. EVIDENCE: Service users spoken with commented that the food remained good, alternatives are available, one service user spoke of how it was fish and they had a poached egg. Another commented that it was “Very nice, always have fresh fruit”. There is a new activity coordinator who undertakes activities with service users collectively and individually. Service users spoke of how they choose what they want to do and relayed that they had watched a film and relaxed instead of the planned activity. During the inspection bingo was being played and the reflexologist visited. A list of daily activities was on display. Visitors were seen to come and go during the inspection. Service users spoke of how they had regular visits, some receiving guests in their rooms others in the lounge. Visitors were relaxed and familiar with staff. One service user spoke of how their relative visits regularly stating they “Visit and joins in …is great fun”. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 12 The pre inspection questionnaire states that the service users families act as advocates and for those who do not have families a care manager takes on this role. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users and their representatives can feel confident and supported to complain. The home is open and transparent in working with agencies to protect the service users. EVIDENCE: The home has had 1 adult protection alert raised, which was made by an anonymous caller. This was investigated and no evidence found to support the allegations made they were found to be false and incorrect. The manager is pro active in protecting the service users and ensuring their safety, good recordings evidenced that action is taken to support service users health and well being. There have been 3 complaints made all of which were responded to within a reasonable time and managed appropriately being partially substantiated. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25, 26 Overall the service users live in comfortable surroundings and can make the most of the space provided in the lounge/dinning areas and garden. EVIDENCE: The provider and manager continue to improve the internal and external environment for the comfort and safety of service users. They are committed to making improvements the manager stated, “We are improving the home on a daily basis”. The improvements include the garden being landscaped made safe and accessible; a new gate at the entrance of the home; decorating of some areas and replacement of equipment The home has cleared out a room used for storage to provide a visitors room. Currently there are two dinning/lounges, discussions were held as to the possibility of utilising the room outside of the kitchen for a dinning area, which would create extra space in the lounges. Advice is sought on an individual basis for any necessary occupational therapist equipment. The home has some disability equipment such as hoists and call systems.
Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 15 There are two shared rooms, currently only one room is being shared neither room have fixed screening. The taps have had restrictors fitted some radiators still have not had covers fitted. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The home provides a range of staff to meet the needs of the service users. EVIDENCE: The staffing levels listed in the pre inspection questionnaire stated that 68 staff hours are provided per day, by 13 care staff. The department of health residential forum indicates that 14 care staffs are required according to the dependency needs of the current service users. The staffing levels are 4 care staff in the morning, 3 in the afternoon/evening and 2 waking night staff, with an extra morning carer on Sunday. There is a domestic for 25 hours per week and a cook for 46 hours. There has been a change in staff with 4 carers having left since the last inspection. The staff training continues to be a priority within the home and regular mandatory staff training has taken place and is booked. There are 2 staff registered for the NVQ level 3, 2 staff already doing this. 2 staff registered for the NVQ level 2 and 2 staff already doing this. Currently only 3 staff have the NVQ level 2 award. The staff files inspected contained all items required. The induction of a new staff file contained a tick checklist of when policies and procedures had been read. The process of induction was discussed with a staff member and the manager it was advised that this process would benefit from having a more formalised itinerary and programme detailing the induction programme into days. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36, 38, standard 31 was met during the last inspection Service users benefit from a well managed home with a pleasant welcoming atmosphere and staff who are given clear direction and leadership. EVIDENCE: The necessary maintenance and associated records were detailed in the pre inspection documentation and were spot-checked during the inspection. The environmental health officer visited the home in January 2005 a further visit was made as a ‘pop in’ to see the new kitchen floor. Improvements in infection control include new laundry bins; washing powder that is specifically for ecoli and mrsa to wash at 40 ; enclosed area for the bins. The Manager and responsible individual are open and transparent in the running of the home and regularly contact and liaise with other agencies such as the CSCI to discuss any issues and seek advice or clarification. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 18 Staff spoken with expressed that they felt supported, they received regular supervision and appraisals and staff meeting were held overall it was expressed that there was “Good management of the home”. Their families or the client financial affairs officer assists Service users with their finances. Service users spoken with confirmed this. A service user spoke of how they were taken shopping by the manager to buy cloths and other items; another detailed how their relative gets what they need on their behalf. The records of transactions of money received into the home for personal spending was seen. The homes policy and procedures were discussed and it was recommended that the invoices for money paid i.e. chiropodist, hairdresser are signed by 2 people including the service user if possible, that receipts are made and kept on all expenditures and that receipts are made and signed in a duplicate book of money received and paid out. A service user stated, “Pauline holds money, only because I ask her to”. Service users surveys are conducted the last on 30th September 2005, the feedback is discussed with staff and service users. Comments in the questionnaires seen included “Keep up the good work” and “All good carers”. Service users sitting in the lounge that does not have a staff member present detailed how they ring the buzzer if they want anything. The buzzer was used during the inspection it was promptly responded to. Regulation 26 visits are made to the home and reports are received by the CSCI. Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 2 2 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 2 3 X 3 Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 20 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 OP1 Regulation 4(1)c Sch 1 5(1)b c 13(4)(a) Requirement Timescale for action 17/02/06 2 OP25 The statement of purpose and serviced users guide shall consist of items listed in Schedule 1 and as detailed in the text. The registered person shall 17/02/06 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 radiator guards are fitted. 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 OP7 Good Practice Recommendations It recommended that the care plans for service users with dementia be more specific in detailing the support required with behaviours and care support needs broken down for staff to follow. It is very strongly recommended that service users sharing
DS0000050691.V265348.R01.S.doc Version 5.0 Page 21 2. OP23.6 Beechtree House 3 OP24 4 5 OP28 OP30 a room have similar needs in that they are either elderly frail or dementia. 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 screens. It is strongly recommended that the homes continues to support staff to undertake the NVQ level 2 or above award so that 50 of care staff are trained. It is recommended that the induction process would benefit from having a more formalised itinerary and programme detailing the induction programme into days. It is very strongly recommended that receipts are made for all expenditures and money received that these are signed as witnessed by 2 staff. 6 OP35 Beechtree House DS0000050691.V265348.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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