Inspection on 01/06/06 for Beechwood

This inspection was carried out on 1st June 2006.

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

The inspector 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

Beechwood 22/12/05

Beechwood 12/07/05

Beechwood 24/03/05

Beechwood 30/11/04

Beechwood 11/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Beechwood The Beeches Holly Green Upton-upon-Severn Worcestershire WR8 0RR Lead Inspector Mrs Yvonne South Unannounced Inspection 08.45 1st June 2006 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 Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beechwood Address The Beeches Holly Green Upton-upon-Severn Worcestershire WR8 0RR 01684 593474 01684 593095 beechwood@heart.of.england.co.uk www.heart-of-england.co.uk Heart of England Housing and Care Limited 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) Mrs Susan Janette Milward Care Home 38 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (38), of places Physical disability over 65 years of age (38) Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd December 2005 Brief Description of the Service: Beechwood is registered to provide long-term and respite care for up to 38 older people of either sex who may have a physical disability and/or dementia care needs. The home also offers a day care service to older people living in the local community. The home is located in the residential area of Ryall on the outskirts of Uptonupon-Severn. It was purpose-built, twenty-five years ago, and is a single storey building divided into four separate units. Each unit has nine single bedrooms (no en-suites) with communal toilets and adapted communal bathrooms, lounges and dining areas. All the corridors have rails for ease of access. The registered providers are Heart of England Housing and Care Ltd and the registered manager is Mrs Susan Milward. On 26.05.06 the scale of charges were quoted at £365 with additional charges for hairdressing, private chiropody, dental care, opticians, taxis, toiletries and magazines and mini bus outings. Information regarding the home is available in the Statement of Purpose and the Service Users Guide. These are available in the home’s reception area and on request, as are the inspection reports. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection. The focus was on the key standards and the requirements made in the previous report. Evidence was gathered from information provided to the Commission for Social Care Inspection since December 2005, questionnaires that the Commission for Social Care Inspection asked the home to distributed to residents, relatives and health care professionals and a site visit that took place on 01.06.06 extending over eight and a half hours during which the inspector talked to four residents, one relative, seven staff, undertook a partial tour of the building and assessed a range on documents. What the service does well: What has improved since the last inspection? Since the last inspection the manager has returned to work full time in the home. A relative commented that it did make a difference. A management plan had been developed for improving the home and service over the next five years and work had commenced. Bedrooms were being redecorated and new carpets were being laid. Improvements had been made in the gardens and a sensory garden was been made. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 6 Work continues to improve the standard of record keeping and the laundry is now tidier and cleaner. 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. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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 Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with information and opportunities to visit and try the home before they make a decision on their future care. Everyone is assessed prior to admission in order to ensure their needs can be met. EVIDENCE: Residents confirmed personally and in questionnaire responses that where possible either they or their representative had visited the home to assess it’s suitability. Assessments had been carried out to ascertain if the home could provide the care that was needed. Trial stays were undertaken before decisions were made. The assessment documents varied as the format was in the process being changed. In one set of documents the necessary information was incomplete. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a risk of confusion and care omissions occurring until the new care record system is fully implemented and the files organised. The health needs of the residents are monitored, identified and addressed. Medication is generally well managed. Residents are treated with respect and kindness. EVIDENCE: Care plans were available for the residents. Some were more detailed than others. A new format is being introduced and it is expected that the plans will improve in quality and detail as staff become more familiar with them. Both systems were operating in tandem and this could lead to confusion. A single system should operate as soon as possible. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 10 Reviews of the care plans and risk assessments were being undertaken but the recording was not done in a systematic manner. Monthly reviews must be recorded in a clear manner that instructs the staff of any progress or deterioration experienced by the resident and how the care plans and risk assessment have been altered to address the changes. The residents, relatives and records demonstrated that health care needs were identified and appropriate action was taken. Doctors, district nurses, chiropodists, dentists and opticians visited the home. The daily records maintained by staff were detailed and informative. There had been one medication error since the last inspection. An acceptable investigation and response had been made. A Boots Modular Dosage system was used and a pharmacist visited the home to monitor management and give advice. There were a small number of signature omissions on the records assessed by the inspector. These would not occur if the procedure were being accurately followed. The instructions for the administration of one drug were unclear and it was advised that the doctor and pharmacist should be consulted for clearer directions. Storage was acceptable although not all tubes of cream had been dated when opened. A small number of residents managed all or some of their medication independently. The inspector was told that their ability and understanding had been assessed but there was no documentary evidence of this. Staff and their records demonstrated that they had received appropriate training. Residents were most appreciative of the care they received and the kindness of the staff. It was observed that communication was courteous and helpful. Staff and a resident confirmed and it was observed that mail was delivered unopened and assistance given if requested. Telephone calls could be made in private in all rooms and residents could hold the keys to their bedroom door and lockable storage if they chose. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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): 12,13,14,15, Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to live the style of life they prefer and participate in a range of in-house and community activities if they wish. They are provided with a choice of good quality meals that they enjoy. EVIDENCE: Residents were able to make personal choices through their daily lives. Their routines were respected and visitors were seen to come and go during the day. Some residents spoke of their visitors and how they had moved to the home to be closer to their family. One person was able to visit a family member independently when he wished and others went out with family members. Not all the records assessed contained information regarding religion and end of life care wishes. This is an area where more detail is required to enable the staff to give the appropriate support. A vicar calls at the home each month and holds a Communion service for those who wish to participate. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 12 A wide range of activities were provided in house and the home benefits from an active, successful and appreciated ‘Friends of Beechwood’ group who provide activities, outings and gifts. The home now shares ownership of a mini bus with a sister home so residents are able to go out into the community more easily. A fund raising/entertainment committee were just organising a ‘Ladies Pamper Evening.’ Two residents showed the inspector their private bedrooms and they were clean and decorated to the liking of the occupant. Personal treasures and photographs were much in evidence. Residents confirmed both in the questionnaire responses and in person that they liked the food and were given a choice of menu. Currently this was given the day before but the manager said that there were plans to change it to the day of the meal so as to support those people who had difficulty remembering their choice. Special diets were provided when necessary. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good access to the complaint procedure and people are confident to use it and receive an acceptable response. Staff are appropriately recruited and trained to protect the residents in the home. EVIDENCE: No complaints had been received by the Commission for Social Care Inspection concerning the home since the last inspection. The information provided by the home indicated that they had received fourteen complaints. Four of these had been partially warranted and the others were unfounded. Assessment of two complaints indicated that an appropriate investigation and response had been made. Although one questionnaire response from a relative indicated that they were unaware of the complaints procedure copies were available in the Statement of Purpose and the Service Users Guide that were available in the reception and a copy was displayed on notice boards. Appropriate pre appointment checks were made when the home was recruiting new staff. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 14 Documents indicated that staff received training in the Protection of Vulnerable Adults and they confirmed this themselves, indicating that they knew what action to take if someone made a complaint or they had a concern. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable clean home that meets their needs. They have access to the garden for fresh air, exercise and recreation. The risks of cross infection are reduced as much as possible by the equipment and systems in place. EVIDENCE: A partial tour of the building was undertaken. It was clean and tidy. Some areas were in need of redecoration and some carpets needed to be replaced. However work had begun to address this. A management plan had been drawn up for the next five years and was being implemented. Some bedrooms had already been redecorated and re carpeted. Work was in progress in another bedroom and the reception area had been measured for a new carpet. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 16 The laundry was clean and tidier than during the last inspection. The room is also used by the handyman and for storage. Care must be taken that infection control measures are not compromised. Protection aprons and gloves were readily available for staff and systems were in place to reduce the risks of cross infection as much as possible. It was observed that equipment was stored in some bathrooms. It is acknowledged that storage is limited but the availability of resident’s facilities must not be compromised. The grounds were spacious and had recently been improved. A sensory garden was being developed. There was level access. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable staff are recruited and employed to care for the residents. The current shortfall places demands on staff to work extra hours to ensure care is provided. There is a strong commitment to training ensuring staff are knowledgeable and skilled to provide a good service. EVIDENCE: An acceptable duty roster was available. However three members of staff and two relatives in their questionnaire responses expressed concern at the staffing levels. Three staff said that there were currently three residents who required a lot of care. They expressed a wish for more time to spend with residents. Two staff had recently had accidents and another had been off sick for a long time. Ten staff had left since the last inspection. Recruitment was in progress. There were three night care posts vacant and one cook post. This inevitably put demands on other staff until the situation is resolved. The manager and the deputy had recently undertaken a dementia care course and intended cascading information to the staff and emphasising the value of the ‘thirty second activity’. This identified the value of constant interaction between staff and residents even when it was only for a short period. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 18 An acceptable recruitment procedure was used and the records indicated checks were undertaken before posts were offered. The staff that were interviewed had undertaken induction training, although in the past the depth had varied. A structured programme was now available. One person was concerned that senior staff had differing perceptions of the areas that new staff could work and this needed to be addressed. The staff, documents and information provided indicated a commitment to training and good systems for monitoring and recording achievements. Eleven of the twenty-four care staff had qualified in NVQ to level 2 or above and another five people were expected to complete their courses by December. This will bring the number above the 50 minimum required. One of the three staff interviewed said that she did not receive supervision, another said that she had had a session three months earlier and the third person said that she did receive supervision. The records indicted that supervisions was being provided for staff and the manager said that frequently supervision was provided as part of a training session. All such sessions need to be documented and signed by both parties concerned. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed in the interests of the residents. Health and safety systems protect those in the home. A quality assurance system is needed to identify areas that could be improved and develop the service further. EVIDENCE: The home is managed by a competent and well-qualified person who had been over-seeing the management of Beechwood and a sister home as a temporary measure for some time. This situation had now been resolved and she had returned to work full time at Beechwood. She was full of enthusiasm to develop and improve the service further. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 20 Audits were routinely undertaken on several systems such as the residents’ finances and equality and diversity. Questionnaires were systematically distributed to residents and health care professionals but not to the relatives. The manager has developed a detailed Quality Assurance Programme that ensures that systems are regularly reviewed and involve residents. The system can be reviewed annually and used to develop the manager’s plan for the coming year. The money that was held by the home for residents was well documented on the computer and audited monthly. Receipts were given for money received, and retained for money spent, on their behalf. Storage and security was acceptable. There was a commitment to health and safety. The registered manager and the home services manager had both recently completed an IOSH Health and Safety course and sufficient staff had qualified on the Four Day First Aid at Work course to ensure at least one trained first aider was on duty at all times. The Hotel Services Manager was part of the organisation’s reviewing group for risk assessments and there was a delegated member of staff to take the lead in assessing risks relating to residents. The information provided by the home indicated that equipment and systems were being checked and serviced. Checks of the fire safety systems were undertaken and a fire risk assessment was available. Staff were receiving fire safety and other health and safety training. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 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 3 X 3 3 X 3 Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 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 OP9 Regulation 13 Requirement Medication must be managed in accordance with the home’s policy and procedure. Timescale for action 01/06/06 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 2 Refer to Standard OP7 OP7 Good Practice Recommendations It is recommended that the new care plan format be fully implemented as soon as possible. It is recommended that there is a clear record of reviews and amendments to the care plans and risk assessments. Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Beechwood DS0000018628.V294181.R01.S.doc Version 5.1 Page 24 - 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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