Inspection on 21/05/08 for Beechwood

This inspection was carried out on 21st May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beechwood 27/11/07

Beechwood 27/07/06

Beechwood 28/02/06

Beechwood 15/09/05

Beechwood 14/03/05

Beechwood 08/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Beechwood Beechwood Road Liverpool Merseyside L19 0LD Lead Inspector Mrs Claire Lee and Mr Mike Perry Key Unannounced Inspection 09:30 21 and 22nd May 2008 st Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 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 DS0000059323.V364633.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 and Care Homes for Adults 18 – 65*. 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 DS0000059323.V364633.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechwood Address Beechwood Road Liverpool Merseyside L19 0LD 0151 427 5963 0151 427 7352 beechwood@europeanwellcare.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) European Wellcare Homes Ltd Mrs Mary Regan Care Home 60 Category(ies) of Dementia (60) registration, with number of places Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of people who can be accommodated is: 60 2. 3. Beechwood Unit Within the overall numbers to be accommodated, 19 people in receipt of personal care may be accommodated. Hunter Unit Within the overall numbers to be accommodated, 41 people in the receipt of nursing care may be accommodated. 27th November 2007 Date of last inspection Brief Description of the Service: Beechwood is made up of two units. The Beechwood Unit provides care and support for elderly mentally infirm residents, and the Hunter Unit provides nursing care for younger adults with early onset dementia. At the time of the inspection staff were providing care and support for forty younger adults and seventeen older people. A small number of day care places are also provided within the overall number accommodated. One to one care by a staff member is based on individual assessment and need. The home is located in the Aigburth area of Liverpool, directly overlooking the River Mersey at Otterspool promenade. The home is set in it’s own grounds and has extensive grounds for the residents to enjoy. Car parking space is available. Most bedrooms are single and each unit has spacious communal areas for the residents to sit in comfort. Residents have a choice of bathing facilities with aids and adaptations to assist those less able. A call system with an alarm facility is operational throughout all the areas and this enables residents to call for assistance when needed. Residents have the use of small kitchens if they wish to make their own drinks and there is a designated activity/ craft room. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 5 There are different weekly fee rates for the two units. Beechwood ranges from £387.50 to £416.75 and Hunter unit ranges from £1221.00 to £2149.54. There are no top up charges. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A site visit took place as part of the inspection and this was carried out for a duration of two days for approximately thirteen hours by two inspectors. Information for this inspection was gathered in a number of different ways. This included an unannounced site visit where time was spent reading service records and looking at different areas of the building. All of the key standards were inspected and also previous requirements and recommendations from the last inspection in February 2008 and from the pharmacy inspection in March 2008. The manager was present for the inspection and also senior managers and the Director were present for part of the inspection. ‘Case tracking’ was used as part of the site visit. This involves looking at the support a resident gets from the manager and staff including their care plans, medication, money and accommodation. Five residents were case tracked, however this was not carried out to the detriment of other residents who also took part in the inspection process. Time was spent meeting with residents, visitors and staff to gain their opinions of the overall service. ‘Have your Say’ Survey forms were distributed to residents, relatives, staff and health care professionals as another means of gaining their views. No surveys were returned. A number of comments from interviews have been included in the report. An AQAA (annual quality assurance assessment) was completed by the manager prior to the site visit. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. The manager had completed the document in good detail. What the service does well: Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 7 Care files seen evidenced good assessments carried out prior to admission. They provided assessment of actual and potential needs of each prospective resident; thus allowing a care plan to be developed. Multidisciplinary healthcare team (MDT) input was evident in the assessments and also the social work assessments. A relative said that the advice was always on hand from the doctor. Residents have access to health care professionals outside the home and this helps ensure their care needs are being met effectively. These were clearly recorded in care notes. On Hunter unit regular three to six monthly reviews are held and each resident has consultant input. The reviews are held ‘in house’ or at Mossley Hill hospital. Family members are invited and there is multi disciplinary team input. Reviews were taking place at the time of the inspection. Individual’s behaviour in terms of risk is carefully assessed and again those recorded in the care files were pertinent and provided good monitoring. The staffing levels were good and provided a means so that social activity is not unduly reduced due to risk and individual needs can be facilitated effectively. Residents observed appeared relaxed and supported by staff. Staff appeared to have a good rapport with the residents and the observations evidenced high levels of staff interaction and involvement by residents in their daily activity. Residents spoken with generally lacked concentration but were able to express positive feelings about being on the Hunter unit. Residents were observed to be appropriately dressed and staff clearly took time to encourage good standards of personal hygiene for residents, some of whom require a lot of assistance with their personal care. Support for personal hygiene was also evidenced in care plans seen. The detail in the care plans was very good and personalised; entries such as ‘likes a wet shave’ or ‘prefers a shower’ evidenced this. Staff have team leader roles and senior carer roles as part of their development and are assigned a number of residents to care for which encourages individualised care. For example one care staff was able to explain the care of an individual resident in great detail and also evaluate how progress had been made so the resident was able to go out on walks on the promenade and how staff support was organised to enable this. The resident was spoken with and appreciated the fact that she could have these walks as they contributed to her quality of life. Staff were seen on both units talking with residents on an individual and/or group basis. What has improved since the last inspection? Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 8 Since the previous inspection the care documentation has been improved and the requirements and recommendations made have been actioned. The documentation seen was much more focused and provided better detail and the care of residents could be followed. The assessment and recording of individual clinical risk in the care files has improved so that residents are able to take part in preferred activities and these are monitored by the staff. What they could do better: There is a need to further update the ‘Statement of Purpose’ and Service User Guide, which has information for the service. This will provide a fuller and more accurate reflection of the service provision. The required changes are listed in the report. Care records seen included untoward incident records. These do not contain any reference to action taken in terms of further reporting. There was no reference to relatives being informed or whether the incident should be reported through to the Commission of Social Care Inspection (CSCI) or indeed safeguarding at social services. This is important, as there may be a need for further input in terms of review. In the case of the incident discussed during the inspection there should have been at least a report (Regulation 37) to CSCI but this had not occurred. All such incidents that may have a detrimental effect on resident wellbeing must be reported to the appropriate agency. Staff have access to an abuse policy and also a copy of Sefton and Liverpool’s Adult Protection Procedures. The policy file has the signatures of staff who have read it although this is not comprehensive. Staff spoken with were not clear about the role of outside agencies such as Care Standards or Social Services. None of the staff new about the ‘Careline’ contact for the reporting of abuse and perhaps this can be advertised about the unit more readily. Trained staff in charge must be conversant with these procedures. The procedures for managing abuse can also be made available in areas outside the office including resident and visitor areas. On Beechwood new care documentation had been introduced and headings on the assessment and care plans were found to be ‘clinical’ and not user friendly. This was brought to the attention of the manager, as the terminology used in the care plans should be easy for staff, residents and relatives to read and understand. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 9 There are daily-recorded notes from nursing staff and care staff. The carer’s notes are recorded separately. Some of these were not up to date. The fact that separate notes exist for care staff and that they receive a separate handover of information (staff interviews confirm this) rather than directly from the nurses could mean that some information may be lost or not passed on. This needs to be discussed by the manager and staff to ensure consistency of care. Some of the toilet areas were not as clean as they should be and one did not have adequate hand washing facilities. This has implications in terms of compromising residents’ dignity and standard of hygiene. The office door on Hunter Unit and Beechwood were not always locked when not in use. The cabinets for the safe storage of care records were also found to be unlocked. A resident was seen to enter the office on Hunter Unit when the room was unoccupied. Data held must be kept secure to protect the information held. A separate room should be provided for residents who wish to smoke on Beechwood. This is in accordance with the changes in the law regarding smoking. Those who smoke at present are not able to come downstairs to the smokers’ lounge on Hunter unit. As much as possible the available space must be maximised to ensure more safe areas of reduced risk - especially for female residents. The good practice principals in the ‘safety, privacy and dignity in mental health settings’ needs to be taken into account in terms of identifying areas that are for single sex only, for example, toilets, bathrooms and bedrooms. The overall plans for any development of the environment need to be taken with reference to discussions held at the time of the inspection and the requirement made in this report. Part of the rear garden remains overgrown and this should be cut back to enable residents to use this area safely. Fencing/railings are still needed in one part to make the garden secure. Not all staff files seen contained a record of induction and a staff member reported that they had not received an induction when they started. A full induction is needed to ensure new staff have the skills and knowledge to undertake their work safely. Other good practice recommendations are made with in the report to help improve the service. 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 Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 10 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 2 (Adults 18-65) and Standard 1 and 3 (Older People). Standard 6 for Older People not assessed, as Intermediate Care is not provided. Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. Residents are admitted following an assessment so that the staff are able to ensure that care needs can be met. Some of the information supplied to people on admission needs updating to provide more clarity. EVIDENCE: The AQAA for the service states that: ‘All prospective Service Users are personally assessed using comprehensive pre admission assessment documents based on a client centred care approach Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 13 detailing an essential lifestyle plan to be created based on individual needs, choices and abilities. We offer our prospective Service Users a trial visit at no extra cost, if appropriate, where they can be reassured, choose a room, make some new friends and admire the view, all helping with the transition to residential care. Statement of Purpose is always available and Service User Guide is given to all prospective new clients and their families.’ The Service User Guide (a brochure of the service) was seen on the site visit and was again discussed with the manager and senior management of the company. There is need for the guide to accurately reflect the work of the unit with people with young onset dementia, which reflects the registration category of the home. The Service User Guide outlines the service on Hunter unit and there remain some anomalies that still need to be addressed: • The Service User Guide states that residents are cared for with ‘acquired brain injury’. This term is misleading and must be removed as the registration of the home is for dementia. The current client group generally fit the category of dementia and the manager stated that all new admissions have dementia (including young onset) as their primary care need. The description of the care group should include examples of the types of dementia cared for. There should be reference to ‘associated conditions that present with cognitive impairment whose needs can be supported by Hunter unit’ that may fall outside of the listed conditions. The Service User Guide states that the accommodation is for 41 service users plus day patients. Currently there are 5 day patients attending the unit. This has implications for the registration of the home as the day care facility needs to be managed separately within the management structure and this was not evident on the inspection. This was discussed and the manager has made suitable arrangements but this needs to be outlined in the Service User Guide and include the separate staffing arrangements. There is now reference to the manager and some biographical details. The manager now no longer ‘overseas operations at Bishops Court’ and this need to be removed. • • There have been no admissions to the unit since the last inspection. Five care files were seen and evidenced good assessments carried out prior to admission. They provide a holistic (treating a person as a whole) assessment of actual and potential needs of each prospective resident; thus allowing a care plan to be developed. The registered manager, deputy manager or senior nursing staff completes these assessments. Multidisciplinary healthcare team (MDT) input is evident in the assessments and also social work assessments and input. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 14 It was observed in one of the files that the home are researching and introducing some more specific assessments for dementia (‘watchabout’ assessment) and this evidences more specialist practice practice. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 15 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7, and 9 (Adults 18-65) and Standards 7,14 and 33 (Older People). Quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. All residents have a care plan, which is evaluated so that care can be given according to need. There needs to be some development of the carers’ records to include reference to the care plans so that consistency of care is reinforced. EVIDENCE: The AQAA for the service states: ‘We implement person centred care plans from detailed pre-admission Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 16 assessments and consultation with Service Users and relatives, so that it accurately depicts their needs and choices. We support Service Users to be as independent as they possibly can without compromising them. We encourage our Service Users committee to meet monthly to discuss any issues or concerns that they may have and to put forward any suggestions to improve care or daily living. The Service Users’ formed the committee.’ Since the previous inspection the care documentation has been improved and the requirements and recommendations made have been actioned. The documentation was much more focused and provided better detail and the care of residents could be followed. Hunter unit Four care files were viewed for residents on Hunter unit. Care plans are loosely based on activities of living model of nursing care and evidenced input from the resident, their representative and the multidisciplinary healthcare team as needed. Evidence of relatives’ input varied but was encouraged. Relatives are always invited to medical reviews (three to six monthly). A relative was complimentary regarding the care and said, “The staff do everything they can to help.” Monthly reviews and evaluations were evident on care plans seen and the plans were based on needs identified on the pre-admission assessments such as more immediate risk factors. Multidisciplinary healthcare team (MDT) input was evident in all necessary care plans. The monthly evaluations were clear in that they were a record of the progress over the proceeding time period and they were a good monitoring guide. For example one resident had been involved in an aggressive incident. This was included in the evaluation and discussed in terms of the resident’s overall condition. Other care plans evidenced personalised care around the management of aggression and agitation by including the recognition of trigger factors as well as individualised intervention for staff to help manage. One plan said ‘Likes to listen to music and look at pictures / photographs’ (which assists the resident to relax).” Care records seen included the incident records and the accident records. The manager now audits these monthly. The incident forms (for example, the above mentioned incident) do not contain any reference to action taken in terms of further reporting. There was no reference to relatives being informed or whether the incident should be reported through to the CSCI or indeed safeguarding at social services. This is discussed further under ‘complaints and protection’. It is important, as there may be a need for further input in terms Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 17 of review. Any decision not to refer should be recorded so the rational for clinical management is transparent. Risk was carefully assessed and again those records in the care files were pertinent and provided good monitoring. For example a resident’s aggressive outbursts had been identified with drinking and the action plan included increased staff monitoring on any outings. The staffing levels remain good and provide a means so that social activity is not unduly reduced due to risk and a resident receives the care they need. There are daily-recorded notes from nursing staff and care staff. The carers’ notes were recorded separately. Some of these were not up to date. Five residents notes were viewed and only one had any recording for the previous day from care staff. A senior carer spoken with stated that all residents should have a daily entry. Those on one to one close observations had charts for recording observations and these were competed. The fact that separate notes exist for care staff and that care staff receive separate handover of information (staff interviews confirmed this) rather than directly from the nurses could mean that some information may be lost or not passed on. The manager said she would be introducing a care plan index to the carers’ records so that any entry can be referenced to this. There may be an argument for single care files and whole team handovers to improve communication. This will also help to ensure that there are not two separate care teams operating. Residents observed appeared relaxed and supported by staff. Staff appeared to have a good rapport with them and the observations evidenced high levels of staff interaction and involvement by residents in their daily activity. Residents spoken with generally lacked concentration but were able to express positive feelings about being on the unit. One resident spoken with said that staff supported him when he went out. Another resident had two to one staff support when going out for walks. There was a copy of a residents’ meeting displayed and two of the residents act as ‘spokes persons’ and help organise these. Beechwood Two care files were viewed and these evidenced a plan of care, which was detailed and provided good information for the staff on the care delivery. This helps to ensure good outcomes for the residents. One care file contained new care documents and the wording used in the headings for assessment and care plans was found to be ‘clinical’ and not user friendly. This was brought to the attention of the manager, as the terminology used in the care documents should be easy for staff, residents and relatives to read and understand. A staff member said that no training had been given on their implementation. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 18 Risk management had been instigated with control measures to help keep the resident safe but also to encourage their independence. This was seen, for example, in relation to nutrition and falls. Advice was given in relation to updating care plans where medical intervention is required. Information required was added to a care plan at the time of the inspection to evidence this. Evaluations of care gave a good summary of care needs over a ‘given’ period of time. Consent to the plan of care had also been obtained to ensure relative involvement. Care staff write up the daily care they give to each resident and records seen were current and made reference to the plan of care. The care files seen contained information relating to social care and family background to enable staff to get to know the resident in more depth. A ‘family tree’ had been completed. As on Hunter unit, the residents appeared relaxed and comfortable with the staff. Beechwood is spacious which enables residents to walk around freely, with the help of the staff as required. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 19 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 20 Standards 12,13,15,16 and 17 (Adults 18-65) and Standards 10,12,13 and 15 (Older People). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to enjoy an active lifestyle, as there is a good range of individualised activities in the home. There remains a need to ensure that privacy and risk factors associated with social interaction on the Hunter unit are thoroughly reviewed so that residents’ safety and privacy is upheld. EVIDENCE: Hunter Unit Residents on the Hunter unit are involved with the community through a good programme of leisure pursuits and activities that are supervised by an activities organiser. Trips out are arranged regularly and residents have the use of two minibuses. The social interests of residents on the Hunter unit were recorded in good detail and this included the completion of a ‘family tree’ with photographs and plenty of personal details. Residents had their own book for recording activities and for photographs. An activities room on the ground floor is equipped with a variety of crafts, painting materials and games. The staff appeared busy sorting out social arrangements and residents were going out at different times of the day. A widescreen TV is now available for film shows and a projector for video clips. Residents are provided with a newsletter and they are able to discuss social arrangements when they attend resident meetings. A resident chairs these. The minutes seen evidenced that they were well attended. Resident care files reference activities and these are also recorded in daily records. One resident has a part time job locally. Other residents enjoy getting involved in gardening and there is also some animals kept at the rear of the home. One resident was spoken with keeps a pet dog on the unit. The issue of intimate relationships is particularly difficult given the nature of disability on the Hunter unit. The brain damage caused by early inset dementia can result in residents becoming at risk from behaviours such as aggression and also disinhibited sexual behaviour. Such incidents are recorded in care files and some have resulted in safeguarding referrals and investigation in the past. The managers have a duty of care to consider risk reduction carefully and part of the over all policy needs to take into account the layout of the unit. Currently both male and female residents freely mix but this means a lack of privacy in terms of some clearly identified areas that are for single sex only (for example, toilets, bathrooms) and could possibly include location of Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 21 bedroom areas. One resident explained difficulties being in a bedroom close to a male resident who ‘could be aggressive’ and also having to pass this room on the way to the toilet / shower room. It was noted that the management has acquired the previously recommended guidance in this area and that there have been discussions with commissioning bodies around the development of good practice guidance for the unit. Senior management have still to come to conclusions over this in terms of policy and also the further developments of different areas on the unit. The manager gave an outline of the current lay out of the unit in terms of male / female mix but this needs further work. The routine appeared relaxed and residents were free to wander around the home with or without the supervision of staff. Residents were receiving a good choice of hot and cold food, served in all the dining areas. The residents can choose which room they wish to have their meal. The menu is based over four weeks and the chef meets with the residents to discuss preferred options. The menu for the day was displayed in the main dining room for residents to decide what they wished to eat. Beechwood With regard to social activities a weekly plan was available and although not extensive it is planned in accordance with residents’ needs. Walks on the promenade are encouraged during the warm weather and residents now benefit from gentle arm exercises. The activities organiser stated that he visits the residents on Beechwood each week. Lavender has been collected for making lavender bags with the residents. Photographs of recent activities were displayed and this included Easter Bonnets. Residents from Beechwood are encouraged to join in with the trips out from the home where possible. Preferred interests and routines are assessed on admission and recorded. Residents receive their meals in a dining room and like Hunter unit the chef meets with them to discuss the meals served. As stated under Hunt unit, the newsletter for the home provides interesting details of ‘what is going on’ and also money raised through a sponsored walk. The AQAA reported that a new minibus has been purchased for the residents. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 22 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 (Adults 18-65) and Standards 8,9,and 10 (Older People). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health care is assessed and supported through adequate liaison with external professionals so that residents’ needs are met. EVIDENCE: Hunter Unit/Beehwood General observations of residents care evidenced good standards in relation to staff attitudes regarding the privacy and dignity of residents. Staff were observed to knock on bedroom doors before entering. Bathroom and toilet Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 23 doors closed effectively and there were locks on doors available. Bedside cabinets also had locks for the safe storage of resident’s valuables. On the Hunter unit some of the toilet areas were not as clean as they should be and one did not have adequate hand washing facilities. The aforementioned notes on the privacy aspect of the male / female bedroom layout on the unit also has implications in terms of residents dignity. (See ‘environment’ for further comments). Residents were observed to be appropriately dressed, however staff clearly took time to encourage good standards of personal hygiene for residents, some of whom require a lot of personal care. Staff interviewed displayed an understanding of the need for patience and tact when carrying out care with more challenging residents. Staff spoke about having to return frequently to residents and not to ‘give up’ if initially they are not compliant in terms of self care. On Beechwood staff were observed to deal with an incident that involved a resident. They dealt with this in a quiet professional manner offering reassurance to the resident at all times. Independence was being encouraged through the activities programmes and family involvement. Support for personal hygiene was also evidenced in care plans seen. The detail in the care plans was very good and personalised; entries such as ‘likes a wet shave’ or ‘prefers a shower’ evidenced this. Residents have access to equipment such as handrails and other moving and handling equipment including bath aids. On Hunter unit staff have team leader roles and senior carer roles as part of their development and are assigned a number of residents to care for which encourages individualised care. For example one care staff was able to explain the care of an individual resident in great detail and had evaluated how progress had been made so the resident was able to go out on walks on the promenade. They described how staff support was organised to enable this. The resident was spoken with appreciated the fact that she could have these walks as they contributed to her quality of life. Residents have access to health care professionals outside the home and this helps ensure their care needs are being met effectively. Residents who cannot attend a surgery receive GP visits. These were clearly recorded in care notes. Care files seen evidenced referrals to other health professionals. A care need reviewed was linked to challenging behaviour in the care plan and provided a clear rational for staff to be aware of when approaching this resident. On Beechwood clinical input was being provided by the district nurse team and the care manager was able to describe in good detail the care and support needed by two residents in relation to wound care and medicines. On Hunter unit there are regular three to six monthly reviews held and each resident has consultant input. The reviews are held ‘in house’ or at Mossley Hill hospital. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 24 Family members are invited and there is multi disciplinary team input. A visiting doctor was spoken with and, although new to the unit, commented that staff knew about the residents and were able to provide necessary information regarding the reviews he was conducting. Medicines A pharmacy inspection was conducted in March 2008 and the requirements issued at this time have been met. The medicine policy was available on both units and a monthly audit is now completed to ensure medicines are administered safely to the residents. The audit seen was completed in good detail. Staff receive medicine awareness training to ensure they have the skills and knowledge to administer medicines. A competency assessment would be beneficial to evidence this following their training. The majority of medicines were packaged in a blister system supplied by the pharmacy and this helps staff administer medicines in an organised safe way. A spot check of a number of medicines evidenced that they were given as prescribed. The manager stated that a second medicine trolley was on order to help with the administration of medicines in a timelier manner and make storage less complicated due to the high number of medicines stored. Records of medicines received into the home, administered to residents and disposed of were clear, accurate and complete. Staff had signed for medicines administered. One handwritten entry evidenced only one staff signature however this was not the case for other handwritten entries seen. The use of covert medication was discussed on Beechwood and the risk management strategies that have been instigated ensure this procedure is controlled. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 25 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 (Adults 18-65) and Standards 16 and 18 (Older People). Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. There has been progress made around the consistency of standards in this area but there remains further work to do to ensure full understanding of the processes involved so that residents are protected. EVIDENCE: Hunter unit/Beechwood The complaint procedure was displayed in the main entrance for people to read and access if they wish. The procedure is also referred to in the Service User Guide for the unit. The entry is brief however and should contain the telephone number of the local Commission office. There have been no complaints since the last visit by CSCI. A resident interviewed said they would speak to the staff if unhappy about anything. The resident knew who the manager was and felt that she could be confided in. Residents felt safe in the home although the comments of one resident around safety and other male residents need to be noted by management. A relative reported that they would always speak with the manager or nurse in charge if Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 26 unhappy. An internal complaint investigation had been completed with regard to a complaint on Beechwood. The complaint has been dealt with to the satisfaction of all parties. Staff have access to an abuse policy and also a copy of Sefton and Liverpool’s Adult Protection Procedures. Staff spoken with knew where these were kept. The policy file has the signatures of staff who have read it although this is not comprehensive. Staff receive training on the recognition of abuse on a regular basis. Staff spoken with were all clear that they would report abuse but were not clear about the role of outside agencies such as CSCI or Social Services. None of the staff interviewed knew about the ‘Careline’ contact for the reporting of abuse and perhaps this can be advertised about the unit more readily. Trained staff in charge must be conversant with these procedures. The procedures for managing abuse can also be made available in areas outside the office including resident and visitor areas. These measures are important given the units previous recent history of management in this area. Concerns have been raised in the past when reporting allegations. Adult protection must be dealt with in accordance with the local procedure to ensure the ongoing protection of all parties. The managers of the unit have made useful contacts with social services safeguarding team and this can be built on in terms of developing consistent standards and communication. There have been no admissions since the last random inspection in February 2006. Social services have suspended admissions to the Hunter unit following a number of protection of vulnerable concerns. The lead officer for social services was spoken with and said that progress was being made within the Hunter unit and that communication was now more ‘open’ and less defensive. The main difficulty is the management decision as to what should be reported through as ‘abuse’ given the daily management difficulties and ongoing incidents that occur with this client group (much of which can be managed locally on a clinical basis but some of which must be referred through safeguarding). The ongoing process of communication with social services and programme of training should assist with this. The manager has also started to audit incidents and the learning process from this needs to be shared during staff meetings. Meanwhile the incident forms themselves can be improved to clarify the decision making process. For example, the untoward incident records do not contain any reference to action taken in terms of further reporting. In one example there was no reference to relatives being informed or whether the incident should be reported through to the CSCI or indeed safeguarding at social services. This is important, as there may be a need for further input in terms of review. Any decision not to refer should be recorded. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 27 In this instance there should have been at least a report (Regulation 37) to CSCI but this had not occurred. The Regulation 37 form was submitted following the inspection. Residents’ finances are assessed under Standard 43 (Adults 18.65) and Standard 34 (Older People) of this report Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 28 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,26,27,28,29 and 30 (Adults 18-65) and Standards 19,20,21,22,24,25 and 26 (Older People). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of accommodation must be improved to ensure residents live in a safe, clean home. EVIDENCE: Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 29 Hunter unit/Beechwod The home is subject to an ongoing programme of maintenance and different areas are currently being redecorated to improve colour schemes and furnishings. One full time maintenance person is responsible for the day to day jobs and he is assisted by outside contractors. Communal areas on both units are spacious with comfortable armchairs and coffee tables. A large screen TV is in the main lounge on the Hunter unit and a good number of residents use this room. Dominoes was being played and the television being watched by a good number of residents. The conservatory on the Hunter unit overlooks the back garden. This remains overgrown however plans are in place to rectify this. The garden to the side of the property now has patio furniture and the garden rails are being extended to make the rear garden safe. The rear garden leads on to the promenade. The inner courtyard has a fountain and seating for residents. Bedrooms were seen on both units. The bedrooms on Beechwood were pleasantly decorated and residents had brought in items from home to make them feel special. Two bedrooms seen on Hunter unit had a bad odour and one of them was not personalised in any way, for example, the walls were bare. The manager said that orientation aids have been purchased for the home however these were not evident in all areas. There was no signage for the toilets and bathrooms and only a few residents have their names on their bedroom door on the Hunter unit. Resident names had been put on resident doors on Beechwood. There were some paintings on the walls on corridors throughout the home to provide a more homely environment. Bath aids were in place to assist residents. On Hunter unit a shower room and toilet were found to have stained floors and needed cleaning. One shower room floor was wet and paper towels were on top of the toilet cistern. The toilet was badly stained and there was no hand washing facility or paper towels. Staff must be provided with suitable washing/drying facilities to ensure good standards of hygiene and minimise the risk of infection control. Whilst touring the building a resident reported concerns regarding being in a bedroom close to a male resident who ‘could be aggressive’ and also having to pass this room on the way to the toilet / shower room. This is addressed under Standards 11-17 of this report. Hot water had been tested to ensure it was delivered to a safe temperature. Residents are currently smoking in the lounge on Beechwood. A separate room should be provided for residents who wish to smoke. This is in accordance with Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 30 the changes in the law regarding the provision of smoke free areas. Those who smoke at present are not able to come downstairs to the smokers’ lounge on Hunter unit. The segregation of male and female residents is also stated under Standards 11-17 of this report. The managers have a duty of care to consider risk reduction carefully and part of the over all policy needs to take into account the layout of the Hunter unit. The good practice principals in the ‘safety, privacy and dignity in mental health settings’ needs to be taken into account in terms of identifying areas that are for single sex only, for example, toilets, bathrooms and bedrooms. The overall plans for any development of the environment need to be taken with reference to discussions held at the time of the inspection and the requirement made in this report. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 31 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34 and 35 (Adults 18-65) and Standards 27,28,29 and 30 (Older People). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Not all staff have had a full induction to ensure they have the skills and knowledge to undertake the work they are assigned. EVIDENCE: Hunter unit/Beechwood Beechwood and Hunter unit are staff independently and both units have their own duty rota. The rotas seen evidenced good number of staff to provide the Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 32 necessary care and support to the residents. The AQAA reports ‘We maintain high ratio of staff enabling us to support our Service Users to the full and support them to achieve maximum independence through a client centred approach’. The good staffing ratio also enables staff to take part in social activities with the residents, which are vital to promoting independence and providing stimulation. Staffing rotas on the Hunter unit remain high due to the dependencies of the younger adults and their associated dementias. At the time of the inspection thirteen residents were accommodated on Beeechwood and thirty nine on the Hunter unit. There were six residents who required one to one observations or close observations and designated staff assigned to provide this. The number of trained staff on duty on Hunter unit has been increased to three during the day and two at night. Three trained staff were on duty at the time of the inspection and staff interviewed stated that this has helped with the care provision and overall management. Sixteen care staff are on duty each day and the activities organiser is based on the Hunter unit. A deputy manager has been appointed and will be starting later this month. A relative was complimentary with regard to the standard of care given and said that the staff were very kind and caring. The AQAA gave details of NVQ (National Vocational Qualifications) in Care and reported that funding has been secured staff to commence NVQ Level 2, 3, or 4 in their specific field of expertise. Over 50 of care staff have acquired a qualification. Five staff files were viewed and these evidenced robust recruitment practices that included police checks and references being obtained prior to appointment. One application form had not details regarding past employment and training. The manager was advised of this. There was evidence of skills for care induction standards for care staff however there was no record of induction for a trained member of staff. The member of staff confirmed that they had not received a ‘formal’ induction. Staff receive a full training programme for courses in safe working practice areas, which helps to ensure they have the skills and knowledge to undertake their work. The AQAA also provided details of training for nutrition, crisis prevention management, wound care, adult protection, the Alzheimer’s society, Huntingtons society and Picks society (all relevant dementias). Staff interviewed confirmed that the home was very busy however the daily activities were well organised and that residents enjoyed the trips out. Staff were observed assisting residents with the trip to Wales at the time of the inspection. Staff interviewed gave examples of how to approach residents who Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 33 have challenging behaviour and to implement best practice for caring for residents with dementias. Staff were receive supervision to enable them to discuss care practices and also to help with them with their development with regard to training. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 34 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,38,39,40,41,42 and 43 (Adults 18-65) and Standards 31,33,35,37 and 38 ((Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the service has been improved but there remains further work to do to ensure full understanding of adult protection processes so that residents are protected. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 35 EVIDENCE: Hunter unit/Beechwood The registered manager is Ms Mary Regan and she maintains her RMN (Registered Mental Nurse) qualification. Ms Regan has completed an NVQ course in management and a dementia care course. The manager is now spending more time at the home and is working with outside agencies and adult protection team to help improve the service. Work is still needed with regard to staff having knowledge of local adult protection procedure with emphasis on ‘Careline’ contact. Trained staff in charge must be conversant with these procedures. This is a management issue and these measures are of high importance in light of the recent history of service and how adult protection referrals have been dealt with in the past. This requirement is stated under Standard 23. The view of the residents and relatives are canvassed by the completion of surveys and also meetings. A newsletter also provides good details of what is going on in the home. Another senior manager compiles a formal report each month following a visit to the service. This provides a review of the service and the findings are fed back to the manager. Staff meetings are also held. The manager and staff have access to a good range of policies and these were found on both units. A number were viewed in relation to privacy and dignity and confidentiality. With regard to confidentiality the office door on Beechwood and Hunter unit was found to be unlocked when unattended and care files not locked away. Data held must be protected. Monies held on behalf of residents were found to be secure and financial records up to date to protect their welfare. The AQAA gave details of contracts for equipment and services to help keep the residents safe. A spot check of the gas, electric, fire prevention equipment, portable appliances and moving and handling equipment certificate evidenced this. Fire alarms had been tested weekly and staff had received regular fire training. A report of an accident that involved a resident was seen, the details of which had also been recorded in the resident’s care file as part of the ongoing care management. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 36 As previously stated all staff need an induction and the requirement for this is stated under Standards 35 of this report. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 37 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 3 x 4 X 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 2 39 3 40 3 41 2 42 3 43 2 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Beechwood Score 3 3 3 X DS0000059323.V364633.R01.S.doc Version 5.2 Page 38 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 YA1 Regulation 5(1) Requirement The service user guide must update with reference to the comments made in the report. Specifically: Removal of the ‘acquired brain injury’ reference. Rationalisation and details as to how the day patient service is managed separately from the registered care home facility. Changes to manager’s role. Fuller, more descriptive complaints procedure, which includes the CSCI‘s contact details. (Remains an outstanding requirement from the last inspection. (Timescale of 11/01/08, 29/02/08 not met) 2. YA23 and 37 All incidents that may have an DS0000059323.V364633.R01.S.doc Timescale for action 16/07/08 02/07/08 Page 39 Beechwood Version 5.2 YA38 adverse affect on residents’ wellbeing must be reported through to the CSCI. Staff must be aware the role of outside agencies such as CSCI or Social Services for the reporting of adult protection. Trained staff in charge must be conversant with these procedures to ensure the appropriate authorities investigate the allegation to protect the welfare of the residents. (Remains an outstanding requirement from the last inspection. (Timescale of 11/01/08, 29/05/08 not met) 3. YA24 23(2) a As much as possible the available space must be maximised to ensure more safe areas of reduced risk - especially for female residents. The good practice principals in the ‘safety, privacy and dignity in mental health settings’ document discussed should provide the basis for this. (Remains at outstanding requirement from the last inspection. Timescale of 29/05/08 not met) 16/07/08 4. YA30 23 (2) (d) The bathrooms and toilets must be kept clean and there must be suitable hand washing and drying facilities. This will minimise the risk of cross infection and protect the health and welfare people at the DS0000059323.V364633.R01.S.doc 02/07/08 Beechwood Version 5.2 Page 40 service. 5. YA35 YA42 18 (1) (c) Schedule 4 (6G) New staff must receive an induction and a record of this be kept. This will help evidence that staff have the knowledge and skills needed to care for the residents. The doors to the offices must be locked and safe when staff are not using it so that care files and information held is protected. (Remains at outstanding requirement from the last inspection. Timescale of 29/05/08 not met) 16/07/08 6. YA41 17(1) (b) 02/07/08 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 YA6 Good Practice Recommendations Incident forms do not contain any reference to action taken in terms of further reporting. There was no reference to relatives being informed or whether the incident should be reported to any external body. This is important, as there may be a need for further input in terms of review. Any decision not to refer should be recorded. The form should be amended to facilitate this recording. It would be beneficial for a copy and/or summary of the resident care plans to be kept with the daily report sheets completed by the care staff. This would provide them with information on the care delivery. It would also provide the basis of the written daily records that care staff make. DS0000059323.V364633.R01.S.doc Version 5.2 Page 41 2. OP7 Beechwood New care documentation should be user friendly to ensure resident, relatives and staff are comfortable with its use and understand the terminology used in the headings for assessment and care planning. All residents should receive a written entry by the care staff as unit policy. It is further recommended that consideration be given ensuring all notes are maintained in a single file for ease of reference. In order to enhance effective communication consideration should be given to having ‘whole team’ handovers from the nursing staff. 3. YA15 The policy of sexuality and intimate relationships lacks any guidance around risk management in this area and this needs to be added. An update to this policy highlights the need for further staff training so that awareness can be raised. The comments in the report around the need to ensure privacy for residents should be reflected on and considered along with the requirement to ensure safe areas for both sexes in the home. A competency assessment should be completed for staff who administer medicines. This will help ensure they have the skills and knowledge to undertake this practice in a safe manner. The current complaints procedure and the entry in the service user guide should have the contact and address for the Commission for Social Care inspection. The ongoing training of staff around safeguarding should continue and be completed and include training for external bodies such as social services. The current liaison with social services regarding safeguarding should continue as this shows good practice and should further enhance understanding and consistency in this area. 8. YA24 To improve the environment in respect of orientation aids for residents. This was discussed in relation to good practice guidance for dementia care and reference to the provision of single sex accommodation. 4. YA16 5. YA20 6. 7. YA22 YA23 Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 42 9. YA28 A smokers’ lounge should be provided for the residents on Beechwood in respect of changes in the law with regard to smoking. Part of the rear garden is overgrown and this should be ‘cut back’ to enable residents to use this area. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 43 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston, PR2 2YQ 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. Beechwood DS0000059323.V364633.R01.S.doc Version 5.2 Page 44 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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