Inspection on 27/11/07 for Beechwood

This inspection was carried out on 27th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beechwood 21/05/08

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 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Beechwood Beechwood Road Liverpool Merseyside L19 0LD Lead Inspector Mrs Claire Lee Key Unannounced Inspection 9:50am 27 and 28th November 2007 th Beechwood DS0000059323.V355759.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.V355759.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.V355759.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.V355759.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 2. 3. The maximum number of people who can be accommodated is: 60 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 July 2006 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 prom. 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. Fees range from £121.00 to £2200.00 a week for accommodation. Different rates are set in accordance with social services and private funding. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A site visit took place as part of the inspection and this was carried out for two days for a duration of approximately fourteen hours. It was conducted by two inspectors from the Commission for Social Care Inspection. 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. ‘Case tracking’ was used as part of the visit. This involves looking at the support a person gets from the manager and staff including their care plans, medication, money and bedroom. 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. There were no family members present at the time of the site visit however two health care professionals visiting the home were also spoken with. ‘Have your Say’ Survey forms were distributed to residents, relatives, staff and health care professionals as another means of gaining their views. A number of comments included in this report are taken from interviews conducted and also survey forms received. One of the inspectors carried out a specific observation as part of the inspection on Hunter Unit using a specialist tool for dementia care which highlights levels of staff interaction, resident well being and engagement with surroundings of the residents observed. This is called Short Observational Framework for inspection (SOFI). The findings are used in parts of 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. What the service does well: Residents observed appeared relaxed and supported by staff. Staff appeared to have a good rapport with residents and the observation carried out using the observational (SOFI) tool 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 admitted to the units have their health and social care needs assessed prior to admission. The information obtained provides details of actual and potential needs of each prospective resident; thus allowing a Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 6 comprehensive care plan to be developed. Multidisciplinary healthcare team (MDT) input was evident to assist staff with collating information for the plan of care. Staff are aware of the importance of gathering as much information as possible to help provide the necessary care. Residents have access to equipment such as handrails, raised toilet seats, moving and handling equipment including bath aids. Staff have team leader roles and senior carer roles as part of their development. They are assigned a number of residents to care for which encourages individualised care. Disabled residents were observed to receive care and support from care staff in a very patient manner. Residents were offered support in different ways to help them feel reassured. Residents on the Hunter Unit have 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. An activities room on the ground floor was equipped with a variety of crafts, painting materials and games. Independence for the residents is encouraged through the activities programme and family involvement. Beechwood is a busy home with ‘a lot’ going on most days. The routine however appeared relaxed and residents were free to wander around the home with or without the supervision of staff. Residents on the Beechwood Unit reported good relationships with the staff and that there were sufficient staff around for a chat. Residents spoken with were complimentary regarding the choice of meals served and said that the food was always good. Staff were quick to offer residents drinks and snacks when requested and residents have the use of small kitchen areas to make their own drinks. This encourages them to be as independent as their condition allows. When discussing the food a resident reported, “It is really good and we get loads to eat”. The Beechwood Unit and Hunter Unit are staffed independently and staffing ratios are high on the Hunter Unit due to the dependencies of the younger adults and their associated dementias. Residents receive care from staff who receive training in safe working practices and dementia care. This helps ensure residents are cared for by staff who have the correct level of experience and skills. What has improved since the last inspection? There was no malodour in the home. Areas seen were clean and a number of soiled carpets have been replaced with suitable floor coverings. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 7 A shower room identified in the last report has been repaired to ensure it is suitable for resident use. The residents’ kitchen areas have cupboards that are accessible and provide suitable storage for them. The security light outside the home is now working to help maintain the security of the premises. What they could do better: The Service User Guide (a detailed brochure of the service) was seen on the site visit. It was noted that there are some anomalies that need to be addressed and these are stated in the main report. The Service User Guide must report accurately on the service provision as the home is for dementia. A resident’s plan of care must record all relevant health and social care with instructions to staff on the care delivery. This will help ensure their care needs are met effectively. The care plans need to be drawn up with the involvement of the relatives and/or advocates and the plan of care be kept under review to report any change in condition. Effective communication between staff is paramount to ensure good outcomes for the residents receiving care. Identified risks should be evidenced in the care files with reference to any medical condition that may affect the resident’s welfare. Appropriate risk management will help identify safety issues and promote the independence of the residents with the assistance of the staff. Social activities on the Beechwood Unit need to be developed to ensure all residents are offered a full stimulating programme based on individual preferences and according to their need. Social interaction plays an important part of dementia care and should be implemented as much as possible. There was no evidence of a complaint log and this must be maintained to evidence any complaints received, timescale for their investigation, outcome and any action taken. This is in accordance with the complaint procedure. The correct adult protection procedures must be adhered to in the event of an allegation being received. This will help protect the referrer and victim to ensure the appropriate authorities investigate the allegation and that the allegation is dealt with in accordance with Sefton and Liverpool’s Protection of Vulnerable Adult Procedure. A number of improvements have been made to the environment however this work needs to continue. The home is big and there are many small jobs that require attention. The maintenance person also undertakes decorating and carpet laying as well as general maintenance work. The improvements to the environment are stated in the main report, most importantly is the Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 8 replacement of bathroom tiles as some are missing in two bathrooms. Heating is also required for the conservatory as this room is currently without any form of heating and was cold. Heaters have been ordered and these must be installed as soon as possible to ensure the residents’ comfort. The environment is generally lacking with respect of orientation aids for residents (for example the use of appropriate signage) and this was discussed with regard to good practice guidance in dementia care and suitable reference material was recommended. A number of corridors are stark in appearance and would benefit from brighter colour schemes and pictures on the walls. This will provide a more stimulating and ‘homely’ appearance for the residents. Recruitment procedures were not robust to protect the residents. Employees can only commence work on receipt of a CRB (Criminal Record Bureau) enhanced disclosure and/or POVA (Protection of Vulnerable Adult) check and two satisfactory references. This will help ensure residents’ safety. Staff receive a good training programme in safe working practice areas however training records should evidence courses undertaken. Not all records seen were up to date. This also includes records for fire prevention, which are essential to evidence the staffs’ knowledge of fire prevention procedures. There was no formal record of staff supervision and it is strongly recommended that supervisory sessions be provided for them on a regular basis. This is due to the nature of the service and the demands that are placed on the staff on a day-to-day basis. There must be an adequate means of escape in the event of a fire. A disused carpet blocked the fire escape at the rear of the premises and the garden was overgrown in this area. The fire exit must be kept clear at all times. Feedback from staff and residents was good regarding the manager’s commitment to the service however the manager spends time overseeing another local European Wellcare home. Staff on duty were not sure if the manager was in the building and the manager’s hours were not recorded on the staffing rota in accordance with her position as the registered manager. The residents and staff must be assured that the home is well managed and staff must be aware of the hours Ms Regan works. The appointment of a deputy manager would assist Ms Regan as currently she is stretched with the managerial duties that she is expected to undertake. The overseeing of another care home should stop to allow Ms Regan to undertake her full position as registered manager for this service. Other recommendations are listed in the main report to implement best practice and help improve the overall service. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 10 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.V355759.R01.S.doc Version 5.2 Page 11 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 3 (Older people). Standard 6 for Older People was not assessed, as Intermediate Care is not provided. Quality in this outcome area 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 Service User Guide (a detailed brochure of the service) was seen on the site visit. The Service User Guide outlines the service on Hunter unit and there are some anomalies that 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 DS0000059323.V355759.R01.S.doc Version 5.2 Page 12 Beechwood 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 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. The information on the senior (executive) management structure is listed in the Service User Guide but there is little reference to the manager or other staff in the home. This needs to be developed. • Two 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 comprehensive care plan to be developed. These assessments are completed by either the registered manager, deputy manager or senior nursing staff and include details of the prospective resident – next of kin, past history both medical and psychological / mental health; a specific mental health assessment and involvement of representatives as needed. Multidisciplinary healthcare team (MDT) input is evident in residents’ care files and includes reference to NHS out-patient’s appointments, opticians, dentistry and tissue viability nurse specialist (TVNS) input at the home when needed. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 13 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, 9 and 10 (Adults 18-65) and Standards 7,14 and 33 (Older Person) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents have a care plan and these are evaluated but identified risks and changes to care are not always recorded so care needs can be unclear. There is a risk that needs may not be met. EVIDENCE: Four case files were examined as part of the case tracking process; two on the Beechwood Unit and two on the Hunter Unit. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 14 Beechwood The two care files seen outlined a number of individual care needs. One care file did not contain any reference to relatives being formally involved in the care planning process. This is required due to the frailty of the residents and to assist relatives to feel more involved and better informed regarding the care needs of their family member. Not all care plans seen contained all the relevant information associated with medical conditions that could affect a resident’s welfare. Staff must meet the diverse needs of residents, for example, the control of alcohol consumption because of a related dementia. Care plans are reviewed on a regular basis by the staff. The reviews are very brief however and record ‘care plans remain the same’. It is recommended that the evaluations be in more depth, as they should be a statement set against the main aim of the plan. A number of risk assessments had been completed as part of the care planning process and these identified any potential risk that may affect a resident’s well being, in areas such as, nutrition, moving and handling, personal care, care of skin and communication. Specifics risks identified with various dementias, for example alcohol, must also be assessed to evidence safety issues whilst trying to avoid limiting a resident’s choice whilst aiming for a better quality of life for them. Residents are encouraged to be independent however the health care needs of residents who are frail are managed by visits from GPs and other health care professionals. Clinical input is obtained for residents at the appropriate time however visits by GPs were not always recorded in the care file. There is a risk that staff are not aware of changes to the care provision or any prescribed treatments. A resident said, “The staff are ok and I am alright here. Likewise another resident reported, “It is another home for me, I am looked after”. Staff were seen talking to residents on a one to one or in groups. They were discussing the news, what music they would like to listen to and what they would prefer for their evening meal. At times however there were no staff in one of the lounges. Residents can make decisions on whether they wish to go out with family members or take part in the organised trips. Advocacy details were available for a resident who wishes to access independent advice. Staff have access to a policy regarding confidentiality and this is also discussed during the induction period for new staff. Resident records on the Hunter Unit are kept in the main office and a lock was applied to the office door at the time of the site visit. Residents and relatives must be assured that records are kept safe, secure and confidential when the office is vacant. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 15 Hunter unit Two care files were viewed for residents on this unit. Care plans are loosely based on an activities of living model of nursing care; and evidenced input from the resident, their representative and the multidisciplinary healthcare team as needed. There was no family input recorded for one resident who had only been admitted for one month. The nursing staff said that relatives’ input varied but was encouraged. Relatives are always invited to medical reviews (three to six monthly). 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 not always in great detail and sometimes omitted to recognise changes in care. There were two obvious examples of this. The first was for a resident who had suffered a problem with an ongoing medical condition, which affected their well being. The monthly evaluation made no reference to the fact that this had occurred; in fact the entry reads ‘no change’. It was therefore unclear whether any further intervention or change to the care had occurred. Another example was for a resident who had been the subject of a safeguarding referral to a social worker. There was no reference to this in the care plan or evaluations for that time period. The incident form detailed some changes to the management of the resident, which were missing from the care plan. The importance of this is that the care plans on both units should be the main communication tool for care staff and failure to highlight changes can mean that care needs may be missed or not planned appropriately. The care evaluations should be a record of the changes and progress made for each resident over the past evaluation period. Also it is an opportunity to record family involvement and discussion and this would be recommended. Other care records seen included the incident records and the accident records. Unlike the elderly care unit the accident book on Hunter is not data compliant and needs replacing. One resident had gone on leave prior to admission to the Hunter Unit, which evidences good practice. Residents on a detention order in hospital should have a copy of the appropriate legal form stipulating leave requirements (section 17 leave form). This should accompany any such future resident so that staff are aware of any orders from the consultant. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 16 Residents observed appeared relaxed and supported by staff. Staff appeared to have a good rapport with residents and the observation carried out using the observational (SOFI) tool 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. There was a copy of a residents’ meeting displayed and two of the residents act as ‘spokes persons’ and help organise these. Residents and relatives participation on both units is welcomed. They are given surveys to complete as part of assessing the quality of the service. Surveys were seen from November 2007 and any concerns raised had been addressed. Extra security around the premises is being arranged in light of comments received. The manager was able to discuss developments in terms of quality issues regarding improvements to the environment since the last inspection and various audits conducted regularly to review the service. This includes health and safety audits, which are carried out internally and also by senior management to ensure the ongoing protection of people accommodated. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 17 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.V355759.R01.S.doc Version 5.2 Page 18 Standards 12,13,14,15 16 and 17 (Younger Adults) and Standards 10,12,13 and 15 (Older People) Standards 12,13,14,15 16 and 17 (Younger Adults) and Standards 10,12,13 and 15 (Older People) Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to enjoy an active lifestyle in many instances but this is inconsistent. Further planning is required with respect to activities on the Beechwood Unit and risk factors associated with social interaction on Hunter Unit so that residents can be assured of a good quality of life. EVIDENCE: 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 have their own book for recording activities and for photographs. The recording of this information must be extended to residents on the Beechwood Unit, as little or no detail was available regarding preferred social interests and family involvement. Family trees had also not been completed in the care files viewed. Although the residents on the Beechwood Unit are not able to participate to the same degree as those on the Hunter Unit they must still be offered a programme of social stimulation to suit individual need. Records need to be kept to evidence their participation and enjoyment. 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 are well attended. 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. 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 bedroom areas. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 19 There was some discussion on the visit around these issues and the inspectors would refer managers to good practice documents such as, ‘ Safety, Privacy and Dignity in Mental health Units: Guidance on Mixed Sex Accommodation for Mental Health Service Users (2000). This can be down loaded from the Department of Health website. A review of present arrangements should be conducted. The routine appeared relaxed and residents were free to wander around the home with or without the supervision of staff. Residents reported good relationships with the staff on the Beechwood Unit and felt that they could talk with them. Staff were seen interacting with residents and a resident said, “The staff are great and always around”. Staff were observed to knock on bedroom doors before entering and residents were able to choose to stay in bed till late morning if they wished. A visiting social worker commented on the care of a resident that had been placed some time ago on Hunter Unit and said, “The staff have worked hard and been instrumental in turning the resident round in terms of his overall presentation”. Residents receive a good choice of hot and cold food, which was served in all the dining areas. The residents can choose which room they wish to have their meal. Lunch time on the Beechwood Unit was observed to be quiet and relaxed with a member of staff on hand to assist. Residents were given time to eat their meals in pleasant surroundings. The menu is based over four weeks and the chef meets with the residents to discuss preferred options. Residents were seen to ask for drinks and snacks during the day and these were provided immediately. A resident said, “You can never complain about the food”. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 20 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 is adequate. This judgement has been made using available evidence including a visit to this service. Generally health care needs are assessed and supported through adequate liaison with external professionals but some inconsistencies in communication mean that good outcomes are not always maintained and some residents may be put at risk. EVIDENCE: General observations of residents care evidenced good standards in relation to privacy and dignity overall. Staff were observed to knock on bedroom doors before entering. Bathroom and toilet doors closed effectively and there were locks on doors available and also to bedside cabinets. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 21 Independence is encouraged through activities programmes and family involvement. Support for personal hygiene is evidenced in care plans seen. Residents have access to equipment such as handrails, raised toilet seats, moving and handling equipment including bath aids. 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 now reading and socialising better. This had been on account of a consistent approach in this instance. Another carer was observed feeding a very disabled resident and was very patient and able to communicate with the resident by touch and reassurance. The visual communication was well paced and had the effect of relaxing the resident who obviously felt secure. Residents have access to health care professionals outside the home and this helps ensure their care needs are being met effectively. On the Beechwood Unit residents receive district nurse visits when their clinical input is needed. Residents who cannot attend a surgery receive GP visits. These and/ or GP telephone conversations had not always been recorded to evidence any changes in care provision or prescribed treatments. This was discussed in relation to an allegation of abuse that is currently being investigated. Accurate record keeping will help ensure the safety of the residents. 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. Family members are invited and there is multi disciplinary team input. A visiting therapist from the local Community Trust was spoken with and stated that generally the approach to care was good but that there could be inconsistencies and these were down to communication difficulties. For example a resident receiving solid foods rather than prescribed soft diet, which is required for swallowing difficulties (one of the care staff in this instance became aware of the mistake). Another observed example of communication failure was that a resident who was to be reviewed that morning had gone out on a day trip and so was not present. Accurate communication between trained staff and carers in terms of care planning and health care is important to maintain consistency. Medications were reviewed on Hunter Unit and found to be satisfactory. Overall there are good standards of recording and monitoring of medicines including regular audits carried out by both managers and supplying pharmacists. The fridge storage temperatures are monitored but are regularly showing temperatures in excess of 8C and the fridge should therefore be checked. This was relayed to the manager. The medication administration policy is kept in the office and is not readily accessible for staff and a copy should therefore be made available in clinic areas. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 22 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 16-18 and 35 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A lack of records for evidencing complaints and concerns that allegations of abuse are not dealt with in accordance with local procedures may affect the protection of the residents. EVIDENCE: The complaint procedure was displayed in the main entrance for people to read and access if they wish. This must be updated with the new address and telephone number of the local Commission office. The complaint log when requested was not provided. A comprehensive file for the recording of any complaints or concerns received must be in place to evidence complaints, their investigation and any action taken. A resident interviewed said they would speak to the staff if unhappy about anything. There was brief evidence in a file of an incident that was reported as an allegation of abuse, which had affected the welfare of two residents. Again these should be recorded in sufficient detail to ensure staff are aware of the facts and subsequent action. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 23 Staff have access to an abuse policy and also a copy of Sefton and Liverpool’s Adult Protection Procedures. Staff receive abuse training on a regular basis. There are two ongoing investigations regarding adult protection issues. The details of these were discussed. Both had been referred through the appropriate channels with regarding to reporting of such incidents to social services, the police and to the Commission for Social Care Inspection so that the locally agreed safeguarding protocols could be instigated. Concerns have been raised as a time delay occurred when reporting one allegation and also contact made with the referrer during the ongoing investigation. Adult protection must be dealt with in accordance with the local procedure to ensure the ongoing protection of all parties. A previous allegation of abuse has been closed. Residents’ finances are assessed under Standard 43 (Adults 18.65) and Standard 34 (Older People) of this report Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 24 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 24,26,28,29 and 30 (Adults 18-65) and Standards 19 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. A lack of general maintenance of the overall accommodation affects the safety and well being of the residents. EVIDENCE: The building is large and is in need of constant upgrading and repair. The manager was able to demonstrate an ongoing programme, which has included some décor, replacement of furniture and floor coverings to improve the Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 25 overall accommodation of the premises. Currently there is only one full time maintenance person who undertakes general day to day repairs, some decoration of bedrooms and carpet laying. Serious consideration should be given to employing another person to assist with this programme. On both units a number of windows and bedroom doors were found not to shut correctly, a handrail was loose and some window catches were broken. On the Hunter Unit tiles were missing from the walls in two shower rooms and one shower room had a lot of dirty surface water. This has the potential to be a trip hazard to residents and staff. Bath hoists and handrails are provided for residents who are less able. Communal areas on both units had spacious lounges and dining rooms with armchairs and coffee tables. There is plenty of room for residents to sit together or to enjoy some quiet time. The conservatory on the Hunter Unit was cold and requires some form of heating. Two electric heaters are on order and these must be installed as soon as possible to maintain a comfortable temperature for the residents. The manager stated that a number of conservatory windows are due to be replaced and are included in the general maintenance plan of the building. The conservatory has a billiard table and on one of the lounges a small bar area. A number of bedrooms have new bedroom suites and residents have chosen colour schemes for their rooms. A resident said, “I have everything here”. One bedroom carpet was identified as needing to be replaced and the manager stated that new flooring was on order. The environment is generally lacking with respect of orientation aids for residents (for example the use of appropriate signage) and this was discussed with regard to good practice guidance in dementia care and suitable reference material was recommended. A number of corridors are stark in appearance and would benefit from brighter colour schemes and pictures on the walls. Gardeners are employed to maintain the external grounds. There is an overgrown area at the rear of the premises that needs to be cut back as this is a fire exit from the building. All fire exist must be kept clear at all times. A disused carpet was also blocking this exit and the manager was instructed to have this removed. The requirement for this is stated under Standard 43 (Adults 16-65) of this report. The gardens are spacious but some are in need of general weeding and landscaping to improve the overall grounds for the residents. There is an inner courtyard with an enclosed fountain and residents can help maintain this area if they wish to be involved with gardening. There is inadequate fencing in one area of the rear garden with access directly on to the promenade. This may place residents at risk. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 26 The laundry room had sufficient equipment and staff had access to gloves and aprons to help minimise the risk of cross infection. The overall plans for any developments of the environment need to be taken with reference to discussions and recommendations under ‘lifestyle’ (Standard 15). Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 27 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 31,32,33,34,35 and 36 (Younger Adults) and Standards 27,28,29 and 30 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment practices are not robust to protect the residents. EVIDENCE: The Beechwood Unit and Hunter Unit are staffed independently and staffing rotas seen reflected the numbers of staff on duty to provide care and support to the residents. Staffing ratios are high on the Hunter Unit due to the dependencies of the younger adults and their associated dementias. Forty residents were accommodated at this time and one registered nurse, one registered mental nurse and eighteen care staff were on duty. There were twelve residents who were on one to one observations or close observations Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 28 and designated staff were assigned. Two residents were receiving twenty four hour one to one care. Seventeen residents were accommodated on the Beechwood Unit, which was staffed by a care/acting manager, deputy manager and one member of the care staff. Residents reported that staff are always available to help and staff were observed to assist with meals and various aspects of personal care. There are some trained staff who are appropriately qualified and experienced with regard to providing dementia care and this includes staff who are trained in mental health. Staff spoken with and the AQAA document confirmed that there is an ongoing National Vocational Qualifications (NVQ) programme. The AQAA provided information on those staff who are NVQ qualified in NVQ. 50 of the care staff employed are qualified. Four staff files were viewed to evidence recruitment procedures. Not all the files contained the required Criminal Records (CRB) and/or protection of vulnerable adult checks (POVA) or two references prior to employment. The manager stated that a number of recruitment checks are held at head office however this information was not provided at the time of the site visit. Staff are given details of job roles and also new staff receive an induction in accordance with the Skills for Care Induction Standards. These standards provide guidance on care practices and health and safety in the work place. Staff interviewed stated that they receive regular training and a training plan evidenced courses arranged till January 2008. Training records however did not evidence an up to date record of courses attended by staff. This includes moving and handling, first aid, food hygiene, infection control and fire prevention. Training records should be maintained to evidence mandatory training in safe working practice areas. There was no formal record of staff supervision and it is strongly recommended that supervisory sessions be provided for them on a regular basis. This is due to the nature of the service and the demands that are placed on the staff on a day to day basis. Staff meetings are held and staff said they receive a hand over at shift changes to discuss the needs of the residents. A designated training officer has been appointed for the ‘in house’ dementia training, which is open to all staff. Training should also be accessed in other courses relevant to this setting, for example, challenging behaviour and Korsakoff’s Syndrome (dementia related illness). Care staff interviewed had had statutory training but it was difficult to ascertain the level of dementia care training whilst viewing staff records. Staff spoke positively about there work in the home and generally felt that care was managed with the right values of respect for the residents. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 29 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, 39,40,42 and 43 (Adults 18-65) and Standards 31,33,35 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 home does not protect the health, safety and well being of the residents. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 30 EVIDENCE: 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. Ms Regan keeps herself updated by attending courses in safe working practices with her staff. Feedback from staff and residents was good regarding the manager’s commitment to the service and her ‘open’ door policy. At present however the manager spends time overseeing another local European Wellcare home. Staff on duty were not sure if the manager was in the building and the manager’s hours were not recorded on the staffing rota in accordance with her position as the registered manager. The manager stated that these are on the ‘returns’ to head office. The residents and staff must be assured that the home is well managed and staff aware of her hours. The appointment of a deputy manager would assist Ms Regan as currently she is stretched with the managerial duties that she is expected to undertake. The overseeing of another care home should stop to allow Ms Regan to undertake her full position as registered manager for this service. A number of requirements have been made in this report and these need to be met with urgency. The manager was able to discuss developments in terms of assessing quality assurance. This includes resident meetings and residents and relatives are given surveys to access their views of the service. This helps display a willingness by the manager to take on board new ideas and suggestions. A member of the senior management team completes a monthly visit and a report is compiled in line with Regulation 26 of the National Minimum Standards. The latest reports were requested but not provided. These should be made available for inspection. There is currently no external quality award however policies and procedures are reviewed to ensure they are in line with current legislation. A number were seen and staff reported that they were given policy details when they started. A spot check of a number of certificates for services and equipment were found to be up to date and also confirmed in the AQAA. An annual service check of the fire prevention equipment took place in October 2007 and the certificate issued following this visit had not been provided. It was agreed that this would be forwarded to the Commission once available. Fire training is provided for staff however fire training records were not up to date to evidence their attendance and competencies. Fire alarms and emergency lighting was being tested each week to ensure the ongoing protection of the residents and staff. A fire risk assessment of the premises was in place however one of the fire exits to the rear of the premises was blocked by a disused carpet and the garden is overgrown in this area. All fire exists must be kept clear at all times. Fire drills are conducted with the day staff. These should also be given with the night staff to ensure are familiar with the correct procedures to be followed. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 31 Hot water temperatures to baths and sinks are checked to ensure the hot water is delivered to a safe temperature. Records seen were satisfactory. Monies held on behalf of residents are place in a Residents’ Pocket Money Account, which is held at head office. A list was provided of residents whose money had been placed in this account. A breakdown of expenditures for three residents was requested but not provided at the time of the site visit. Financial records maintained by the staff at the home are for individual pocket monies for every day expenditures. Records seen were satisfactory however it is recommended that family members sign when they receive money or deposit to on behalf of a resident. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 32 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 X 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 x 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 2 39 3 40 3 41 X 42 2 43 3 2 3 X 2 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Beechwood Score 3 2 3 x DS0000059323.V355759.R01.S.doc Version 5.2 Page 33 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. • Biographical details of current manager and staff. The registered person must ensure the care plans on both units are drawn up with the involvement of the relatives and/or advocates and that the plan of care is kept under review. This will ensure they are aware of the care provision and help them to be involved with the care planning process. The registered person shall provide a written plan of care. The plan of care must include details of current health care needs that may affect the resident’s well being. DS0000059323.V355759.R01.S.doc Timescale for action 11/01/08 2. YA6 15 (1) 15 (2) (b) 11/01/08 3. YA6 15 (1) 11/01/08 Beechwood Version 5.2 Page 34 4. YA9 13 (4) (b) 5. YA14 16 (m) (n) 6. YA19 12 (1) (a) 6. YA22 22 (8) 7. YA23 13 (6) 8. YA24 23(2) (b) The registered person shall promote the health of the residents. Risk assessments should be completed for any specific risk that is related to a medical condition that may affect a residents’ welfare. This will help promote their personal safety with the assistance of the staff. The registered person must consult with residents regarding the social programme. The social programme for residents on the Beechwood Unit must be developed to provide social stimulation according to their individual assessed need. The registered person must make provision for the health and welfare of the residents. Communication between trained staff and carers in terms of care planning and health care is important to maintain consistency and promote the well being of the residents’ assessed needs. The registered person must provide a complaint log containing a summary of the complaints received. This will ensure complaints have been investigated within the timescale stated on the complaint policy. The registered person must ensure the correct adult protection procedures are adhered to. This will help protect the referrer and victim to ensure the appropriate authorities investigate the allegation and the allegation is dealt with in accordance with the local procedure. The registered person must ensure that the environment of DS0000059323.V355759.R01.S.doc 11/01/08 11/01/08 11/01/08 11/01/08 11/01/08 11/01/08 Beechwood Version 5.2 Page 35 9. YA28 16 (2) (c) 10. YA34 19 (1) Schedule 2 (1-7) 11. YA42 23 (4) (d) (e) 12. YA42 4 (b) the care home, both internally and externally is well maintained in good order at all times. The tiles in the shower room need to be replaced, bedroom doors and windows must shut correctly, window catches must be mended and the handrail must be made secure. Outside there is inadequate fencing around the grounds. (The fencing remains an outstanding requirement from the previous inspection, timescale of 30/09/06 not met) This will improve and make safe the accommodation for the residents. The registered provider must provide comfortable communal space. The conservatory is cold due to the lack of heating. Heating must be provided to ensure the comfort of the room for the residents The registered person must ensure staff are recruited via robust procedures. Employees can only commence work receipt of a CRB enhanced disclosure and two satisfactory references. This will help protect the residents. The registered person must maintain a record of fire training for all staff. This will evidence their attendance and competencies to deal with a potential fire. The registered person must provide adequate means of escape in the event of a fire. The fire escape at the rear of the premises must be kept clear at all times. The garden is currently overgrown. 18/12/07 18/12/07 18/12/07 18/12/07 Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 36 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 YA15 Good Practice Recommendations Serious consideration should be given to issues around privacy, safety and dignity with respect to reducing risks associated with mixed sex accommodation. The references discussed need to be reviewed and any plans for the development of the environment should take good practice guidance into account. Visits by health care professionals should be recorded in the care files to evidence any change in care provision or prescribed treatments. The fridge temperatures the clinic room on hunter are recording high and therefore the fridge needs to be checked. The medication policy should be readily available in clinic rooms for easy reference by staff. Corridors in the home would benefit from bright colours and pictures. The environment is generally lacking with respect of orientation aids for residents and this was discussed with regard to good practice guidance in dementia care and suitable reference material was recommended. Also see recommendations under standard 15 regarding mixed sex accommodation. Training records should be maintained to evidence courses attended by the staff. Training in dementia care should be conducted for all care staff. Supervision should be given to staff to assist them with their work and development The manager should no longer take on responsibility for another care home as this impinges on the time spent at Beechwood and the overall management of the service. A deputy manager should be appointed to assist Ms Regan with the management of the service. Reports of Regulation 26 visits should be kept at the home and made available for inspection An accident-recording book, which is data compliant, should be made available on Hunter Unit. Fire drills should be conducted with the night staff to DS0000059323.V355759.R01.S.doc Version 5.2 Page 37 2. 3. YA19 YA20 4. YA24 5. YA35 6. 6. YA36 YA38 7. 9. 10. YA39 YA42 YA42 Beechwood 11. YA43 ensure they are aware of the procedures to be followed in the event of a fire. The service contract for fire prevention should be forwarded to the Commission once available. Family members should be asked to sign financial records when depositing or receiving monies on behalf of residents. There should always be two signatures on any record relating to finances. Beechwood DS0000059323.V355759.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG 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.V355759.R01.S.doc Version 5.2 Page 39 - 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. 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