Inspection on 28/02/06 for Beechwood

This inspection was carried out on 28th February 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Beechwood 21/05/08

Beechwood 27/11/07

Beechwood 27/07/06

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 HOMES FOR OLDER PEOPLE Beechwood Beechwood Road Liverpool Merseyside L19 OLD Lead Inspector Julie King Unannounced Inspection 28th February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beechwood Address Beechwood Road Liverpool Merseyside L19 OLD 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) 02077237071 02077248086 European Wellcare Homes Ltd Mrs Mary Regan Care Home 60 Category(ies) of Dementia (36), Dementia - over 65 years of age registration, with number (24) of places Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 24 DE(E) PC to be accommodated in the Beechwood Unit. 36 DE(N) Service Users under the age of 65 years with Early Onset Dementia accommodated in the Hunter Unit The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 15th September 2005 Date of last inspection Brief Description of the Service: Beechwood is made up of two units. The Beechwood Unit provides care and support for 24 elderly mentally infirm residents; and the Hunter Unit provides nursing care for 36 younger adults with early onset dementia. A small number of day care places are also provided for at Beechwood. 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 ample parking spaces for parking at the front of the building. Most bedrooms are single, and each unit has adequate communal space and bathing / toileting facilities; and the home was in process of a complete renovation at the time of this inspection. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over five and a half hours. A full tour of both units took place. A range of records such as care plans, staff personnel files, policies & procedures and medication charts were examined. A selection of staff on duty, and a number of service users were spoken to during the course of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. The service users assessed needs are being met, and the home is able to provide assurances to service users and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: The home’s Statement of Purpose and Service User Guide have been recently updated in accordance with the changes to the facility. The contracts for service users are not in line with current legislation as they refer to The Registered Homes Act 1984. The Care Standards Act 2000 and accompanying Regulations from 2001 is what the home ought to be referring to. Service users are only admitted into the home on the basis of a full assessment is carried out prior to they move in. All pre-admission assessments are carried out by either the registered, or deputy manager, and include direct input from the prospective service users’ family / representative as agreed. Multidisciplinary healthcare team members such as the service users’ social worker, physiotherapist or NHS ward nurse, are part of this process. Specialist healthcare professionals continue to be involved in the care of service users Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 8 after they are admitted into Beechwood and Hunter Units. All the service users spoken to during this unannounced inspection told the inspector that they felt “it’s nice here”, and “my family are involved”. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. There is a consistent care planning system in place for most service users. This provides staff with the information they need to satisfactorily meet the service user’s needs. EVIDENCE: Individual care plans had been documented for each service user, and all seen were in the process of being updated and reviewed with the involvement of the individual service user as far as possible. Some improvements are needed in the way the recording of observations is completed following falls by service users. Systems are in place to ensure good communication between the care home, the NHS and other professionals involved in the care of all the service users. The service users spoken to during the inspection commented on the standard of care they received. They confirmed they had access to various healthcare professionals as necessary, and stated that the nursing and care staff always respected their privacy and dignity by “treating me well” and “asking me what I want”. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 10 Medication management, and the medication rooms were examined as part of this unannounced inspection. Since the previous inspection, the younger adult’s medication room has been moved to a new site, with all new facilities. This room was clean, tidy and well organised, and all necessary recordings and documentation were found to be in accordance with current good practice requirements. The medication management on the older person’s unit was compliant with requirements, and well managed. However the medication room was unsatisfactory, as it had blown plaster on a damp wall, and clear evidence of damp in other areas. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Links with the local community are good, and support and enrich service user’s social lives. The meals in this care home are good, offering both choice and variety, and catering for special dietary needs. EVIDENCE: The daily routines provided were flexible as far as possible, and service users are encouraged to exercise choice and control over their lives. Friends and family are actively encouraged to participate in the service user’s lives. A varied and nutritious diet was provided with specialist service user’s medical needs (such as diabetes) being catered for. Service users told the inspector that they were “listened to”, and the staff “always knocked” on the door before coming in. They also told the inspector that they felt able to “choose” what they wanted to wear, where to sit, what to eat, what to do, etc. Activities are offered on a daily basis, buy the two in-house activities coordinators, who organise a wide variety of activities, including outings to local places of interest. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 12 Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. An efficient complaint and adult protection policy and procedure is in place to help ensure the safety and welfare of service users. EVIDENCE: Beechwood and Hunter Unit have an efficient complaint and adult protection policy and procedure in place to help ensure the safety and welfare of service users that they, their relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’, in accordance with the Department of Health ‘No Secrets’ guidelines. Most of the staff have, or are in process of completing training in adult protection, with the remaining having training planned for the near future. However all staff do receive basic training in the protection of vulnerable adults during induction. The service users all spoke highly of the staff team and said they “have no complaints about how I’m treated”, and “nothing is too much trouble”. Some advocacy information was available if required by service users or their relatives. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Since the previous inspection the environment has deteriorated and is not conducive of a homely, safe environment in all areas. EVIDENCE: The Hunter Unit has benefited from having most areas refurbished and redecorated. Some areas still require attention and refurbishment, but generally the standard on this unit is good. The Beechwood (elderly person’s unit) is in urgent need of a total refit and redecoration, with most areas evidencing extensive wear and tear. The main environmental findings on Beechwood unit are as follows• • Bathroom 2 – bath panels taped up with black insulating tape Room 2 – wallpaper peeling off damp wall, plaster blown, damage to ceiling tiles, radiator cover hanging off, window frame rotten and large gap to outside DS0000059323.V281173.R01.S.doc Version 5.1 Page 15 Beechwood • • • • • • • • • • • • Most window frames rotten throughout this unit, many having gaps and not closing fully into rebates Many windows also evidencing that the units have blown – condensation evident between glass panels Room 23 – very malodorous, sink unit damaged with urine, woodwork on sink unit splitting, floor stained, walls marked, chest of drawers damaged Room 21 – very malodorous, carpet rucked up presenting as a tripping hazard, stained and marked Corridors – walls damaged, wall coverings damaged and ripped, plasterwork damaged, door frames damaged Main lounge – badly nicotine stained – requires complete redecoration Room 20 – wall coverings ripped off wall in large pieces, headboard on be filthy – required immediate removal Many clinical waste bins had no lids Many general waste bins no lids All bathrooms had communal soap, razors, sponges, toothpaste – all required to be removed immediately by the inspector Rooms 13 & 14 – walls and plaster damaged, light-shade smashed, rotten sink unit Lounge next to bathroom 6 – requires total redecoration Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29. Staffing levels are adequate to ensure the safety and welfare of the service users. Pre-employment checks are thorough, helping ensure the protection of the service users. EVIDENCE: The home is staffed with satisfactory levels of staff required to meet the needs of the service users, with the registered manager, qualified nurses and care staff on duty. Additional staff are brought in to accompany service users to hospital appointments, etc. The staff rota evidenced minimal use of agency staff, with the homes own staff covering the majority of hours. Staff spoken to during the inspection confirmed that a range of mandatory and specialist training was now available, with the majority of the cost being paid for by the care home. This approach to training is a positive aspect of the care home, as it helps ensure that service users are being cared for properly and their needs are being met in accordance with current good practice guidelines. Staff personnel files were examined; all now evidenced training records, preemployment checks, references, inductions and most had some record of supervision. The inspector was informed that CRB and POVA checks were not kept in the home, but were at head office. It is a requirement under the Care Homes Regulations 2001 that all documents as listed in paragraphs 1-7 of Schedule 2, are available for inspection at the care home. The inspector was Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 17 informed that all staff personnel files are going to be forwarded on to each home to ensure future compliance with this standard. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 38. The service users benefit from a manager who is qualified and competent to discharge their duties and who ensures the health and safety of service users is promoted. EVIDENCE: The manager was been in post for many years. The manager has completed an NVQ Level 4 qualification in management, and has obtained their Registered Manager’s Award. The manager reported that both she and the senior staff have attended training to keep their knowledge and skills up to date. The inspector was informed that the deputy manager will be commencing his NVQ 4 Registered Manager’s Award in the near future – a move that should further enhance care practice within his unit. Staff spoken to told the inspector that they were happy working at the home, and the management supported, and listened to them as needed. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 19 Required safety certificates were examined, including the fire book. This evidenced that safety checks on fire equipment had not been carried out at the required intervals over the past two months. The inspector was informed that the person responsible for these checks had been away, but another designated person would be appointed to complete all necessary checks within the week. Nursing and Midwifery professional identification numbers (PINs) are to be faxed through to the CSCI, as they were not in the office at the time of this inspection. The registered person still is not providing Regulation 26 visits as previously required in the last inspection. This is now non-compliance. For security and safety reasons, it is required that the external grounds are made safe. It is strongly recommended that suitable and adequate fencing is obtained around the premises; and that the front security light is fixed as soon as possible. Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x X X X 2 2 Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP 19 Regulation 16 & 23 Requirement The registered person must ensure that all areas of the care home are kept reasonably decorated at all times – refer especially to Beechwood Unit. The registered person must ensure that all communal areas are well maintained, clean and safe at all times – refer to Beechwood Unit. The registered person must ensure that all bathing facilities are in a good state of repair at all times – refer to damaged baths and bath hoists in Beechwood unit The registered person must ensure that all areas have call alarm systems that are accessible for service users – refer to bathroom in Hunter Unit without a call alarm pull cord The registered person must ensure that service user’s bedrooms are well maintained and safe at all times – refer to damaged bedroom walls, broken lights and rotten sink units in Beechwood unit. DS0000059323.V281173.R01.S.doc Timescale for action 30/05/06 2 OP 20 23 30/05/06 3 OP 21 16 & 23 30/05/06 4 OP 22 13 & 23 30/03/06 5 OP 23 23 30/05/06 Beechwood Version 5.1 Page 22 6 OP 24 16 & 23 7 OP 25 23 8 OP 26 16 9 OP 37 17 10 OP 37 26 11 OP 38 23 (4) The registered person must ensure that each service user’s private room has adequate, safe and suitable furnishings – refer to damaged furniture, chest of drawers and damaged sink units in Beechwood unit. The registered person must ensure that the rotten windows are replaced as soon as practicable on both units, especially Beechwood unit, prioritizing the windows with a gap to the outside in the frames. The registered person is required to ensure that all parts of the care home are kept clean and odour free at all times – refer to malodorous bedrooms, corridors, and bins without lids. The registered person is required to ensure that all documents and records as specified in Schedules 1, 2, 3 & 4 of The Care Homes Regulations 2001, are kept at the care home, up to date and valid, for inspection at any time. The registered person is required to complete Regulation 26 visits in accordance with this regulation. The registered person is required to ensure all necessary fire safety and equipment checks are carried out at the required intervals at all times. 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beechwood DS0000059323.V281173.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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