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Inspection on 19/12/05 for Beechwood Cheshire Home

Also see our care home review for Beechwood Cheshire Home for more information

This inspection was carried out on 19th December 2005.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents spoken with said that the staff are helpful and supportive. The inspectors noted that the residents enjoy good relationships with the staff and the manager of the care home. The staff at the care home continues to work hard to meet the needs of the residents. The manager is committed to improving standards in the home.

What has improved since the last inspection?

There has been some maintenance and redecoration completed in the home since the last inspection. Some action has been taken to address the homes fire escape. The organisation has consulted the fire authority and the structural engineer.

What the care home could do better:

All the residents should be involved in the formulation and the review of their plan of care. The care records should clearly identify the care required to meet the health and welfare needs of the residents. The organisation must address the general maintenance and refurbishment of the home. The organisation should develop a staff training and development programme to ensure that all the staff are suitably trained to meet the needs of the residents.

CARE HOME ADULTS 18-65 Beechwood Cheshire Home Bryan Road Edgerton Huddersfield West Yorkshire HD2 2AH Lead Inspector Bronwynn Bennett Unannounced Inspection 19th December 2005 09:30 Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 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 Cheshire Home DS0000001109.V272651.R02.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 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 Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beechwood Cheshire Home Address Bryan Road Edgerton Huddersfield West Yorkshire HD2 2AH 01484 429626 01484 455483 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) Leonard Cheshire Mr Paul Raymond Lewis Care Home 27 Category(ies) of Physical disability (27), Physical disability over registration, with number 65 years of age (27) of places Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2005 Brief Description of the Service: Beechwood is part of the Leonard Cheshire Foundation, and it is a well established care home providing personal support and nursing care for up 27 adult service users with a physical disability. A number of people attend the home to use the day care facilities. The home is a large stone built detached house set in its own grounds situated on a quiet road in the Edgerton area of Huddersfield. There are adequate parking facilities and the home is conveniently situated close to a major bus route. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection during a five-hour period. The inspectors made a tour of the building and looked at a sample of records kept by the home. The inspectors also spoke to some of the residents and staff. The inspection was conducted with the help of the manager of the home. What the service does well: What has improved since the last inspection? What they could do better: All the residents should be involved in the formulation and the review of their plan of care. The care records should clearly identify the care required to meet the health and welfare needs of the residents. The organisation must address the general maintenance and refurbishment of the home. The organisation should develop a staff training and development programme to ensure that all the staff are suitably trained to meet the needs of the residents. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 6 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 Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. The resident’s needs are assessed before they move into the care home but there was no written confirmation available during this inspection that the home could meet the resident’s needs. EVIDENCE: Details of a pre-admission assessment were evident in the residents care records looked at. There was no evidence in the care records kept that the registered person had confirmed in writing that having regard to the assessment the home is suitable to meet the needs of the resident. However, there are contracts in place for the residents. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. Improvements should be made to ensure that all the residents are consulted about their plan of care. The residents are supported to make decisions and take risks in their lives. EVIDENCE: All of the residents spoken with said that they were satisfied and with the care and the support they receive from the staff. There were comments such as “ I could not wish to be cared for by anyone better” and “ the staff are nice and helpful”. The care records for four residents were examined and the detail in these records is generally good. However, some of the daily records were vague and did not show how the residents have spent their day. Only one of the records showed that the resident, or a representative had been involved in the development and review of the plan of care. There was evidence in the care records looked at that the residents are supported to make decisions and take risks in their daily lives. There were some risk assessments in the care records looked at for minimising identified risks and hazards. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 10 Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16. The residents are supported to be part of the local community and take part in appropriate activities. The residents are supported to maintain family links and friendships. Generally the residents’ rights are protected with the individuals’ choice being promoted. EVIDENCE: The residents are supported to take part in preferred and appropriate activities. There are no residents with jobs or educational training but the residents are supported to take part in community activity. There was evidence in the care records looked at that the residents are consulted about choice of lifestyle and daily living. The home supports the residents to be part of the local community. Where they have chosen to do so, some of the residents go out to day-care facilities, Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 12 church and shopping. On the day of this inspection there was a carol service at the home. The staff do support the residents to maintain family links and friendships. One service user said that they regularly go out to spend time with their relative. There was evidence of family and friends being welcomed into the home on the day of this inspection. Generally the resident’s rights are respected. The residents spoken with said that the staff support them in their preferred way and speak to them using their preferred form of address; this is also recorded in their personal care record. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. 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. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19. Generally the residents receive personal support in the way they prefer. Some of the residents are at risk of not having their health and welfare needs fully met. EVIDENCE: The guidance and support that may be required by the resident is recorded in their care records. The residents spoken with said that they are able to get up and go to bed when they choose to do so. One of the care records looked at showed how to support a resident with their evening meal. There were assessments in place for some of the resident’s health care needs. Some of the information held in these records was not clear or easily followed. The inspector also noted that some of the documentation was not updated or signed. Where there was concern of the nutritional intake for one resident, a weight record was not in place. Some residents had not been weighed as specified in their assessment. This is not acceptable and needs to be addressed. The manual handling assessment for one resident did not reflect their current situation. Some assessments had required several changes resulting in the current information being difficult for the staff to follow. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 14 There were care plans in place for wound care. Greater care needs to be taken to ensure these records are specific and give the full details of the care that is to be provided. Where a wound or sore is healed this should be recorded in the specified plan. Generally the inspectors were unclear about the condition of some residents as many records were not fully completed, signed or updated. There was no information in the care records looked at relating to the oral hygiene needs of the residents and this was discussed with the manager. The standard for dealing with medicines was not looked at during this inspection. The home is currently in the process of changing its medication system. The manager said that the requirement from the last inspection relating to those residents who choose to self medicate has now been addressed. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The residents feel able to raise concerns or make a complaint. EVIDENCE: The complaint procedure has now been updated to include the information of how to contact the Commission for Social Care Inspection. The residents spoken with said that they were aware of how to raise concerns or make a complaint. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,30. The exterior of the building poses a potential health and safety risk to some of the residents. The identified toilet facilities do not provide the residents with facilities that are adequate. The lack of suitable ventilation in the laundry facilities poses a potential health and safety risk. EVIDENCE: The exterior of the building continues to lack proper care and maintenance. The risk assessment for these areas does not give sufficient detail. All risk assessments should give the details of the identified risk, the measures taken to minimise that risk, and the timescales for subsequent review. Some of the toilet facilities are in need of updating and redecorating. The identified toilet should be given priority as the present floor covering presents a tripping hazard to the residents and the staff. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 17 During a tour of the building the inspectors noted that the home was clean and odour free. The ventilation in the homes laundry facilities needs to be replaced. The inspectors noted that a vented window had been blocked up with a towel thus preventing adequate ventilation. This is not acceptable and needs to be addressed. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,35. Robust recruitment procedures should be followed in order to protect the residents. Not all the staff has received the appropriate training in order to meet the needs of the residents. EVIDENCE: Employment records for three of the staff were examined. There were gaps in the employment history of one record and another did not have the relevant reference. Clear records need to be kept of referees contacted and reasons, if any, why references are not provided from the application form. The inspectors looked at the training and development records for the staff. The training records kept showed that not all staff has undertaken induction training. All the staff requires training for the protection of vulnerable adults. And the records showed that some staff had not received fire training. An immediate requirement was made on the day of inspection regarding fire training. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 19 A requirement was made at the last inspection regarding the current staffing levels at the home. The manager advised the inspectors that negotiations were still taking place relating to staffing levels in the home. The requirement made at the last inspection is carried foreword. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. 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 home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39. The home is run by a manager who is competent and of good character. The home has a quality monitoring system in place that seeks the views of the residents. EVIDENCE: The registered manager is suitably competent and experienced to run the home. Mr Paul Lewis is currently working towards the NVQ Level 4 in Care. The residents spoke highly of the manager stating that he is supportive and approachable. During this inspection the inspector noted that the manager has a good relationship with residents. The home has a quality monitoring system in place. There are regular residents meetings with one resident been on the committee for such meetings. Annual questionnaires are completed for both the residents and the staff. However, there was no evidence that the results from these Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 21 questionnaires are published and made available in suitable formats for the residents. This was discussed with the manager. Although standard 42 was not looked at during this inspection a requirement was made at the last inspection relating to fire safety. There has been consultation with fire authority and other professionals to progress in this matter, and it is expected that the works required to the identified fire escape will shortly be addressed. However, until this work is completed the requirement will be carried forward. The training programme for safe movement and handling continues to be delivered on a two yearly basis. The recommendation for staff to receive annual updates in movement and handling training is carried forward. Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 22 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. 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 X 2 2 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 3 23 X ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 1 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 X X 2 X 2 X X 1 X Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 23 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 YA2 Regulation 14 (1) (d) Requirement Timescale for action 19/01/06 2 YA6 15 (2) (a) (b) (d) 3 YA19 12 (1) (a) The registered person must confirm in writing to the resident, that having regard to the assessment the care home is suitable for the purpose of meeting the residents’ needs in respect of their health and welfare. The registered person shall make 19/01/06 the residents plan available to the resident; keep the service users plan under review; and notify the resident of any such revision. The registered person shall 19/01/06 promote and make proper provision for the health and welfare of the residents. The registered person shall having regard for the care home and the needs of the residents ensure that the care home is kept in a good state of repair internally and externally. Previous timescale 04/09/05 not met. The registered person shall having regard for the care home and the needs of the residents DS0000001109.V272651.R02.S.doc 4 YA24 23 (2) (b) 19/03/06 5 YA27 23 (2) (b) (c) 19/02/06 Beechwood Cheshire Home Version 5.1 Page 24 6 YA33 18 7 YA35 23 (4) (d) 8 YA35 13 (6) 9 YA35 12 (1) (a) 18 (1) ensure that the care home is kept in a good state of repair internally and externally. That all parts of the care home are kept clean and reasonably decorated. Staffing levels must be provided to meet the needs of the residents living at Beechwood. Previous timescale 04/09/05 not met. The registered person shall after consultation with the fire authority; must make arrangements for persons working in the care home to receive suitable training in fire prevention. The registered person shall make arrangements, by training staff or by other measures, to prevent the residents being harmed or suffering abuse or being placed at risk of harm or abuse. (Regs 12 (1) (a) 18 (1) (a) (c) (i) (ii) CSA 2000 (Miscel-laneous Amendments) Regs 2004) 19/02/06 19/12/05 19/03/06 19/03/06 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and safety of the residents. The registered person shall ensure that at all times suitably qualified, competent and experienced staff are working at the home in such numbers as are appropriate for the health and welfare of the residents. The registered person must ensure that the staff who work in the care home receive, training appropriate to the work they are to perform; and suitable assistance, including structured Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 25 10 YA42 23 (4) (a) (b) (c) induction training and time off, for the purpose of obtaining further qualifications appropriate to such work. There must be consultation with the fire authority to ensure adequate precautions are taken against the risk of fire, adequate means of escape and evacuation in the event of a fire. 19/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA30 YA34 Good Practice Recommendations Daily records should evidence delivery of the care plan and any outcomes. The ventilation window in the homes laundry facilities should be repaired or replaced. In order to maintain a robust recruitment procedure the manager should obtain references as specified in the application. Where this is not possible a note should be placed on the individuals file. Any gaps in the employment history should be explored. The manager of the home should continue working towards achieving the NVQ level 4 award. The results from resident’s surveys should be published in suitable formats. Staff should complete movement and handling training annually. 4 5 6 YA37 YA39 YA42 Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beechwood Cheshire Home DS0000001109.V272651.R02.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!