Inspection on 26/09/06 for Beechwood Cheshire Home

This inspection was carried out on 26th September 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beechwood Cheshire Home 13/09/07

Beechwood Cheshire Home 19/12/05

Beechwood Cheshire Home 03/08/05

Beechwood Cheshire Home 04/11/04

Beechwood Cheshire Home 18/05/04

Beechwood Cheshire Home 14/01/04

Similar services:

Snydale Care Home

Staveley Birk Leas Nursing Home

Fairmount Nursing Home

Currergate Nursing Home

Brookfield

Castlethorpe Care Home

Elmleigh Convent

Woodlands Respite Care Centre

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

CARE HOME ADULTS 18-65 Beechwood Cheshire Home Bryan Road Edgerton Huddersfield West Yorkshire HD2 2AH Lead Inspector Helen Battle Key Unannounced Inspection 26th September 2006 09:25 Beechwood Cheshire Home DS0000001109.V306898.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 Cheshire Home DS0000001109.V306898.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 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.V306898.R01.S.doc Version 5.2 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) www.leonard-cheshire.org.uk Leonard Cheshire 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.V306898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 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 to 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. The Provider informed the Commission for Social Care Inspection on the 2 October 2006 that the fees range from £492 to £921 per week. There are additional charges for hairdressing, newspapers, chiropody and toiletries. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home carried out by one inspector. The inspector arrived at the home at 9.25 am and left at 4.00 pm. During this visit the inspector spoke to some of the service users, some of the staff and the home’s management. The inspector read care records, audited a sample of medications, reviewed staff recruitment and training records, and carried out a tour of the building. Prior to the inspection, ten service user questionnaires were sent to Beechwood to obtain the views of service users living at the home. Five completed questionnaires were returned. There were twenty three service users living at the home on the day of this inspection. Surveys were sent to ten relatives and friends of service users, GPs and social workers. At the time of writing this report, the inspector had received two responses from relatives and one GP. There were no responses from social workers. Other information used as part of the inspection process included notifications from the home to the Commission for Social Care Inspection about deaths, illnesses, accidents and incidents at the home, copies of the monthly management visit reports produced by the provider, and a pre-inspection questionnaire completed by the manager. The inspector would like to thank everyone for their assistance during the inspection process. What the service does well: The service users are supported by a dedicated and competent team of staff. The service users spoken to spoke highly of the staff saying they are kind, caring, pleasant and committed. The home ensures that service users are protected by adult protection policies, medication policies and procedures and the complaints policy. All the service users spoken to said that they knew who to speak to if they were unhappy about anything. Positive interaction was observed between service users and staff. The meals provision at the home is of a good standard. Service users stated that the food was good and there is lots of choice. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 6 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 Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 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.V306898.R01.S.doc Version 5.2 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, 4 Service users have their needs assessed prior to admission into the care home. Service users are invited to take the opportunity to visit the home before making a decision to live there. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Pre-admission assessments are carried out by senior members of staff working at the home, prior to agreement that individual needs can be met by the home. Examples of pre-admission assessments were seen for two service users. One service user stated that they had been invited to visit the home before admission took place. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 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, 8, 9. Plans of care are in place and service users are aware of the plans regarding their care. Service users make decisions about their lives and take risks as part of a more independent lifestyle. Service users are consulted on, and participate in, all aspects of life in the home. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The care plans of three service users were examined. These generally did reflect the needs of the service users. However, where needs had been evaluated, the evaluation was not reflected in the actual care plan. Not all needs identified in the daily records had a care plan to direct staff in the consistent delivery of care. There was clear evidence of service users being involved in the formulation or review of their care plans. Entries in the daily records varied in detail. Some entries were very good and detailed what care Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 10 and support had been given to individuals on a daily basis, other entries, however, were less detailed. Two service users spoken to at length stated that they were happy living at the home. Both stated that the staff are very good and that they are able to have a laugh and a joke with staff. They also said that staff are kind and patient. The support provided by staff at the home to enable service users to make choices and take risks were reported to be good. This was also evident on the day of the visit in observing staff interaction and speaking with service users. Service users spoken to stated that they are involved and consulted in making decisions about the running of the home and attend service user led meetings every six weeks. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 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, 14, 15, 16, 17. Service users take part in appropriate activities and are part of the local community. Appropriate relationships are maintained. Service users’ rights and responsibilities are respected. Meals provided at the home are good. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Service users take part in a variety of activities and attend day centres suitable for their needs. These include going out to do their own shopping, going to local restaurants and going out on trips to places such as Bridlington. One service user regularly goes for nights out to the town centre. Service users were observed on the day of the inspection to be reading newspapers, spending time in their rooms or seeing visitors. Some of the service users joined day care clients in their activities. A new post of Volunteer Co-ordinator has been developed since the last inspection. This was reported by staff and service users to have had a positive effect on the service users and has taken some of the pressure from the care Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 12 staff. Open days have been held during the summer, which involved a barbeque and entertainers. A karaoke evening has also been held recently and was spoken about enthusiastically by the service users. A group of volunteers have now been recruited and group activities are held every Wednesday afternoon. These have included quizzes and bingo. An art class has also been held over a period of ten weeks and some of the service users’ art work has been displayed in the home. Service users stated that the meals provided at the home are of a good standard. The main meal served at lunchtime on the day of this visit was cottage pie, carrots, cabbage and gravy, followed by Bakewell tart and custard. Service users confirmed that they are able to choose what they want to eat and where they eat it, whether it be in the dining room or their own room. During lunch, one service user said that they didn’t feel too well and was promptly offered a lighter alternative to the lunchtime meal. Staff were seen to provide assistance to those service users who required help in a discreet and appropriate manner. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 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, 20 Service users receive support in a way they prefer and require. Emotional and health needs are met. Service users are protected by the home’s policy and procedure for dealing with medication. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Service users spoken to stated that the staff are kind and provide personal assistance in a discreet manner which promotes privacy and dignity. Service users also stated that they are able to choose what times they get up and go to bed. It was evident that service users choose their own clothes and hairstyles. There was evidence in the records of service users that support is also provided from specialist healthcare services where this is required. The medication of three service users was checked and all were found to tally with the records held. Procedures are in place to safeguard service users regarding medication. All medication is kept individually in service users’ rooms in appropriate storage facilities. A monitored dosage system is in place. Service Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 14 users are encouraged, where possible, to self-administer medication to retain some independence. New sit-on scales have been purchased since the last inspection, however they have not yet been used. Service users should be weighed regularly as part of their healthcare and particularly where a risk has been identified regarding nutritional status. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 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, 23 Generally, service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Two of the service users spoken to felt that they could speak to any member of staff and that they would be listened to. Any complaints received by the home are fully investigated and comprehensive records were seen of complaints investigations and outcomes. The complaints procedure is displayed in the home. The majority of staff have received adult protection training. The three remaining staff who have not yet received this training should undergo this training within a month of this visit. The personal monies of three service users were checked and were found to reconcile with the records held. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 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, 30 Generally, the service users live in a comfortable and safe environment. The home is generally clean and hygienic. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A sample of service users’ rooms were seen to be personalised according to the personal taste of individuals. Three rooms were in the process of being decorated at the time of this visit. One service user had chosen their own colour scheme for their bedroom. Communal rooms are well maintained. There are still some signs of wear and tear throughout the home, these are predominantly in toilet and bedrooms areas. Specific areas noted were tiles missing in one toilet, the floor covering was badly marked and there was a hole in the door of another. These areas were brought to the attention of the acting manager at the time of this visit. The home was clean and hygienic on the day of this visit. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 17 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): 32, 33, 34, 35 Service users are supported by competent and qualified staff. Service users are protected by the home’s recruitment practices. Service users’ needs are met by appropriately trained staff. There are not sufficient numbers of staff to meet the needs of the service users. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 18 Staffing levels at Beechwood are not up to the required level. This remains an area of concern for the inspector. The staff group continue to work hard to meet the needs of the service users living at Beechwood. This issue must be addressed by the line managers of the home and the responsible individual. The staffing notice issued by the previous registering authority relates to the service users receiving nursing care only, and was issued in 1994. This states that for 12 patients there must be 2 staff on duty during the day and night, one of which must be a first level nurse. Staffing levels at present for all 26 service users are: 8am – 2 pm = 1 nurse 5 carers 2pm – 5pm = 1 nurse 3 carers 5pm – 9pm = 1nurse 3 carers Nights = 1 nurse 2 carers The home must ensure that there is a first level nurse on each shift plus 6 carers in the morning, 5 carers throughout the afternoon and evening and 2 carers at night. This is due to the increasing dependency levels and the layout of the home. The requirement for adequate numbers of staff to be on duty to meet the needs of the service users has been a requirement for the home since 2004. Although reassurances have been given by the provider that this issue would be resolved, staffing levels are still not adequate to meet the needs of the service users. This was confirmed by service users and staff who were spoken to on the day of this visit. Examples of service users not being able to get up when they wanted were also documented on two recent occasions in one set of care records. Service users and staff expressed concern regarding the numbers of staff on duty, particularly on an evening. An example of three care assistants, one of whom was a bank carer, were on duty when a member of staff had to escort a service user to hospital at short notice. This left just two carers and a nurse on duty. The layout of the home makes it difficult for staff to be available at all times for service users. Failure to meet this requirement may result in further action being taken. The records of three members of staff were examined as part of this inspection. All three were found to contain the required information. There is a comprehensive training programme in place at Beechwood, and a dedicated training officer employed by the organisation. Clear records are held on computer of the extensive range of training provided. This includes fire safety, movement and handling, POVA. Staff spoken to were positive about the training they had received. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 19 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, 42 Service users benefit from a well run home. Service users’ views underpin development at the home. The health, safety and welfare of service users is protected. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Since the last inspection, the registered manager has left the employment of the home. The senior nurse at the home is acting as manager and has many years of experience in looking after this service user group. Service users and staff were positive about the acting manager and said that the atmosphere in the home has improved since she took over the management of the home. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 20 Service users’ views are listened to and underpin any development of the home’s policies and practices. This has been particularly apparent in improving the activities provision. Monthly management visits are carried out. Discussion took place with the acting manager about how quality assurance processes could be implemented to improve the service provided at the home. The Leonard Cheshire Foundation carries out a four yearly quality audit process. Where a bedroom had been decorated, the window restrictors had not been replaced. This was highlighted at the time of the visit to the acting manager. Weekly tests of the emergency lighting and fire alarm systems are recorded. There were two periods where this had been missed for a week. It was reported that the work on the fire escape is planned to be undertaken in the near future although a specific date has not been arranged. Failure to meet this requirement may result in further action. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 21 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 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 1 X Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 22 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 YA33 Regulation 18 Requirement Staffing levels must be provided to meet the needs of the residents living at Beechwood. Previous timescales 14/01/04, 31/12/04, 04/09/05, 19/02/06 not met. Failure to meet this requirement may result in further action. 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. Timescale for action 30/11/06 2. YA42 23 (4) (a) (b) (c) 30/11/06 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. Refer to Standard YA6 Good Practice Recommendations Care plans should reflect the evaluation of current needs. Daily records should evidence delivery of the care plan and Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 23 2. 3. YA24 YA42 any outcomes. A rolling programme of decoration should continue to be implemented at the home. Care should be taken that weekly tests of the emergency lighting and fire alarm are maintained. The identified window restrictor should be refitted. Beechwood Cheshire Home DS0000001109.V306898.R01.S.doc Version 5.2 Page 24 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. 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