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Inspection on 03/08/05 for Beechwood Cheshire Home

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

This inspection was carried out on 3rd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

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 staff at Beechwood are working hard to meet the needs of the residents. The residents spoken to said that they are satisfied with the care and support that they receive from the staff. The residents, relatives and staff said that they felt that the manager is approachable and that they would feel listened to should they wish to raise concerns or make a complaint.

What has improved since the last inspection?

There has been some general maintenance to the home with the corridors and some bedrooms being redecorated. The manager advised the inspector that the home`s fire system has recently been updated. There have been new water tanks fitted and the identified bath from the last inspection has now been replaced.

What the care home could do better:

The manager and staff should ensure that all the residents are involved in the formulation and review of their plan of care. The care records for the residents should clearly identify the care needed to meet the health and welfare needs of the residents. The home`s policy and procedure for medication must be followed to ensure that the residents are protected by safe practice. There was a discussion with the manager about the staffing levels in the home and meeting the resident`s needs. The current staffing levels means that the staff struggle to meet the residents social care needs. The organisation needs to take action to resolve this.The fire and health and safety issues at the home should be explored and the necessary actions taken to protect the residents. A programme of routine maintenance should be carried out.

CARE HOME ADULTS 18-65 BEECHWOOD CHESHIRE HOME Bryan Road Edgerton Huddersfield HD2 2AH Lead Inspector Bronwynn Bennett Unannounced 3 August 2005 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 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 Stationary 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 J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Beechwood Cheshire Home Address Bryan Road Edgerton Huddersfield HD2 2AH 01484 429626 01484 455483 Telephone number Fax number Email 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 Lewis Care Home with Nursing 27 Category(ies) of Physical Disability 18 - 65 years - 27 registration, with number Physical Disability - over 65 years - 27 of places BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Conditions of this registration are listed on the registration certificate displayed at the service. Date of last inspection 4th November 2004 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. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection lasting for a period of approximately seven and a half hours. The residents and the staff on duty were spoken to and one visiting relative. The inspector also looked at written records. What the service does well: What has improved since the last inspection? What they could do better: The manager and staff should ensure that all the residents are involved in the formulation and review of their plan of care. The care records for the residents should clearly identify the care needed to meet the health and welfare needs of the residents. The home’s policy and procedure for medication must be followed to ensure that the residents are protected by safe practice. There was a discussion with the manager about the staffing levels in the home and meeting the resident’s needs. The current staffing levels means that the staff struggle to meet the residents social care needs. The organisation needs to take action to resolve this. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 6 The fire and health and safety issues at the home should be explored and the necessary actions taken to protect the residents. A programme of routine maintenance should be carried out. 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 J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 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 standard(s) EVIDENCE: Not assessed during this inspection. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 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 standard(s) 6. The care plans are generally good, but the home needs to improve the way in which some residents are consulted about their individual plan of care. EVIDENCE: The residents spoken with said that they feel supported by the staff in the home. The care records for three residents were looked at. The detail in each individual plan of care was generally good. There was evidence that some residents are involved in the care planning process, however there was no evidence that one resident had been involved in their plan of care. One resident said that he had been involved in the development of his care plan. Some of the daily records are vague and this was discussed during the last inspection and a further recommendation is made in this matter. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 10 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 standard(s) 17. The residents are offered a varied diet and specialist diets are catered for. EVIDENCE: The inspector had lunch with the residents and the meal was well presented. The staff were seen appropriately supporting the residents with their food. One relative informed the inspector there were concerns regarding how her partner is supported to eat and this was discussed with the manager. The residents spoken to said that they enjoyed their meals. There is a four weekly menu and an alternative diet can be requested although this is not recorded. Specialist diets are catered for and the home presently caters for diabetic and soft diets. The home should review how food taken, or the choice of food is recorded to ensure that nutritional needs are monitored and reviewed. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 11 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 standard(s) 19,20 Some of the residents are at risk of not having their healthcare needs met. The home’s policy and procedure for medication does not protect those residents who wish to self-medicate. Greater care needs to be taken with the safe handling and dispensing of medication. EVIDENCE: There were assessments in place for some resident’s health care needs. One resident’s assessment for wound care did not have an up to date plan. The inspector noted a continence assessment and a nutritional assessment were not dated; this needs to be addressed so that the staff are sure of the care that is to be provided. Some information in the residents care records is not completed and therefore it is not clear if those residents do receive input from healthcare professionals. There was no information in all the care plans examined relating to the oral hygiene needs of the residents and this was discussed with the manager. There are medication records kept for each resident. The medication records for three residents were checked. The inspector noted that there were signature omissions and one medication could not be reconciled with the records kept. The inspector looked at the procedure in place for a resident who wishes to self-medicate part of their medication. The current procedure for this practice BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 12 is not acceptable. The supplying chemist and not the staff in the home must complete the loading of any dosette boxes. There is no risk assessment is in place for this procedure which needs to be addressed. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 13 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 standard(s) 22,23. The residents feel able to raise concerns or make a complaint. EVIDENCE: The home has a complaints policy in place however this policy requires updating to include the information of how to contact the Commission for Social Care Inspection. There is a record of all the complaints made to the home. A relative and some service users said that they did feel that their were listened to should they raise a concern or make a complaint. The home has a whistle blowing policy in place and the staff spoken to had a good understanding of adult protection. The training officer informed the inspector that the staff are to undergo adult protection training. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 14 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 standard(s) 24,27,30. The health and safety issues at the home pose a risk to some of the residents. There is a lack of maintenance to some of the bathroom and toilet facilities. The lack of suitable hand washing facilities poses a health and safety risk. EVIDENCE: The home has a handyperson to carry out all minor works in the home and all major work been carried out by contractors. The exterior of the building lacks proper care and maintenance. At the front of the building there is a garden area complete with a pond, the steps to access this area have been partially cordoned off by warning tape. The manager and the provider should take precautions, to ensure that any residents identified as being unsafe to access this area are excluded through the completion of the relevant individual risk assessment and required actions. There is a smoking lounge that is in need of redecorating, new floor covering and suitable furniture. The identified fire extinguisher should be mounted on the wall. There should be no storage of equipment in this area as it poses a health and safety risk to the residents and staff. The ladders stored in this area must be removed. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 15 The communal areas of the home offer domestic style furnishings and the corridors have been redecorated. The inspector was concerned about fire safety. The inspector was also concerned that insufficient nurse call leads are fitted to the communal areas to allow the residents to call for help (please refer to standard 42). There are bathroom and toilet facilities for the residents, however these require updating and redecorating. One bath has been replaced since the last inspection that is suitable for the service user group. The home was clean airy and free from offensive odours. The laundry facilities were clean and well organised and staff are employed to deal with the homes laundry. There is a washing machine with a sluicing facility. There were no suitable facilities for hand washing facilities in the laundry and this was discussed with the manager. All the staff are about to complete a course for infection control and the home has a policy in place for control of infection and clinical waste. The inspected saw moving and handling slings hanging over the rails on the fire doors located just outside the laundry facilities. This poses a fire safety risk and this practice must stop. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33. The staff are working hard to meet the needs of the resident’s.The current staffing levels means that the staff struggle to meet the social care needs of the residents. EVIDENCE: The residents spoken to said they were happy with the staff team at the home, but some residents and a relative did express their concern at the continued shortage of staff in the home. One resident said that they have been occasions when he has had to wait for long periods for staff and a relative expressed concern that her partner had to wait for long periods for staff to assist with personal care tasks. There are concerns about the current staffing levels and meeting the residents’ needs. These concerns were discussed with the manager and were also discussed at the last inspection. The organisation needs to take action to resolve this. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The health and safety of the residents is not currently promoted or protected sufficiently. EVIDENCE: A discussion with a resident highlighted that there are problems with the nurse call system in the home. The inspected also noted that the nurse call system to the communal areas was not satisfactory. This is unsafe and was discussed with the manager. During this inspection the inspector noted that the hot water temperatures were not satisfactory. The hot water temperatures should be delivered at a temperature of close to 43 centigrade. During a tour of the building the inspector saw that the fire escape to the first floor was sealed off with warning tape and a “Do not use” notice. There are concerns about the safety of this escape route and the manager was advised to consult the local fire officer for advice in this matter. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 18 A discussion with the organisation’s training officer identified that the staff still continue to have manual handling training every two years. The recommendation for staff to receive annual updates for movement and handling training was highlighted at the last inspection and needs to be addressed. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 1 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x 2 x x 1 Standard No 11 12 13 14 15 16 17 x x x x x x 2 Standard No 31 32 33 34 35 36 Score x 1 1 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 BEECHWOOD CHESHIRE HOME Score x 1 1 x Standard No 37 38 39 40 41 42 43 Score x x x x x 1 x J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 20 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. 2. Standard 19 20 Regulation 13 13.2 Requirement Assessments must be in place to prevent the residents being placed at risk. The policy and procedure for medication must be followed to protect all the residents including those residents who wish to self medicate. The complaint procedure must include the details of the Commission for Social Care Inspection. The identified ladders in the smoking lounge must be removed. The exterior of the building is in need of proper care and maintenance. Risk assessments should be completed for any areas that are unsafe for the residents. There should be suitable arrangements to prevent the spread of infection in the care home. A hand wash dispenser and paper towels should be made available in the laundry facilities. Staffing levels must be provided to meet the needs of the residents living at Beechwood. Timescale for action 4.9.05 4.8.05 3. 22 22 4.9.05 4. 24 13(4)(a) 23(2)(b) 4.9.05 5. 30 13(3) 4.8.05 6. 32 & 33 18 4.9.05 BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 21 7. 42 23(4)(a) (b)(c) There must be consultation with the fire authority to ensure adequate precautions are taken against the risk of fire, adquate means of escape and evacuation in the event of a fire. 4.8.05 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. 4. 5. 6. Refer to Standard 6 17 23 24 27 42 Good Practice Recommendations The residents should be consulted about the formulation and the review of their individual plan of care. The home should record the food choosen by the residents. The manager should ensure that all staff undergo adult protection training. The smoking area is in need of redecoration and maintenance. The identified bathrooms and toilets are in need of updating and redecoration. The hot water for bathing should be maintained at a suitable temperature of close to 43 degrees centrigrade. Staff should complete movement and handling training annually. BEECHWOOD CHESHIRE HOME J51J01_S1109_Beechwood_V229220_030805.doc Version 1.40 Page 22 Commission for Social Care Inspection 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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