Inspection on 21/06/07 for Beechwood House

This inspection was carried out on 21st June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beechwood House 06/06/06

Beechwood House 07/11/05

Beechwood House 14/04/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Beechwood House Beechwood House 40 Beechwood Road Sanderstead Surrey CR2 0AA Lead Inspector Peter Stanley Key Unannounced Inspection 21st June 2007 9:30am 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 House DS0000062807.V343059.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 House DS0000062807.V343059.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechwood House Address Beechwood House 40 Beechwood Road Sanderstead Surrey CR2 0AA 020 8651 2937 020 8405 2572 beechwoodcare@hotmail.co.uk 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) Mr Hariharen Pavaday Mrs Anjoo Poovadee Pavaday Mrs Anjoo Poovadee Pavaday Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow one specified service user in the Dementia - over 65 (DE(E)) category to be accommodated until such time as the needs of the service user can no longer be met or until such time as the placement ceases. 6th June 2006 Date of last inspection Brief Description of the Service: Beechwood House is a small residential home for older people situated in a quiet residential road in Sanderstead. A bus service is available to access the home. The nearest railway station is Sanderstead. The home is owned by Mr and Mrs Pavaday, and is managed by Mrs Anjoo Pavaday. The house is set back from the road and has a ramp and steps to access the front entrance. There is a large back garden that can only be reached by steps. The home accommodates up to fifteen elderly residents and is registered in the category of care provision for older people. The home consists of eleven single bedrooms and two double rooms. There is a residents’ lounge and dining room on the ground floor and another, smaller lounge on the first floor. The dining room is next to the large kitchen, with a door leading to the patio and back garden. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of the home took place over six and a half hours on 6 June 2006. The registered providers, Mr and Mrs Pavaday, were present during the course of the inspection. Mrs Anjoo Pavaday is also the home’s registered manager. The inspector checked out the progress in meeting the outstanding requirements, met with a cross-section of residents, and observed staff on duty. The inspector examined a wide range of documentation. This included staff and service user records, care plans, complaints, incidents and accidents records, policies and procedures, and documentation relating to health and safety. The inspector also case-tracked the records of two residents who have been admitted to the home since the last inspection. No complaints have been received within the last 12 months, and there was evidence from review notes and questionnaires of a high level of satisfaction from both residents and relatives. Feedback from the residents at this home was again very favourable, with individuals presenting as settled and happy with their environment, and with the care being provided. The outcome of the inspection was very positive, with evidence indicating that this is a pleasant, caring and well-run home, and that there is a continuing commitment to maintaining and raising standards. There was evidence of regular daily activities and flexibility of routines, with residents being able to exercise a high level of choice and control over their day-to-day lives. Residents are being consulted individually and collectively regarding their day-to-day living and routines, and in planning menus, arranging outings and events. Staff presented as caring and skilled in their interactions with residents, this being affirmed by the feedback received from residents. There is also evidence of good support and supervision for staff and of a comprehensive and ongoing programme of staff training and development. All 14 requirements from the previous inspection have been met. From this inspection there are two requirements and three recommendations. The inspector would like to extend his thanks to Mr and Mrs Pavaday, and staff, for their assistance in helping to facilitate this inspection. He would also like to extend his thanks to the residents at Beechwood for their involvement, and to those individuals who spoke at some length with the inspector. What the service does well: Prospective residents are being provided with the comprehensive and up-todate information required with which to make an informed choice regarding the suitability of the home. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 6 Prospective residents, their friends and relatives are able to visit to assess the suitability of the home. The home is able to demonstrate that it is obtaining full information regarding the health and support needs of prospective residents prior to their admission, and that their needs are being appropriately assessed and met. Residents’ care plans, detailing their health, personal and social care needs are being drawn up with the involvement of residents and their relatives. These are being reviewed on a monthly basis. The home is ensuring that residents’ health care needs are being fully met. Residents are being protected by the home’s medication policies, procedures and training. Residents are being treated with respect and their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Residents are being provided with a varied range of opportunities for leisure and social activities. These are in accord with their social, cultural and religious interests and needs. Residents are being encouraged to maintain contact with their family and friends, with visitors being made welcome at the home. Residents have some opportunities for accessing links with the local community. Residents are able to exercise choice and control in their day-to-day activities and routines. Residents receive a wholesome and appealing diet, with choice being offered, in pleasant surroundings, and at times convenient to them. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being protected and promoted. The home’s policies and procedures are helping to ensure that residents are being protected from abuse. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 7 Residents are living in a safe, well-maintained environment, with access to safe, sufficient and comfortable facilities. Residents’ rooms are safe, comfortable and pleasantly decorated, reflecting residents’ personal identities, and being suited to their individual needs. The home has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s residents, and to ensure their safety. Residents are being safeguarded by satisfactory staff recruitment policy and procedures. Staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. Residents are living in a home that is being competently managed, and run in a way which creates an open, positive and inclusive atmosphere. Through the appropriate supervision, appraisal and support of staff, good practice is being promoted and the welfare and best interests of residents is being protected. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. What has improved since the last inspection? Care plans are now being regularly reviewed on a monthly basis. Accredited medication training has been extended to all care staff. Statutory training in adult protection has been extended to all care staff. The home has been assessed by a qualified occupational therapist, and, with the addition of raised toilet seats and frames, has sufficient aids and adaptations with which to safely meet the needs of the residents. The home is employing a cleaner solely for cleaning duties, for at least 18 hours per week. This has contributed to improved levels of cleanliness and hygiene throughout the home. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 8 The home is consulting widely with residents, relatives and other stakeholders, and is beginning to evidence the home’s ability to meet its aims and objectives. The home needs, however, to develop a more detailed and explanatory Development Plan for 2007-08. The home has provided audited accounts for 2005-06 and 2006-07, and a Business Plan, with which to demonstrate that it is financially viable. There is some delegation of supervision taking place, with appropriate support and training being provided. Annual appraisals are now being completed for all staff. 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. The summary of this inspection report can be made available in other formats on request. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 9 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 House DS0000062807.V343059.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are being provided with the comprehensive and up-todate information required with which to make an informed choice regarding the suitability of the home. Prospective residents, their friends and relatives are able to visit to assess the suitability of the home. The home is able to demonstrate that it is obtaining full information regarding the health and support needs of prospective residents prior to their admission, and that their needs are being appropriately assessed and met. EVIDENCE: Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 11 A comprehensive statement of purpose and service user guide is in place. These are produced in an appropriate and accessible form (using large print) and are made available to all prospective and current residents. These documents were last reviewed by the home’s registered manager on 25.1.07, and have been signed and dated. The home’s policy is for prospective residents to be invited to visit the home and to move in on a trial basis for 4 weeks. Following this trial period a review is held with the individual and his/her relatives/advocates. A decision regarding permanent placement is then made. Unplanned admissions are avoided where possible. The home issues a statement of the terms and conditions applying to the placement, this being agreed with each resident prior to their admission. The home also ensures that local authority contracts are obtained for those residents who receive local authority funding. The inspector evidenced a local authority contract on the file of a resident who has recently been admitted to the home. There have been two admissions to the home within the last 12 months. The inspector examined the relevant two service user files and evidenced the receipt of care management assessment information, and the completion of assessments, risk assessments, moving & handling assessments, and dependency profiles, by the home. A copy of the service user plan is being included on the service user files. New residents are admitted on the basis of a full assessment undertaken by a person who is suitably qualified to do so. This is usually the home’s registered manager. The assessment is completed with the prospective resident, his/her relative or delegated representative, and any relevant professionals that have been party to the referral. Following a concern raised at the last inspection, relating to the inappropriate admission of two residents with mental health problems, the home has now revised its assessment format so as to include a number of questions relating to the individual’s mental health. The registered manager indicated that she now ensures that full information regarding a person’s mental health history is obtained at the point of referral, and that all information is checked out during the assessment. The inspector confirmed that where there is any indication of dementia or of any other mental health problems, no admission to the home can be allowed to proceed. There is, however, one resident at the home who developed dementia following her admission, and for whom a variation has previously been agreed. Staff and training records indicate that the home has the range of skills and abilities with which to meet the needs of the residents. There was evidence from the residents’ care plans plans that specific social and cultural needs are being addressed. The inspector met with one resident, from a minority ethnic Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 12 group, who has been recently admitted to the home. He indicated that he has settled well since moving in and that staff are respectful of his cultural beliefs and values. The home is able to provide food which meets different cultural tastes and preferences. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 to 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care plans, detailing their health, personal and social care needs are being drawn up with the involvement of residents and their relatives. These are being reviewed on a monthly basis. The home is ensuring that residents’ health care needs are being fully met. Residents are being protected by the home’s medication policies, procedures and training. Residents are being treated with respect and their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 14 EVIDENCE: Each resident has a personal dependency profile which details emergency contacts, details of the person’s GP and social worker, and information relating to the person’s preferences, health or disability. The home maintains a care plan for each resident, for which a photograph of the resident is attached to the front sheet. These are being presented in a structured format, and provide a clear and comprehensive breakdown of residents’ care and support needs and how these are being addressed. The inspector examined a sample of care plans. These detail residents’ health, personal care and social needs, and are drawn up in consultation with the individual and his/her relatives/advocates. The plans are based on information from assessments and are now being reviewed on a regular monthly basis. Risk assessments, and manual handling assessments, are also being completed and reviewed on a regular basis. The health care needs of residents are evidenced from records as being generally well met. The manager advised that apart from one resident, who is currently in hospital for treatment of an ongoing condition, there have not been any major health concerns, or any instances of pressure sores having developed. Residents’ health and physical condition are actively monitored, with professional medical help being sought as and when the need arises. The home is covered by a local GP practice, with one resident exercising his preference to retain his own GP. Service user records detail visits from the GP, district nurse and other health and care professionals. Residents attend for hospital visits and other appointments as required, including optician and dental appointments. Personal and oral hygiene, including the care of dentures, are actively encouraged. The promotion of continence is monitored with advice being obtained from incontinence advisors when this becomes necessary. The home has a medication policy and procedures in place. The home uses the Monitored Discharge system for administering medication. All medications are kept in a locked cabinet in an area adjacent to the lounge. While any resident who wishes to take full responsibility for their own medication is (subject to a risk assessment) able to do so, none is doing so at the present time. Advice is available from a pharmacist concerning the home’s policy on the safe handling and administration of medicines. The home has recently received a pharmacist’s inspection (on 19.6.07) from the Croydon Primary Care Trust. The home received a generally good report. There were, however, two Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 15 recommendations which need to be implemented. The first relates to the need for the home to draw up a list of homely remedies in consultation with the home’s GP, and to store all homely remedies in a separate container. The second recommendation relates to the need for new guidelines to be put in place for the ordering of medication from the pharmacy, so as to provide clarity in this area. In the interests of safety, these recommendations must be fully met; a requirement applies. Three residents are currently taking controlled drugs. These are being stored separately from other medication in a locked metal cupboard in the office. The manager advised that all controlled drugs are being reviewed at six-monthly intervals by the home’s GP. A previous requirement, for all staff to receive accredited medication training, has now been met. The home has recently appointed a new staff member who is on the waiting list for training. Training is now being provided by the London Borough of Croydon. The home adheres to a clear policy and practice with regard to ensuring that the dignity and rights of residents are upheld in all matters associated with personal physical and medical care. Individuals are able to see their GP in the privacy of their own bedroom and without the attendance of staff if they prefer. Residents’ wish to spend time in their own rooms is respected, and staff were observed to knock on residents’ doors before entering. All residents have a lockable space in their bedrooms for storing personal possessions and valuables. The inspector spoke to a number of residents during the inspection. Feedback indicated that staff are respectful of residents’ privacy and dignity, and are sensitive to individuals’ needs and rights. Residents indicated that their relatives and friends are made welcome at the home and that they are able to see them in the privacy of their own rooms. Relatives are also encouraged to take residents out for tea or an outing if they so wish. There is a pleasant quiet lounge on the first floor where visitors can be received. Staff were observed to interact with residents in a caring and respectful manner, and there was evidence of good, trusting relationships between staff and residents. Over the last 12 months there has been one death at the home, one resident having died in hospital. The home has previously accessed training in loss and bereavement. This has assisted staff to develop relevant skills with which to support residents and relatives throughout the bereavement process. The home is not able to specifically cater for the needs of older people who are terminally ill and who require nursing and palliative care. The home recognises that residents may pass away unexpectedly whilst in residence and this has happened in the past. The manager and staff are given all the necessary information through policies and procedures if such an event occurs. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 16 Individuals’ and relatives’ wishes regarding the eventuality of death and funeral arrangement are duly noted in each file. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 to 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being provided with a varied range of opportunities for leisure and social activities. These are in accord with their social, cultural and religious interests and needs. Residents are being encouraged to maintain contact with their family and friends, with visitors being made welcome at the home. Residents have some opportunities for accessing links with the local community. Residents are able to exercise choice and control in their day-to-day activities and routines. Residents receive a wholesome and appealing diet, with choice being offered, in pleasant surroundings, and at times convenient to them. EVIDENCE: Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 18 The inspector spoke to a number of residents and observed activities taking place. This included a bingo session in which six residents were participating, the session being facilitated by a staff member. Inspection of the minutes from residents’ meetings indicated that residents are being consulted as to their interests and wishes. Views expressed individually by residents indicated that there is a variety of organised activities that take place within the home and that residents are presented with otions as to proposed activities and outings. The range of activities offered includes a weekly music and movement session, bingo and manicure. A reminiscence session, which is held every 2-3 weeks, has proved popular. An entertainment, comprising of song, dance and performance, is provided three times a year by a group of entertainers called Troubadour- at Christmas, Easter and at the annual summer garden party to which relatives, friends and visitors are invited. A Christmas party was also held at the home. Occasional outings to places of interest are also arranged. There have been more attempts to canvass residents’ views and to organise outings to places such as garden centres, country pubs, tearooms, theatres and concert halls. One recent event was an evening of musical and theatrical nostalgia at the Fairfield Halls, which was attended by some of the residents. A visit to the Garden Centre in Warlingham, in April, provided the opportunity for residents to enjoy the tearoom. The home has access to a minibus that it is able to use for outings. Visitors are encouraged to visit and maintain contact with residents. From the feedback that has been received, relatives and other visitors are made to feel welcome at the home. Links with the community are maintained with a range of visitors to the home. Residents are able to go out to the shops, or elsewhere, providing they have been risk assessed as safe to do so. Dial-a-ride is available if required. Residents also attend community lunches at the local Church Hall, these being held about three times a year. The views expressed by a number of residents indicate that individuals feel that they are consulted, and are able to exercise choice in their daily routines and activities. Where there are stated preferences of food or activity, the home endeavours to meet these. The manager stated that 7 residents choose to have breakfast in their rooms, while 3 residents also wish to have lunch in their room. Residents are able to spend time in their rooms as they please, or to arrange to go out with friends, relatives or with a staff member. In line with a recommendation from the last inspection, residents’ meetings are now being held on a regular two-monthly basis, with individual views and more detailed minutes being recorded. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 19 Views expressed by residents indicated that the food served is felt to be very good and varied, and accommodating of individual tastes and preferences. Any special dietary needs are taken account of. One resident, who has diabetes, is provided with a sugar free diet, whilst another resident from a British Asian background is has been consulted regarding his food preferences. Residents are being consulted as to their preferred choices in residents’ meetings, and, subsequently, curries have become a popular choice. One resident now regularly has sardine salad following her expressed wish. The inspector examined menus provided over a three-week period. These evidenced a nutritious and varied choice of food with fresh vegetables and fruit being included in the diet, and with an alternative main course being provided. Meals are served in a very pleasant dining room area, though residents are able to take meals in their own rooms if they wish. The home provides tea and biscuits in the afternoon, and supper at about 5.30 which includes soup, sandwiches and cakes. A hot drink is available before going to bed if required. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 to 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. The legal rights of residents within the home are being protected and promoted. The home’s policies and procedures are helping to ensure that residents are being protected from abuse. Statutory training in adult protection has been extended to all care staff. EVIDENCE: Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 21 No complaints have been made within the last 12 months. The home has an appropriate complaints policy and procedure in place, which residents and their relatives are made aware of. A summary is included in the Statement of Purpose and Service User Guide. The inspector spoke with a wide cross-section of residents during the course of his visit. No concerns were raised, and residents presented as safe and secure, and trusting of staff. The home aims to protect residents’ legal rights by involving family and friends in respect of their contracts, benefits and monies, and in discussing any issues that may arise. All residents are registered to vote, and are supported to exercise this right, usually by the use of postal vote. The home has appropriate adult protection and whistle-blowing policies in place. No adult protection concerns have arisen since the last inspection. All staff in the home have now attended Croydon’s statutory adult protection training, thus meeting a previous requirement. During the inspection, staff were observed to be respectful and caring in their interaction with residents. Feedback indicated that residents liked and trusted the management and staff, and that they felt safe, settled and secure in their environment. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a safe, well-maintained environment, with access to safe, sufficient and comfortable facilities. The home has been assessed by an Occupational Therapist and has sufficient aids and adaptations with which to safely meet the needs of the residents. Residents’ rooms are safe, comfortable and pleasantly decorated, reflecting residents’ personal identities, and being suited to their individual needs. The home presents as being clean, pleasant and hygienic. EVIDENCE: Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 23 The accommodation provided for the home’s residents presents as being safe, warm and comfortable throughout. The home has been externally redecorated, with all residents’ rooms having been redecorated. Paving around the home has been re-laid and levelled out to improve both appearance and safety. The garden areas have been re-planted, and there are plans to try to improve accessibility to the large upper garden at the rear of the home. Generally, the home is in a good state of interior decoration and the premises have been well maintained and comply with both fire and health and safety requirements. There has been re-carpeting of the corridors and communal areas, and most of the residents’ rooms. Plans to re-carpet the remaining rooms are planned. Double-glazing has been installed throughout the home; this has assisted in reducing the external noise of traffic and in reducing heat loss. The communal areas provide a pleasant, homely environment. There are two lounges, one of which is on the first floor. The lounges provide adequate space for the residents to sit, and were warm, comfortable and pleasantly furnished. The dining room provides a very pleasant area in which to take meals. Residents who spoke with the inspector indicated that they were very happy with their surroundings and with the facilities provided. The inspector completed a tour of the premises and found residents’ bedrooms to be pleasantly furnished and laid out, and reflective of the personal tastes and identities of their occupants. There are 11 single rooms and 2 double bedrooms, which meet the requirements for minimum size. There are two bathrooms, one with an ambu-hoist and there are sufficient bathing and washing facilities to meet residents’ needs. All the bathrooms and toilets had liquid soap and paper towels provided. Generally, adaptations have been made to various areas of the home so as to ensure the health and safety of the service users and maximise their independence. One bathroom has an ambu-hoist and grab rails are in place in the other bathroom. There is a passenger lift in place from the ground floor to the first floor. Handrails are in place on the staircases. Any adaptations or specialist equipment that is needed is assessed by an occupational therapist on an individual basis as and when required. Following a requirement from the last inspection, the home has been generally assessed by an occupational therapist. As a result the home has implemented a recommendation for the installation of raised toilet seats and frames. Central heating can be controlled in each individual room. There is an emergency lighting system. Hot water temperatures are tested daily and records indicate that these are within safety limits. All radiators within the Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 24 home are either low surface temperature radiators or have been covered with appropriate guards. The home presented as clean and free from offensive odours at the time of the inspection. Following a requirement from the previous inspection, the home now employs a cleaner to cover cleaning duties for at least 18 hours throughout the week. This has assisted in maintaining and raising standards of cleanliness and hygiene within the home, and enabled care staff to focus more fully on meeting the care and support needs of the home’s residents. The manager advised that all staff at the home have completed both infection control and food hygiene training. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s residents, and to ensure their safety. Residents are being safeguarded by satisfactory staff recruitment policy and procedures. Staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. EVIDENCE: Staffing levels are in accordance with the original agreement prior to the Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older people. This is subject to adjustment should the dependency of the residents increase or if a crisis occurs that would warrant an increase in staffing levels. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 26 On the day of inspection appropriate numbers of staff were found to be on duty. The home has 11 care staff and 2 ancillary staff (a cook and a cleaner). The inspector examined staff rotas. These indicated that the manager (or person-in-charge) is on duty with two care workers (together with a cleaner and cook) throughout the day, and two care workers (one waking, one sleepin) at night. A requirement, for the employment of a cleaner to cover cleaning duties for at least 18 hours per week, has been met. This has assisted the maintenance of hygiene in the home, and enabled care staff to focus more exclusively on meeting residents’ care and support needs. Inspection of files evidences that staff have the relevant qualifications and skill mix with which to meet residents’ needs. The home currently has 11 care staff, of whom two have an NVQ Level 3, and nine have an NVQ Level 2. The registered manager possesses an NVQ Level 4, and a senior care worker (who deputises in the manager’s absence) has a nursing qualification (RGN). The inspector was advised that two other care staff have registered to do an NVQ Level 3, and four other staff, to do an NVQ Level 2. Since the last inspection two new staff have commenced employment at the home. The inspector completed checks on staff files and found that all identity and recruitment checks had been completed, including obtaining up-to-date CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) certificates. A checklist is being included on each staff file, indicating all the checks and documentation required and the date when these have been obtained. The home provides a comprehensive programme of induction and foundation training, which is completed within the first three months of the staff member’s start date. A wide range of ongoing training is provided, which includes health and safety, moving and handling, medication, food hygiene, fire safety, first aid and infection control. The training completed and scheduled by each staff member is recorded and monitored on a staff training profile. This was examined by the inspector and found to have been appropriately maintained. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a home that is being competently managed, and run in a way which creates an open, positive and inclusive atmosphere. The home is consulting widely with residents, relatives and other stakeholders, and is beginning to evidence the home’s ability to meet its aims and objectives. The home needs, however, to develop a more detailed and explanatory Development Plan for 2007-08. Through the appropriate supervision, appraisal and support of staff, good practice is being promoted and the welfare and best interests of residents is being protected. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 28 Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. EVIDENCE: The registered providers, Mr and Mrs Pavaday, present as fit persons to run the home. Mrs Pavaday, who is the registered manager, has been undertaking studies leading to the award of the NVQ Level 4 and RMA (Registered Managers Award) management qualification, and is also studying for an AA1 NVQ Assessors Award. The management approach was evidenced as being open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. Views expressed by residents were again very favourable, with individuals indicating that the home is being run in their best interests. No relatives were available to speak to on this inspection, but previous feedback has been positive. The home has been developing its quality assurance processes and has completed questionnaires with all residents. Questionnaires have also been completed with the relatives and friends of residents, and with those who visit in a professional or voluntary capacity. Following a requirement from the last inspection, the home has compiled a development plan for 2006-07. The report is, however, somewhat brief and, for 2007-08, needs to be developed into a more detailed and explanatory format. The Plan should aim to summarise the main findings from the feedback received from questionnaires and other sources, identify relative strengths and shortcomings, and detail the main priorities (and strategies for addressing any shortcomings) for the year ahead. The Plan needs to evidence that the home is meeting its aims and objectives and that it is being run in the best interests of its’ residents. While included as a recommendation, this must be given a high priority. The home is now able to demonstrate it’s financial viability, the home’s providers having obtained an audited set of accounts for the years ending 2005 and 2006. A business and financial plan has also been put in place. The registered manager ensures that service users who wish to control their own monies are able to do so. The manager advised that the home does not act as an appointee for any residents, and that either a relative or solicitor fulfils this role where the person is unable to manage their own monies. The Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 29 home maintains a record of receipts and expenditure on behalf of one service user for whom a solicitor makes periodic payments from the service user’s account. Following a requirement from the last inspection, the record now records an authorised signature, by the responsible person, for each receipt and item of expenditure. The inspector examined a sample of staff supervision notes. These evidenced that supervision is being provided on a regular two-monthly basis. A recommendation from the previous inspection has been acted upon, a senior care worker having been delegated the supervision of a small number of care staff. The senior care worker has been supported by the manager in assuming this role, and has been placed on the waiting list for a supervision training course with the London Borough of Croydon for later in2007. A system of appraisal has been developed, with staff completing a preappraisal self-evaluation prior to their appraisal session. All staff have completed their appraisals, in May 2007. The inspector examined a wide range of the home’s records, including staff and residents files, complaints, accidents/incidents logs, and records relating to the running and maintenance of the home. These were found to have been satisfactorily maintained, with residents’ best interests being protected. Following a previous requirement, an appropriate incidents record is now being maintained. The manager is ensuring that all the home’s policies and procedures are being reviewed on an annual basis. A checklist is being maintained detailing when these were last reviewed. Generally, the inspector was satisfied that the health, safety and welfare of residents and staff are being appropriately protected. Fire and Health & Safety risk assessments were last updated in January 2007. Health and safety checks, including the inspection of the home’s portable electrical appliances, gas supply, fire equipment and alarms, emergency lighting and nurse call system, legionella and water supply, have been completed within the last 12 months. Hot water temperature, fridge/freezer and oven temperature checks are all being completed on a regular basis. The home’s lift is being serviced on a 3 monthly basis, the date of the last service having taken place on 6 June 2007. The manager advised that the servicing of the bath hoist last took place on 29 January 2007. However, as there was nothing in writing to confirm this, this needs to be obtained and a copy forwarded to the CSCI. A requirement applies. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 30 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 X 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 3 3 Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2), 13(4)(c) Requirement Medication. The two recommendations detailed in the Croydon PCT pharmacist report (19.6.07) must be fully met. These relate: 1. To the home’s recording and storage of homely remedies. 2. For guidelines to be drawn up to clarify the home’s procedure for ordering medication. Compliance is necessary to ensure the safety of residents. 2 OP38 13(4)(a) & (c) Health and safety The servicing of the bath hoist, on 29 January 2007, must be certificated or confirmed in writing by the contractor, and a copy forwarded to the CSCI. 31/07/07 Timescale for action 30/09/07 Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 32 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 OP14 Good Practice Recommendations Choice and Control. The minutes of residents meetings should be made available in large print, and a copy given to each resident. 2 OP33 Quality Assurance. The Development Plan should summarise the main findings from the feedback received from questionnaires and other sources, identify relative strengths and shortcomings, and detail the main priorities (and strategies for addressing any shortcomings) for the year ahead. The Plan needs to evidence that the home is meeting its aims and objectives and that it is being run in the best interests of its’ residents. 3 OP36 Staff supervision The inspector recommends that a senior care worker is given the opportunity to undertake supervision training with view to assisting with the supervision of staff. A new job description and higher salary grading would need to be put in place to facilitate this. Beechwood House DS0000062807.V343059.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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