Inspection on 29/01/08 for Beechwood House

This inspection was carried out on 29th January 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beechwood House 15/07/08

Beechwood House 07/09/07

Beechwood House 29/06/06

Beechwood House 29/11/05

Beechwood House 15/06/05

Beechwood House 19/11/04

Beechwood House 23/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Beechwood House Woodberry Lane Rowlands Castle Havant Hampshire PO9 6DP Lead Inspector Sue Kinch Unannounced Inspection 29th January 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechwood House DS0000049982.V357940.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 DS0000049982.V357940.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechwood House Address Woodberry Lane Rowlands Castle Havant Hampshire PO9 6DP 023 9241 3153 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) Rowland Court Healthcare Ltd vacant post Care Home 37 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (37), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (9), Old age, not falling within any other category (37) Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of ten service users may be admitted in the category Dementia (DE), all of whom must be aged over 45 years. 7th September 2007 Date of last inspection Brief Description of the Service: Beechwood House is registered to accommodate and provide personal care to thirty-seven older people, including nine with either dementia (DE (E) or a mental health problem (MD) (E). It has also recently registered to provide care for up to ten service users who are younger adults with dementia. Rowland Healthcare owns the service and has a number of care and nursing homes in Hampshire. The home is located in a quiet residential area, close to the centre of Rowlands Castle and within easy reach of local shops, amenities and public transport. Services not included in the fee are hairdressing, chiropody, newspapers and magazines, personal telephone lines and personal toiletries. The current fee charged is £415-£480 per week. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. An unannounced visit to the service was undertaken as part of the inspection on the 29th January 2008 for seven and a half hours. Owing to issues raised about medication at the last inspection a pharmacy inspector, Geraldine Yates, accompanied the lead inspector and spent five hours reviewing practices in the home. The inspection process included observations of medication storage and administration, care practices, interactions between people in the home, a selection of bedrooms, shared areas and bathrooms. Views of a number of residents and staff were sought during the visit and a sample of care and other records was looked at. Information gained from the Annual Quality Assurance Assessment (AQAA) was used in September 2007 and not directly included in this report. However, discussions were held with the manager and one of the directors and information provided has been taken into account. The report was also influenced by information gathered by the Commission since the last inspection and contributed in assessing judgements in this report. Questionnaires, about the care provided at the home, were sent to a sample of residents and relatives, before the inspection visit. The commission received five written responses from relatives. What the service does well: The home has a good pre admission assessment process in place looking at the needs of potential people planning to use the service to ensure that the home can meet their needs. There is an ongoing refurbishment programme in place where the majority of the bedrooms and communal areas have been recently refurbished. There is a good system in place to investigate concerns/complaints and residents feel able to raise issues with the management and are confident that action will be taken. The home has a good induction and supervision system for staff. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 6 A range of activities is provided regularly and residents are provided with choice over food. Residents are regularly surveyed about the care in the home and the results are made available to them and relatives and regular meetings are held for consultation. 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. The summary of this inspection report can be made available in other formats on request. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 7 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 DS0000049982.V357940.R01.S.doc Version 5.2 Page 8 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): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission assessment process is good and ensures that the prospective residents needs are assessed and that the home can meet them. EVIDENCE: The admission documentation, for two people admitted to the home since the last inspection visit in September 2007 persons, was viewed. The manager carried out pre-admission assessments of needs and this was documented. At the last inspection it was discussed with the staff that a care manager’s assessment must be sought and form part of the pre admission assessment process as appropriate. This had been obtained for one of these people admitted. In discussion about one of the people the manager said that the care manager and the family had been spoken with as part of the assessment .A family member confirmed this. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 9 At the last inspection it was reported that the statement of purpose was not available on the day of the visit, this has been addressed and was available with a copy of the last inspection report in the foyer of the home. The home does not provide intermediate care Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans and records of care given need further development to give staff clear information about how the assessed care and health needs of people using the service are to be met and to ensure that they are met. Medication practices in the home including ordering and providing prescribed medication must be more rigorous to ensure residents are provided regularly with all medication and their health needs are met. The home’s staff treat the people using the service with respect and support the maintenance of privacy. EVIDENCE: After the last inspection a requirement was made in the report about care plans not having enough information in them to state how the needs of residents would be met. Also it was required that there is evidence that resident/families are involved in the formulation of care plans. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 11 At this inspection a sample of four care plans were viewed during case tracking. These are set out in consistent manner there are regular reviews recorded by staff on the reverse of the care plans. However, it is difficult to work out which information is current. Care plans, although reviewed, had not been updated in light of changing care and health needs and contained different information to the reviews and information on the running records. From discussions with staff and residents and observations of needs it was evident that the information that was recorded was incomplete and not clear enough to ensure that staff had enough guidance to provide the care consistently and as the people receiving the service preferred as described in examples below. There was no written evidence of residents or relatives involved in care planning in the files sampled. In the first care plan sampled it was recorded that the person was challenging and needed lots of one–one support but there was no information about how this should be done or record of how often it should be provided. There was written evidence of food and drink provided and information about food supplements. Staff said that they recorded this but there was no clear guidance in the care plan about frequency or what should be monitored. In terms of mobility the person’s abilities and support needed had changed and although this was documented, there was a lack of guidance about how the support should be given and what was needed or preferred. It is recorded that the resident has paper-thin skin and is at risk of bruising but although pressure-relieving equipment is provided and the manager said that the community nurse is involved regularly, there was no guidance to staff about how to monitor the risk or action to take if concerned. The resident was heard shouting for care at one point during the inspection and there were mixed views from the staff and the manager about whether the person could use the call bell. The manager said that she would look into it. For another resident a risk of falls was identified in the care-plan. The resident uses equipment for mobility but this was only partially referred to in the care plan and although the resident does not move far alone, the care plan doesn’t give advice regarding use of toilet or bathing or accessing the rest of the home. Needs with diet and stimulation were also identified but staff guidance was not recorded. However at the inspection the resident was able to inform us about her needs. Records were sampled for a third person more recently admitted to the home. This was again not in enough detail for example to explain about how staff should support with incontinence pads, toileting or bathing in a way that the resident likes or needs the support. For a fourth person in the records it stated that there was a history of falls, in the sample of running records viewed there was evidence of recent falls, including one in the bathroom, however in the records for that person it said Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 12 that staff should prompt to use a frame but nothing was recorded about mobility in personal care and bathing in light of the recent falls. A requirement was made in the last inspection report about ensuring that privacy and dignity are upheld. On the day of this inspection visit, caring and friendly approaches to residents were noted and staff spoken with were able to give some details about the residents needs and were seen to be providing care based on those needs, such as in mobility, personal care, eating and social issues. Residents spoken with were positive about their care at the home and the way that they were treated and said that staff were ‘good’ ‘ respectful’, ‘lovely, kind, understanding’,’ amenable’, and ‘staff very good, polite, always someone around if you want something’. One resident said that they trusted staff and that information would not go any further. Relatives provided mostly positive views about care provided to residents in the five survey forms returned. One said that their relatives needs were always met, three said usually, but one said sometimes and gave examples of the type of needs not met such as hearing aid batteries not changed when flat and sometimes the resident being cold. Another said that some staff lack the skills and experience needed. In the last report four requirements were made about medication and at this inspection a pharmacy inspector assessed the safe handling of medication. They looked at the medication records, procedures, and storage, talked to care staff and watched medicines being given to people. A requirement was made in the last report about staff ensuring that the medication administration record contains the variable dosages administered to the people using the service as applicable. This was found by the pharmacy inspector to have been met at this inspection. The other areas are addressed below. People who live in this home are given the choice to independently look after their own medicines. People’s ability to safely hold and administer their medication and any risks to other people living in the home had not been assessed for one person whose care we looked at. This could be putting people in this home at an unnecessary risk. Other people chose to have their medicines given to them by designated, trained care staff. We watched one carer giving medicines to people who live in the home. Medicines were given to them safely and in a way that took into account their specific needs. From the records and supplies of medicines in the home we could see that people do not always get the medicines that they are prescribed. This could be putting their health and welfare at risk. • One person had not been given any night sedatives for 14 nights, their Alzheimer dementia tablets for 17 days and their antipsychotic medicine for 8 days. These medicines were recorded as F = none, on the medication administration record chart. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 13 • • • One person had one of their tablets recorded as having been given on the morning we visited but it had not been given as it was still in the blister pack. One person prescribed an antibiotic had 12 capsules recorded as given but only 10 had gone from the supply. One person’s records showed 15 tablets given and 2 refused and destroyed but only 13 had gone from the supply. All medicines were stored securely for the protection of the service users. Controlled drugs were stored securely, though the cupboard did not meet the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. A recent change in the law means that all care homes must now keep all Controlled Drugs in a Controlled Drugs cupboard. The manager was informed of this change. Additional records were kept of the usage of Controlled Drugs so as to readily detect any loss. These were not accurately kept. No entries had been made in the register for the night of 28th January 2008, though the administration records showed that the medicines had been given. No stock balances had been recorded for one person’s supplies on 26th and 27th January. This means that any losses may not be picked up and dealt with. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to lead varied lifestyles and are supported to be mentally stimulated although how to meet the needs of more dependent people are not sufficiently documented. They are supported to maintain family links and individual dietary needs are regularly catered for. EVIDENCE: The home continues to provide support for those who can arrange their own daily lives to continue to do so and a range of activities for mental stimulation for other residents is provided. On the morning of the inspection one of the residents had gone out independently and spoke about it on return. There are planned, activities on the notice board outside the kitchen and residents say that these are provided on a regular basis for those who want to be involved. On the morning of the visit some of the residents and staff were engaged in a regular exercise session in the main lounge. There was a light- hearted atmosphere and the several residents involved looked as though they were enjoying the session. A hairdresser was also in the home giving people, wanting their hair done, individual attention. Residents not joining in were in Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 15 the other lounges or in their own rooms. One person chose to sit in the corridor outside the kitchen. One person spoken with said they knew what activities took place and they chose not to join in. Staff were involving people in hoopla in the afternoon and other spoke of going in the garden, bingo and quizzes. Some social and recreational needs are written into the care plan files but as referred to above in the section on individual needs and choices how some of these individual needs are to be met are not documented. The manager reported to be looking into supporting trips out of the home including to the pub. Suggestions have come from the residents meetings. Contact with families and friends is supported and one resident spoke of visiting and receiving friends. There are spaces for receiving visitors as well as in private rooms. The manager was positive about relatives being involved in some joint meetings with residents. Mostly positive but varied views were received about whether enough information is provided to relatives about important issues. At lunchtime food was attractively presented in pleasant surroundings and the alternatives on the menu were provided with other options for those not wanting them. One person was not eating and saying she was not hungry and that she had already eaten. The cook talked to her and helped her choose an alternative. Staff said that people do change their mind at meal times and that they can offer other things. People eating lunch were mostly positive about the food and some plates were completely cleared. Staff were heard offering people cream or custard with their apple pie. Staff were able to say how they support people with food in different ways at mealtimes. One person had a plate guard. One comment was received that the food was variable depending on who was cooking and another decided not to eat their lunch. Staff were viewed assisting a resident to eat and food records were being maintained. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 16 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are confident that their views are sought and that they are listened to but some relatives are less confident. Staff have clear understanding of adult protection and ongoing training is available. EVIDENCE: At the, last inspection in September 2007 good management of complaints was found and there was evidence of these being recorded. At this inspection evidence about how concerns and complaints are managed were sought from a sample of residents and relatives. One resident said that they had no complaints that staff listen and that they would talk to the manager if they had a complaint as they had trust in her. The resident was aware of forms for complaints in the front hall. The resident had no complaints to make to us. Another also said that they had no complaints. They would feel able make a complaint, that they can make comments and that management are interested. A third person and a relative had no complaints but the relative said that things were not always followed through. Most relatives said that they know how to make complaints. In the responses to five surveys two said that the home always responded to concerns, two Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 17 usually and one sometimes. One relative said that ‘little action follows complaints’. One of the relatives who said that the home usually responds appropriately and also said that some staff are excellent but that ‘some staff have no idea how to respond to my queries’. However the manager said that they had received two complaints since the last inspection and they had been fully investigated and resolved. Another relative suggested that a newsletter or meeting once a year could be helpful to relatives. Another relative spoken with said that they felt confident to raise issues and that they would be dealt with. The manager said that adult protection training is planned for staff in 2008 and it is included in the induction package (recognise and response to abuse – neglect) and staff are required to complete assessed units during induction. She said that the four new staff were to be working through this section of induction and that this included reading the General Social Care Council’s Code of Conduct. Adult protection was discussed with a member of staff who said that they had not had adult protection training but was able to give examples of signs of abuse and said that if concerned would report it straight away to a manager or person in charge. This person understood that training in this area was planned. In separate conversations with two residents about how they feel about living in the home, both said that they felt safe. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 18 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): 19,24 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with an attractive, well decorated, well furnished, clean and hygienic environment to live in and they are encouraged to bring their own possessions to assist in meeting their personal needs. EVIDENCE: Observations were made of a sample of shared areas of the home and bedrooms. Shared areas viewed included, lounges, the dining room, bathrooms and corridors. Five bedrooms were sampled and some en-suite facilities. A call bell system is in place and was accessible to residents. Conversations with residents about the environment included comments that: things were fixed when necessary; that the environment had improved with the current owners; that the shower area under development at the last inspection had been completed; and that the lift worked regularly. In the Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 19 surveys from relatives one commented on the ‘ newly decorated home being beneficial to the residents’ and another of ‘comfortable surroundings’. A third said that the home was clean, nicely decorated and generally a good home but felt that some small things needed attention such as the risk of an accident where a chair was too near to the shelf at the bottom of a notice-board in one of the corridors. The manager said that this had been attended to but would take further action if needed. Two staff were spoken with about the environment and one said that there is regular decorating and maintenance. Both said that things are fixed when needed and were not aware of any current hazards to residents. Comments about the environment from all were mostly positive in respect of cleanliness. One person said that the home at times ‘smelt of excrement in the lower hallway’ but this was not evidenced at the inspection visit. There was a slight smell of urine in that area but no other unpleasant smells were noted in the home. The manager pointed out that there is a regularly used toilet off that corridor and that she would carry out a check. There was evidence of the staff knowing about the infection control procedures and they were using white disposable aprons and disposable gloves for personal care and blue aprons at lunchtime. Two staff spoken with said that they had received training in infection control. The laundry was visited with a member of staff who said that it had been relocated and this provided better access, that it was all in working order and that a high temperature could be achieved in the washing programme if needed. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are increasingly protected by the home’s improved recruitment procedure. They are supported by a number of new staff being trained into their roles by induction and a range of courses also available for existing staff. They would benefit from staff receiving more training in person centred care planning and refresher training in medication. EVIDENCE: A requirement was made in the last inspection report in respect of recruitment to ensure that all checks are carried out before employment. Queries were raised about the records for two staff at the last inspection and this time we were informed that they had left the home. The director in attendance at the inspection visit told us that a new procedure has now been put in place for staff from overseas to ensure that they are eligible. This was not tested out on this occasion, as the sample of records checked was not for staff from overseas. In the sample of records viewed for two of the four new staff we found that there was evidence that full recruitment checks are taking place. A member of staff also confirmed that Criminal Records Bureau checks and references were taken up before employment. We observed caring and supportive care practices during the inspection visit. Residents spoke favourably about staff including that they are ‘lovely, kindBeechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 21 know what to do’ ‘very good, polite’, ‘ good to talk to’ and ‘ know what they are doing’ but some less positive comments were received in two of the five survey forms returned by relatives. One said ‘there are some staff who are not suited to the job. They lack the skills and experience needed’ and another commented on more caring and trained staff needed. Similar comments were received in the last inspection report. Training and support was discussed with three staff who confirmed that they have supervision regularly. A new member of staff confirmed that they were receiving induction training and was expecting to have moving and handling training next, which the manager said, trained and qualified staff would teach. More established staff were not sure of training planned for them as they thought that the focus was on new staff but on going training was found to be provided by us in September 2007 and one spoke of receiving fire training and dementia awareness training in the autumn. The manager has a training plan for the first half of 2008 and plans to include dementia awareness, adult protection, falls prevention, basic food hygiene, basic life support and refresher moving and handling training. Evidence for the need for refresher training in medication and person centred care planning training is documented in the health and personal care section above. The manager said that she would address these issues. Staff levels were similar to those found at the last inspection. The manager said that there are usually four carers and a manager on duty in the morning. She continued that on the day of the inspection visit the staff level was unusual as a one carer was sick. In the afternoons, there are usually three carers (as on day of inspection) and two waking night staff from eight pm, which she said met needs of the twenty-seven residents. She said that she had the flexibility to increase the staff ratio and was recruiting again to ensure that staff were available for this. The rota was viewed and days sampled supported the manager’s views of staff levels. There are also domestic staff for cleaning, cooking and assisting in the kitchen, these were all working in the day of the inspection visit although one cleaner had left the day before the inspection and the manager was recruiting to that post. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from regular consultation about the service they received but more rigorous quality monitoring is needed to ensure that all care practices in the home are fully effective in meeting residents needs. The residents are safeguarded by adequate attention to health and safety in the home. EVIDENCE: The registered manager left after the last inspection but there is a manager in post full time. The director informed the inspector that an application would soon be submitted for the registration of a manager. Most comments received from residents, relatives and the staff indicated confidence in the manager Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 23 dealing with any concerns raised. Comments like ‘it’s a well run home’ and ‘the home is well organised.’ were received. Quality was discussed with the manager who completed quality audit last year and collated information in September 2007. This was viewed and included feedback from professionals, relatives and resident returned questionnaires. The manager said that she acted on some things straight away and has left a copy of the audit on the resident and relatives notice board. The manager said that regular meetings are held with residents and that recently three relatives also attended. Suggestions made were to include more trips out and including to the pub, which the manager said that she was going to talk to the director about. She also said that she has an open door policy and has a range of monthly checks for monitoring practices in the home but agreed that these needed reviewing for care plans and medication. (Details of issues in respect of these are in the health and personal care section above). Resident’s finances were assessed as satisfactory in September 2007 and relatives or residents raised no issues as part of this inspection process. We sampled aspects of health and safety. Staff said that water in the home is regulated and records of bath water checks were in the first floor bathroom. Window restrictors were in place in bedrooms where sampled. No obvious hazards were viewed during the inspection visit. Staff were using the mobile hoist for moving people where necessary. Cupboard doors with keep locked signs on them were locked. One door wedge was in use but the hairdresser explained this as temporary. Staff said health and safety training is provided. The manager said that further health and safety training was planned in 2008. A large file of service records was sampled for hoist and lift servicing all in were date. There was evidence of a recent gas service. Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 24 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x 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 x 18 3 3 x x x x x x 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 2 x 2 x 3 x x 3 Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement The service users’ plan must set out in details how all the assessed needs of the people using the service would be met. Evidence of service users/ family involvement in the formulation of care plans must be maintained. This requirement remains outstanding from 07/09/07. So as to reduce the risks to people who use this service, the risk assessments for people who look after their own medicines must be completed and show how people are supported in this activity. People must not be left without access to medication prescribed for them by their GP. Systems must be put in place by the provider to ensure that medication is ordered and received at appropriate times to ensure it is always available to people who use this service. Timescale for action 29/02/08 2 OP9 13(4) 29/02/08 3 OP9 12(1)(a) 29/02/08 Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 26 4 OP9 13(2) In order to show that people who 29/02/08 use this service get their medicines as prescribed, a complete and accurate record must be kept of all medicines received into the home and given to people. This requirement remains outstanding from 07/09/07 Controlled Drugs, Including Temazepam, must be stored in a Controlled Drugs cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. 29/04/08 5 OP9 13(2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Beechwood House DS0000049982.V357940.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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