Inspection on 29/06/06 for Beechwood House

This inspection was carried out on 29th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Beechwood House 15/07/08

Beechwood House 29/01/08

Beechwood House 07/09/07

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 Mrs Pat Trim Unannounced Inspection 29th June 2006 09:00 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.V299573.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.V299573.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 Vivienne Solomon 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.V299573.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. 29th November 2005 Date of last inspection Brief Description of the Service: Beechwood House is registered to accommodate thirty-seven older people, including nine with either dementia (DEE) or a mental health problem (MDE). It has also recently registered to provide care for up to ten service users who are younger adults with dementia. The home is owned by Rowland Healthcare Limited which is part of the Brookvale Group. This organisation owns a number of care and nursing homes in Hampshire. The building was originally a large family home, which has been extended to provide 29 single and 4 shared rooms. The majority of these have en suite facilities. Communal space comprises a very large room, which is divided into two lounges and a dining area. There are also two areas, one on the ground and one on the first floor, which although are not included in the communal space, provide space that can be used for seeing visitors in private or for residents who wish for some quiet time. 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. The pre inspection questionnaire contained information about current fees and services not included. The fees are £385.00 to £415.00 per week. Services not included in the fee are hairdressing, chiropody, newspapers and magazines, personal telephone lines and personal toiletries. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection carried out by one inspector in 8 hours. The key standards were assessed by case tracking three residents and talking with people currently living in the home and their visitors. Time was also spent observing staff practice, talking with three care staff and the registered manager, care services manager and operations manager. Some time was spent reviewing documentation and a partial tour of the premises was carried out. Information was also obtained from the pre inspection questionnaire, completed by the registered manager. The people living in the home had previously expressed their wish to be called residents. This term is therefore used throughout this report. What the service does well: What has improved since the last inspection? Care plans were beginning to be used to identify individual abilities, needs and wishes. A social care plan was included that asked residents to identify what things were important to them about their daily routine. This information could then be used to ensure these needs were met. For example, whether Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 6 someone liked to get washed and dressed before breakfast, or whether they preferred to have it in bed before getting up. Improvements to the garden and area around the home have made these areas more accessible to residents. A large patio area with benches, chairs and an awning has been provided. Access to the garden has been ramped which means residents may walk around it, provided someone is with them, as the ramp is quite steep. Areas around the outside of the home have been cleared and a ramped path provided so residents have clear access. All outside areas of the home have hanging baskets and pot plants, giving a cheerful and pleasing aspect for residents to see. A member of care staff has completed a course that enables her to train staff in moving and handling techniques. This will enable all staff to receive in house training. What they could do better: Risk assessment must be used to enable residents to participate in activities they enjoy, such as going for a walk alone or bathing without a member of staff present. If the risk is unacceptable, the reasons should be agreed with other involved professionals and the decision explained to the resident and clearly recorded. The current system for monitoring health care needs is not being used effectively and some residents are not being referred to health care professionals as soon as they should be. Current practice must be reviewed to make sure health care needs are identified and monitored so that help can be requested as soon as it is needed. Accurate records are not being kept of medication when it is received into the home. All medication must be checked and a record kept that this has been done to make sure the correct medication has been supplied. The method currently used to monitor the use of medication stored as a controlled drug must be reviewed to ensure it complies with the Royal Pharmaceutical guidelines. A member of staff is now qualified to give moving and handling training, but staff are still not being assessed as competent before being allowed to give this assistance. Staff training records must contain a written assessment of their competence before they assist with moving and handling. The home has a complaints procedure, but this has not been consistently followed when dealing with complaints. A record must be kept of all complaints, together with any responses made to the complaint and the outcome of any investigation into it. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 8 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.V299573.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given sufficient information about the service to enable them to make a choice about whether they live there. Basic assessments, completed prior to admission, ensure residents may be confident the home will be able to meet their needs. EVIDENCE: The statement of purpose and service user’s guide give detailed information about the admission process. Prospective residents are informed they will need to meet the admission criteria and have an assessment of need. They are also invited to visit the home prior to admission and encouraged to consider a short stay or day care before coming permanently to the home. All residents are admitted for one month’s trial period. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 10 A copy of the contract is included in the service user’s guide and this gives information about fees, services provided and what residents are expected to pay for. Three residents were case tracked to review their experience of admission to the home. All three had a pre admission assessment completed by a member of the management team. These included basic information about abilities and needs that was sufficient for the registered manager to identify whether the home could provide the required level of care. Information was also obtained from other health care professionals such as care managers or hospital staff. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst residents are treated with respect and have many needs met, and an improvement in care planning means residents have some support to receive personal care in the way they like it, they cannot be confident their health care needs will be monitored and met all of the time. The procedure for receipt and recording of medication received into the home is insufficient to ensure medication is managed safely. EVIDENCE: A requirement was made following the last two inspections that care plans must be developed to provide detailed information about residents’ abilities, needs, wishes and aspirations. Four care plans were reviewed as part of the case tracking process. Two residents had lived in the home for over one year, one had been admitted in May, but had subsequently been in hospital, and one had only just been admitted. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 12 The plans showed an improvement as more personal information was recorded. A section had been added for residents to complete about their personal preferences. There was a section for recording any changes and these had been completed on a monthly basis, demonstrating the plans were regularly reviewed, although in some instances information from the daily records had not been used to identify the need to change the plan. A social care plan was included for residents, which gave them the opportunity to identify aspects of their care that were important to them. For example, going out regularly, spending time resting on their bed during the day, or being able to carry out some personal care for themselves. There were some examples of good practice, for example, identifying a trigger that could have a detrimental outcome for a resident and providing an action plan to remove the trigger. However, plans still need to be developed further, so that they reflect in more detail residents’ needs and wishes. For example, several said that someone needed total help with personal care, rather than identifying how this should be given. One care plan stated that someone should be encouraged to use their right hand to brush their hair. The plan stated that this was to be done by providing aids and implements but none were identified. Staff spoken with did not know what this meant and were not aware of any specific aids being required or supplied. Some residents commented that staff were aware of their abilities and needs and supported them to do what they could for themselves, for example, encouraging them to choose their clothes each day, or brush their hair. Staff were able to describe the support needed by some residents and how they liked to receive it. Risk assessments were now being used but did not always clearly link with the assessment or care plan. For example one had been put in place for a resident who bathed independently. This said staff should not leave him but should stay outside the bathroom. No risk had been identified in either the assessment or care plan and the registered manager said the resident was quite able to ring for assistance if required. Another resident went out alone every day and was showing signs of increased confusion. There was no risk assessment in relation to this or action plan for staff to follow in the event he did not return to the home. Limitations had been imposed on residents without a risk assessment clearly identifying the issues. They had not been reviewed and agreed by a multiagency group and there was no record that the reason for the limitation had been explained to the residents. The care services manager said the limitations imposed on one resident following guidance from hospital were Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 13 already being reviewed as it was felt they were not necessarily required in a residential home but there was no record of this. There was evidence that health care needs were not always monitored effectively or that referrals to relevant health care professionals made as quickly as they should be. Records showed that minor wounds had not been monitored through risk assessment or referred to the district nurse for advice and treatment. Guidance given by a doctor had not been recorded on a care plan so that effectiveness of treatment could be monitored. A comment was made that staff ‘had to be pushed’ before referrals to doctors were made. Medication is provided by the local pharmacist in a monitored dosage system. Records for residents being case tracked had been completed for morning and lunchtime medication and the medication had been given as recorded. The service users’ guide states that residents may self medicate if they wish and the registered manager confirmed that one resident currently manages their own medication. No records for checking the amount of medication received into the home in the monitored dosage system could be found. There were also no records for medication brought into the home by new residents. This was not in a monitored dosage system. The registered manager contacted the person responsible for ordering medication, who said they were aware of the need to check and did it when they had time. Controlled drugs were stored in a controlled drugs cupboard, which was kept locked. Records kept of medication stored as a controlled drug did not comply with the Royal Pharmaceutical guidelines, as the number of tablets held was not recorded. The registered manager was advised to refer to them to ensure compliance. There was no record kept of signatures of staff authorised to give out medication which is recommended as best practice. Residents said staff treated them with respect. When providing personal care staff always asked if residents wanted help rather than just doing things for them. Staff were observed addressing people by the name they wished to be called. This choice was recorded on care plans. Several people expressed their gratitude at the way staff had handled recent bereavements. They felt their support had helped them cope with a difficult experience and thought staff had shown empathy with their feelings. Beechwood House DS0000049982.V299573.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 at least once during a 12 month period. 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 supported to make choices about all aspects of their daily living. They are able to participate in activities that provide mental stimulation and that they enjoy and are able to maintain contact with family and friends. EVIDENCE: Residents said they felt able to make choices about all aspects of their daily living. The use of a social care plan, completed by the resident ensures that information about their preferred daily routine is recorded. At the start of the inspection some residents were having breakfast in the dining room. Staff said breakfast was now offered at the later time of 8:30 a.m. and felt that this was too late for residents who got up early. However, residents said that if they wanted it earlier they could have cereals and toast in their rooms. Care plans recorded this preference. The home is undergoing an extensive refurbishment. One resident had moved downstairs whilst her room was redecorated. She liked the new room so much she asked if she could stay there and has been able to do so. She was very pleased with this outcome. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 15 The statement of purpose says that residents may bring their own belongings to the home. Information from residents and evidence seen in their rooms confirmed they were able to do so. During the morning a number of activities were provided for those who wished to join in. A large notice board in the corridor gives everyone information about what is happening. On the day of the inspection there was a bingo session, followed by armchair exercises. Later a craft activity took place in the dining room. The home has a large garden. A ramped access has recently been provided, but the registered manager felt the slope was still too steep for residents to use without assistance. There are chairs, benches and a covered awning provided in the patio area, which has been filled with hanging baskets and tubs of flowers. Residents and their relatives were seen using this space, although at one time there was a large number of staff sitting under the awning having their break, which could have discouraged residents from sitting there. Residents and their families said how much they liked the garden and patio area. Some wished they could use the garden more and that seats were provided there. The registered manager said she had some funds to do this and would be purchasing more as soon as she had time to do so. An area next to the laundry had been recently cleared. The registered manager said it was hoped to provide raised flowerbeds so that service users could do some gardening. Several residents like to go out alone during the day and walk to the village. As commented on in the previous section, a risk assessment must be completed to ensure all possible steps have been taken to identify and minimise any risks involved. Residents said their relatives were always made welcome when they visited and that there were no restrictions. Visitors were seen coming to the home throughout the inspection and spending time with their relatives in the garden, patio area and lounges. The statement of purpose says that residents may attend any religious services and that staff may accompany when possible. The operations manager said part of the refurbishment programme might include the provision of a small chapel or quiet area. Residents said they thought the meals were very good. The menu plan showed two choices of main meal and residents confirmed this was always offered. The menus showed meals were balanced and offered a wide range of choices. Homemade puddings and cakes were particularly popular with residents. The cook said several residents had diet controlled and insulin controlled diabetes. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 16 She did not make any special cakes for them, but agreed to get advice about what could be provided to make sure they were able to have the same choice as other residents. It was observed during the inspection that staff set tables for lunch immediately after breakfast. Staff were asked what they thought this might imply to a person with dementia. They said it might make them think it was time for lunch and said that some residents did actually sit down and ask for a meal. It was suggested this practice be reviewed and that some residents might like to set the tables just before lunch is served. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 17 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home has a complaints procedure, this is not used to ensure residents and their families may make complaints and be confident they will receive a response. Residents are protected from abuse by satisfactory training of staff. EVIDENCE: Residents said they felt they could raise issues with the management and were confident they would be addressed. However, a relative expressed concern that a response to issues raised had not been received within the timescale given in the home’s complaints procedure and that the letter had to be sent a second time before receiving any response. The response had been satisfactory. The pre inspection questionnaire stated that no complaints had been received by the home since the last inspection. The complaints book recorded that the last complaint was made in July 2005. There was a letter of complaint written in September 2005 in the file, which had a response to it, but had not been recorded in the book as a complaint. There was nothing to indicate the complainant had not been satisfied with the outcome. During discussions, the registered manager produced the letter referred to by a relative during the inspection. She said she had written a response to it but Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 18 had not kept a copy. When asked why these letters had not been recorded in the complaints log the registered manager, operations manager and care services manager, said that only formal complaints were recorded. Issues raised in the letters seen during the inspection were clearly complaints and should have been dealt with through the home’s complaint procedure to ensure that issues, action taken and outcomes were clearly identified. The home had an adult protection policy and procedure so that staff had guidance about adult protection issues. Staff were able to demonstrate they were aware of their responsibilities to report abuse and know about the whistle blowing policy. Some staff had attended adult protection training, either as a separate course or as part of their National Vocational Qualification (2). The registered manager had identified the need for more training to be provided in the training programme, as some staff had not yet attended training. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 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 live in a clean, safe and comfortable environment that meets their needs. The renovation programme being undertaken will provide more choice for residents about where they spend their time. EVIDENCE: There had been no recent visits from Hampshire Fire & Rescue service or the Environmental Health office. The renovation programme is continuing with the refurbishment of first and second floors completed. There were a number of proposals for altering current ground floor provision and the operations manager agreed to notify the commission when plans were finalised. Possible changes included incorporating the current manager’s office into communal space, moving the laundry to inside the main building and extending the kitchen. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 20 The changes already mentioned in relation to the garden have improved service provision. Residents are now able to walk safely around the outside of the home. They are discouraged from going down the slope to the rear garden unaccompanied by a small bolted garden gate. The home employs a gardener to keep the gardens to a high standard. Bedrooms have been refurbished to a high standard, but it was noted that the existing door locks had not been replaced. The existing locks no longer meet the required standard as they cannot be overridden by a pass key and do not open from the inside with a single action. Consideration should be given to replacing them as part of the renovation process. Residents said they liked their surroundings and thought the home was kept clean. On the day of the inspection the home was clean and there were no unpleasant smells. The cleaning staff had a rota to work to so every area is regularly cleaned. The home employs someone for 30 hours a week to manage the laundry. The laundry has washing machines that are able to deal with soiled linen. The home has a policy and procedure for infection control. The home has provided staff with recent training on infection control. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. 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. Residents are supported by qualified and well trained staff in sufficient numbers to meet their needs EVIDENCE: The registered manager said that some staff had recently left and she was currently recruiting more staff. She wanted to increase staffing levels so that there would be more opportunities for staff to spend time with residents. The maximum staffing levels were 3 care staff in the morning, 2 care staff in the afternoon and evening and 2 waking night staff. The sample rota sent to the commission as part of the pre inspection questionnaire indicated that these levels might not always maintained, but the registered manager said that staff volunteered to do extra hours or agency staff were called in to cover shifts. On the day of the inspection there were 3 care staff on duty as well as a new member of staff shadowing an experienced one as part of her induction programme. Care staff do not have to undertake domestic, laundry or cooking tasks as a routine part of their role, as domestics, cooks, kitchen assistants and a laundress are employed to carry out these jobs. Residents said there were sufficient staff to meet their needs. One said calls for assistance were answered promptly and this was observed in practice throughout the day. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 22 Three staff were case tracked to assess the employment, induction and training of staff. All had completed an application form, attended an interview, given two references and completed a Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) check prior to their employment. They all had contracts giving information about their roles and responsibilities and a job description. The care services manager said that the home used two agencies to provide care staff when they were short of staff. Both normally sent information about the employment checks completed in respect of the staff provided. On the day of the inspection an agency staff was required at short notice. The registered manager said the agency staff who turned up to cover the shift did not bring this information with them, but she thought this was because there had been very short notice given that an agency staff was needed. She agreed to contact the agency to ask for the information to be faxed through. This was received before the inspection ended. The care services manager explained she had developed an induction programme that complied with the guidance given by Skills for Care. This included workbooks that staff were expected to complete and a copy of the Code of Conduct. The new member of staff working that morning confirmed she had been given the induction pack and was working with a mentor for the first few weeks. She had been given a basic induction on her first day, including an introduction to the fire procedures and was going to start working on her induction record. The provider was actively supporting staff to achieve their National Vocational Qualification (NVQ) 2. An assessor was working with one member of staff during the inspection. The pre inspection questionnaire stated that 27 of staff have achieved NVQ 2 and more are working towards it. Staff said they hoped to continue on to NVQ3. The care services manager said all new staff were told they were expected to complete the qualification as part of their training. The pre inspection questionnaire identified recent training included NVQ 2 and 3, infection control, manual handling, medication awareness, dementia, and one member of staff had completed a train the trainer course in moving and handling. It was established that when this person gave training to care staff, their ability to practice was not being formally assessed. This was a requirement following the last inspection. The training was discussed and it was established staff were expected to complete a questionnaire following the training that demonstrated their understanding. Staff’s fitness to assist with manual handling should be recorded on their training record. The staff working in the home during the inspection had previous experience of working in a care setting and had attended a range of training sessions, such Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 23 as first aid, dementia, and adult protection, which enabled them to develop the skills required to provide care. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. 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. The manager of the home ensures that residents and their families are able to give feedback about the service they receive. However, residents and their families cannot be confident issues raised will be addressed. There are systems to make sure safety issues are addressed and residents are protected, but service users do not always receive the health care they need as quickly as they should. EVIDENCE: The registered manager has worked in residential care for many years and has managed Beechwood since April 2004. She has recently completed her NVQ 4 and Registered Manager’s Award. Residents and staff said she was approachable and willing to listen. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 25 Issues have been raised in health and personal care and complaints sections of this report that indicate the registered manager is not effectively managing all aspects of her management role. Residents have not always received the health care they need and complaints have not been dealt with using the home’s complaint procedure. There had been no resident meetings for a year, but the operations manager said one would be held shortly to inform residents and their families of the plans to be put in place whilst the kitchen refurbishment took place. Residents and their families were asked to give their views through an internal quality audit system that provided questionnaires every six months. One of these had been completed in February 2006. Data was analysed and a report sent to the provider and the operations manager. Feedback was not given to the residents and their families. The operations manager said if anyone responded to the questionnaires negatively the registered manager contacted them to discuss their concerns. However, not everyone chose to identify themselves, and those that did not could not be contacted to discuss issues. It was suggested that feedback from the questionnaires should be given to residents and their families in an appropriate format. The operations manager said there were plans to employ an external audit company to carry out a quality audit survey on all the homes in the organisation. Reports were completed every month to comply with Regulation 26. Copies of these were available to see. In addition, the care services manager said she was required to complete quarterly audits of care provision and health and safety provision. The registered manager said she held small amounts of money on behalf of service users. These are kept individually with a written record of expenditure. The pre inspection gave details of service contracts and visits to the home to service equipment. From this list and those randomly checked during the course of the inspection, there was evidence that the safety of residents was being maintained. The registered manager had a training matrix that recorded when staff had attended basic training such as first aid, moving and handling and food hygiene. This enabled her to monitor who needed training or refresher training and to plan training needs for the year. A training session in food hygiene had been arranged for next month. The new member of staff said she had already been put forward for it. Training records showed that staff received basic training to enable them to work with residents’ safely, although as stated Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 26 previously, staff must be formally assessed and this assessment recorded, before they can assist with moving and handling. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 27 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 1 9 2 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 1 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 28 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 13(4) Requirement Risk assessments must be used to identify any potential risk to a service user in respect of any activity he/she wishes to participate in. The risk assessment must give staff guidance on how to minimise the risk to an acceptable level. If the risk identifies the activity is too great for the service user to carry out the activity, this must be agreed at a multiagency level, the reasons for the decision recorded and explained to the service user. The current recording systems used to monitor health care needs of service users must be reviewed to ensure they identify and record areas of concern. Referrals must be made to health care professionals immediately a health care need is identified that cannot be met by care staff. Systems must be put in place that record all medication received into the home. DS0000049982.V299573.R01.S.doc Timescale for action 01/09/06 1 OP8 13(1) 01/09/06 2 OP9 13(2) 01/09/06 Beechwood House Version 5.2 Page 29 3 OP9 13(2) 4 OP16 22(3) 5 OP30 18(2) Records kept for all drugs stored as controlled drugs must show the amount received into the home and the balance left after each time the medication has been administered. The current system must be reviewed to ensure it complies with the guidance given in the Royal Pharmaceutical Guidelines. A record must be kept of every complaint, together with action taken to investigate the complaint and written responses made to the complainant. Each care staff must be assessed as competent to assist service users with moving and handling before being permitted to provide this care. A written record of their training and assessment must be kept. Previous timescale of 01/01/06 not met 01/09/06 01/09/06 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations That a record is kept of the signatures and initials of all staff responsible for administering medication. Beechwood House DS0000049982.V299573.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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