CARE HOMES FOR OLDER PEOPLE
Beechwood House Woodberry Lane Rowlands Castle Havant Hampshire PO9 6DP Lead Inspector
Mrs Pat Trim Unannounced Inspection 29th November 2005 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.V269605.R01.S.doc Version 5.0 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.V269605.R01.S.doc Version 5.0 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.V269605.R01.S.doc Version 5.0 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. 15th June 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). 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. Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second statutory inspection carried out for 2005/2006. It was an unannounced inspection, completed by one inspector, and took five hours. The focus of the inspection was to confirm compliance with the requirements made following the last inspection and to assess the remaining core standards. Information for this report was obtained by speaking with four of the residents, two members of care staff and the care services manager. A partial tour of the environment was carried out and a range of records inspected. Information was also obtained from comment cards, received from residents and health care staff. The registered manager was not working in the home on the day of the inspection, so information was obtained from the deputy manager and the organisation’s care services manager. What the service does well: What has improved since the last inspection? Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 6 A new personal alarm call system has been installed which enables the registered manager to monitor calls for assistance and to assess whether staffing arrangements are sufficient. A care planning system has been introduced which, when fully completed for each resident, will provide clear guidance on how to meet individual need. A questionnaire, completed by residents and their families, provides information about the resident’s life history. This can be used to help staff when talking with residents and also in developing an activities programme that meets the individual needs. Staffing levels have been increased during the early evening so there are more staff to meet the needs of residents and to provide a more flexible approach in assisting residents in their night time routine. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 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.V269605.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 was assessed on the last inspection. Standard 6 does not apply. EVIDENCE: Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 9 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. The format being used for care planning could provide detailed information about resident’s individual needs and provide a consistent approach to meeting them. However, the failure to complete the plans appropriately means residents cannot be confident their individual needs will be met. Risk assessment is not used as a tool which will help staff to minimise risk and promote and enable residents to maintain their independence and lifeskills. EVIDENCE: This standard was assessed on the last inspection when it was felt the care plans and risk assessments did not provide sufficient information for staff to have a clear understanding of how to meet individual resident’s needs. Since the last inspection, a care planning format has been introduced that, when fully completed, provides a basic individual care plan for staff to follow. This still needs to be more fully developed, especially for residents who may not be able to express their needs verbally. The care plan should provide staff with the information they require to give care to each individual resident, in the way the resident wants it. It should say what a resident is able to do as well as what they need help with. For example, several residents said they could
Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 10 dress themselves and required help only with putting on stockings and shoes. The care plans said ‘requires help with washing and dressing’. Risk assessments had been completed for assisting residents with moving and handling, but need to be developed to provide an action plan to enable residents to participate in any activity that may have an element of risk. For example, having a bath or going outside for a walk. The care services manager said she was aware the current risk assessment did not achieve its objective and confirmed new risk assessments were being developed that would be introduced shortly. A requirement was made following the last inspection that a risk assessment should be completed for each resident in respect of going in the garden. These had not been completed but access to the garden had been improved. Risk assessments should still be completed where there is an identified risk to individual residents. Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 11 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): Key standards were assessed on the last inspection. EVIDENCE: Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 12 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): Key standards were assessed on the last inspection. EVIDENCE: Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 13 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 22. Systems are in place that ensure the temperature of water is controlled to a safe level so residents are not at risk of accidental scalding. EVIDENCE: These standards were assessed on the last inspection, when it was found that the hot water system in the home presented a risk to residents and the heating system was inadequate. The provider complied with the Environmental Health officer’s requirement to find a long-term solution, by fitting communal baths with thermostatic control valves. En suite baths were made safe by having the water supply locked off. The provider said that they were being fitted with thermostatic control valves as part of the renovation programme. The provider also said that the objective was to fit thermostatic valves to all communal and en suite baths and hand basins. The problems with heating had been resolved and the home was warm. Residents confirmed they were not cold at any time.
Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 14 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): 28, 29 and 30. The provider is committed to achieving the requirement that 50 of staff must have NVQ 2 so that residents will be able to be confident they are in safe hands at all times. The home has a robust employment procedure that ensures residents are protected. The current induction programme does not evidence that staff are assessed as competent before working unsupervised so residents may not be confident they have the skills they need. EVIDENCE: The home currently employs 11 care staff. Of these, 4 have completed their NVQ 2, 2 are doing the course at the moment and 3 staff are registered to start the course in January 2006. When the 2 staff currently completing the course have finished, the home will meet the standard and have over 50 of staff with an NVQ 2 qualification. Staff confirmed they were told when they started working at the home that they were expected to complete this training. Two staff files were assessed to evaluate the home’s recruitment procedure. Both files contained all the required information, such as a completed application form, two written references and a Criminal Records Bureau Disclosure (CRB) and Protection of Vulnerable Adults (POVA) check. One member of staff was interviewed and confirmed she had attended an interview prior to her employment.
Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 15 Both staff had completed an induction programme. The member of staff interviewed confirmed she shadowed a more experienced care staff for two weeks before working unsupervised. During this time she was regularly supervised by the manager and deputy manager. Both staff had completed an induction checklist which identified various areas of work, such as fire safety, health and safety, meeting the residents and assisting with personal care. It did not identify what staff had to do before being assessed as competent in each area and not all aspects had been signed as completed by both staff and supervisor. The care services manager said that the need for a more comprehensive induction programme had already been identified by the management and she had been in touch with the Skills for Care council to obtain guidance to develop a more suitable tool for future employees. It was expected this would be completed shortly. The new care staff who was interviewed had previous experience of working in care and copies of her training certificates were on her file. She confirmed that her current training needs had been discussed as part of her induction and supervision and that training was being arranged for her. It was noted that the moving and handing section of her induction record had not been completed, so there was no evidence she had been assessed as competent to assist residents. She confirmed training was being arranged, but a requirement was made that no staff may assist residents with moving and handling unless they have received training and been assessed as competent to undertake this aspect of care. The home was developing its service and had applied to the Commission for Social Care Inspection for a variation to accommodate up to 37 residents with dementia and up to 10 residents aged 45 to 65 with dementia. Training was being arranged on a rolling programme to ensure staff had the skills and experience to work with these client groups. Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 16 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 and 35 The registered manager is well qualified and runs the home in the residents’ best interests so they may be confident their views about the day to day running of the home are actively sought and acted upon. The systems in place are effective and protect residents’ financial interests. EVIDENCE: The registered manager has many years experience of working and managing a residential care home. She has been the registered manager of Beechwood for a year. She is currently completing her NVQ 4 in care and will then be completing the Registered Manager’s award. She is supported by the care services manager, who provides one to one supervision every six weeks and visits the home regularly. She is assisted in the day to day running of the home by the deputy manager.
Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 17 The care services manager said that it was the policy of the provider to conduct a quality audit of the service every six months. Questionnaires were completed by residents and their families to give feedback on the service they received. The care services manager said residents meetings were held, but were poorly attended. The registered manager was trying to develop this as it was an opportunity for residents to speak out about the service. Regulation 26 visits were conducted on a monthly basis and the management held a meeting every three weeks to discuss issues and review progress. The home looks after money for some of the residents. This is kept secure and written records kept of sums received or spent. Entries are made in a book with a separate page for each resident. It was recommended that it would be more appropriate to have a separate record for each resident to provide a more confidential approach. It was also recommended that relative should sign the record when they put money into the account. Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 X 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15(1) Requirement Timescale for action 01/01/06 2 OP19OP7 13 2 OP30 18(2) Care plans must be developed that identify service users’ abilities as well needs so that staff are able to give care and support only where it is needed. They must contain detailed information that is individual to each service user so that care may be provided in the way they wish. A risk assessment must be 01/01/06 completed for each service user in respect of their access to the garden. An action plan to minimise the risk must be put in place where a high level of risk is identified. (Previous requirement – timescale of 01/09/05 not met) Each care staff must be assessed 01/01/06 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. Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 20 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 OP35 Good Practice Recommendations That the records of service users’ money are kept in separate books to enable a more confidential approach to be taken. It is also recommended that relatives are asked to sign the record to evidence the home has received money from them to put into the service user’s account. Beechwood House DS0000049982.V269605.R01.S.doc Version 5.0 Page 21 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
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