Inspection on 06/06/06 for Beechwood House

This inspection was carried out on 6th 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 21/06/07

Beechwood House 07/11/05

Beechwood House 14/04/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Beechwood House Beechwood House 40 Beechwood Road Sanderstead Surrey CR2 0AA Lead Inspector Peter Stanley Key Unannounced Inspection 6th June 2006 9:30am X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechwood House Address Beechwood House 40 Beechwood Road Sanderstead Surrey CR2 0AA 020 8651 2937 020 8405 2572 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Hariharen Pavaday Mrs Anjoo Poovadee Pavaday Mrs Anjoo Poovadee Pavaday Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow one specified service user in the Dementia - over 65 (DE(E)) category to be accommodated until such time as the needs of the service user can no longer be met or until such time as the placement ceases. 7th November 2005 Date of last inspection Brief Description of the Service: Beechwood House is a small residential home for older people situated in a quiet residential road in Sanderstead. A bus service is available to access the home. The nearest railway station is Sanderstead. The home has recently changed ownership, and is now managed by Mrs Anjoo Pavaday. The house is set back off the road and has a ramp and steps to access the front entrance. There is a large back garden that can only be reached by steps. The home accommodates fifteen elderly residents and is registered in the category of care provision for older people. The home consists of eleven single bedrooms and two double rooms. There is a smoking lounge on the first floor and a smaller lounge on the ground floor. The dining room is next to the large kitchen, with a door leading to the patio and back garden. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of the home took place over six and a half hours on 6 June 2006. The registered providers, Mr and Mrs Pavaday, were present during the course of the inspection. Mrs Anjoo Pavaday is also the home’s registered manager. The inspector checked out progress in meeting outstanding requirements and spoke to a number of service users and staff. Care records and other documentation were examined, and three recent admissions were casetracked. Comments cards were received from a number of relatives. Feedback from both service users and relatives, regarding the home and the care provided by staff, was very favourable, and service users presented as settled and satisfied with their environment. The outcome of the inspection was generally positive, with evidence of a pleasant and well-run home, with high standards of care and support being maintained. As a result of the inspection, 14 requirements were made, 3 of which remain outstanding from the previous inspection. Of these, the continuing need for all staff to receive statutory adult protection training is paramount and must be given the highest priority. Also concerning was the admission of two service users for whom full information concerning their mental health needs had not been given by the referring agency, and which resulted in the breakdown of these two placements. The home’s assessment procedures must, in future, ensure that no service user is admitted without full information regarding both the person’s physical and mental health needs being obtained. What the service does well: Prospective service users are being provided with the comprehensive and upto-date information required with which to make an informed choice regarding the suitability of the home. Prospective service users, their friends and relatives are able to visit to assess the suitability of the home. Service users are having their health, personal and social care needs set out in an individual plan of care. Service users’ care plans are being reviewed on a monthly basis. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 6 The health care needs of service users are being fully met. Service users are being treated with respect and are having their right to privacy upheld. The home’s policy and procedures indicate that the views and wishes of service users and their relatives, regarding the eventuality of the service user’s infirmity or death, are being respected. Service users are being provided with a varied range of opportunities for recreational and social activity that is in accord with their social, cultural and religious needs. Service users are being encouraged to maintain contact with their family and friends, with visitors being made welcome at the home. While there are some opportunities for service users to develop and maintain links with the local community, these could be extended so as to provide more variety and choice. Service users are being assisted to exercise a significant degree of choice and control over their day-to-day routines and decision-making. Service users receive a wholesome and appealing diet, with choice being offered, in pleasant surroundings, and at times convenient to them. The legal rights of service users within the home are being protected and promoted. Service users are encouraged and assisted to vote if they wish. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are encouraged to raise any concerns that they may have. Service users are evidenced to live in a safe, well-maintained environment, with access to safe and comfortable facilities. Sufficient bathing, washing and toilet facilities are provided with which to meet the needs of service users. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. The home presents as clean, pleasant and hygienic. The home has the skill mix of staff with which to meet service users’ needs. The new registered manager/provider presented as a fit person to be in charge, with the necessary skills and experience with which to manage the home in the best interests of the home’s service users. The management Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 7 approach was evidenced as being open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. The home is developing its quality assurance processes so as to demonstrate that the home is meeting its aims and objectives and that it is being run in the best interests of the service users. Service users’ financial interests are being safeguarded. While, generally the health, safety and welfare of service users and staff are being appropriately protected, there are two safety checks that must be addressed. What has improved since the last inspection? What they could do better: Generally, the home is able to demonstrate that service users needs are being properly assessed, and that the range of needs presented is being appropriately met. However, the home has been unable to meet the needs of two service users for whom full assessment information regarding their mental health needs had not been obtained. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 8 While service users are being protected by the home’s medication policy and procedures, their protection also requires the extension of accredited medication training to all care staff. While the home’s policies and procedures are helping to ensure that service users are safeguarded from abuse, their protection requires that statutory training in adult protection is extended to all care staff. While, generally, service users are being provided with the aids and specialist equipment they require to maximise their safety and independence, this needs to be assured with an assessment of the home by an occupational therapist. For the home to have sufficient numbers of care staff with which to safely meet the care and support needs of the home’s service users, additional input of auxiliary cleaning support must be provided. A development plan needs to be put in place. The home needs to demonstrate that it is being safeguarded by it’s accounting and financial procedures. An appropriate incidents record needs to be maintained. 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 DS0000062807.V295225.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 5 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective service users are being provided with the comprehensive and upto-date information required with which to make an informed choice regarding the suitability of the home. Each service user is now being provided with a copy of their terms and conditions at the point of moving into the home. This provides clear information regarding the fees charged and services provided. Generally, the home is able to demonstrate that service users needs are being properly assessed, and that the range of needs presented is being appropriately met. However, the home has been unable to meet the needs of two service users for whom full assessment information regarding their mental health needs had not been obtained. Prospective service users, their friends and relatives are able to visit to assess the suitability of the home. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 11 EVIDENCE: A comprehensive statement of purpose and service user’s guide is in place. This is produced in an appropriate form and is made available to all prospective and current service users. Following a requirement from the last inspection, both these documents have been reviewed and revised, and signed and dated. The home’s policy is for prospective service users to be invited to visit the home and move in on a trial basis for 4 weeks. Following this trial period a review is held with the service user and his/her relatives/advocates. A decision regarding permanent placement is then made. Unplanned admissions are avoided where possible. The inspector evidenced local authority contracts on the files of service users who have been admitted to the home. Following a requirement from the last inspection, a separate Statement of Terms and Conditions is now being agreed by the home with each service user prior to their admission. The inspector examined a sample of six service user files relating to recent admissions. The home completes assessments, risk and moving & handling assessments, and dependency profiles. Following a requirement from the previous inspection, a copy of the service user plan is now being included on the service user files. New service users are admitted on the basis of a full assessment undertaken by a person who is suitably qualified to do so. The assessment is completed with the service user, relative or delegated representative and any relevant professionals that have been party to the referral. While the home has been obtaining the necessary care management assessments from social services for all recent admissions, the inspector was concerned to find that two admissions from hospital had been made for which information relating to mental health problems had not been disclosed in the hospital assessments provided. As a result inappropriate admissions were made which led to the breakdown of these placements with subsequent transfer to more appropriate care homes. Whilst the inspector was satisfied Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 12 that the providers did not knowingly admit anyone out of category, the providers were reminded that full information regarding both the person’s physical and mental needs must be obtained in all cases, and that where there is any indication of dementia or other mental health problems, no admission can be allowed to proceed. A requirement applies. From the inspection of files, it was evidenced that care reviews have generally been taking place. Reviews for two recent admissions have yet to take place, but are still within the required timescale of six to eight weeks. The inspector was satisfied that, with the exception of the two aforementioned admissions (for whom transfers have taken place), the home has the capacity to meet the assessed needs of individuals admitted to the home. The inspector spoke to a large number of service users, including two service users who have been recently admitted. The feedback received was generally very positive, with service users feeling that they are well cared for and happy with the care being provided. Both new service users said that they had settled in well and were feeling well supported. There was evidence from the service user plans that specific social and cultural needs are being addressed. Staff and training records indicate that the home has the range of skills and abilities with which to meet the needs of service users. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 to 11 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are having their health, personal and social care needs set out in an individual plan of care. Service users’ care plans are being reviewed on a monthly basis. The health care needs of service users are being fully met. While service users are being protected by the home’s medication policy and procedures, their protection also requires the extension of accredited medication training to all care staff. Service users are being treated with respect and are having their right to privacy upheld. The home’s policy and procedures indicate that the views and wishes of service users and their relatives, regarding the eventuality of the service user’s infirmity or death, are being respected. Training in bereavement and loss has been provided for all staff. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 14 EVIDENCE: The inspector examined a number of service user plans. These evidenced that service user plans detailing the health, personal care and social needs of service users are drawn up by the home in consultation with the service user and his/her relatives/advocates. The plans are based on information from assessments and are being reviewed on a regular monthly basis. Risk assessments, including manual handling, were evidenced as having been completed. Following a previous requirement, a copy of the service user plan is now being included on service user files. The health care needs of residents are evidenced from records as being appropriately met. The home is covered by a local GP practice, with one service user exercising his preference to retain his own GP. Service user records detail visits from the GP, district nurse and other health and care professionals. Service users attend for hospital visits and other appointments as required, including optician and dental appointments. One service user has been receiving visits from a physiotherapist. The inspector was informed that there are no service users with pressure sores. Personal and oral hygiene, including the care of dentures, are actively encouraged. The promotion of continence is monitored with advice being obtained from incontinence advisors when necessary. Feedback from service users indicated that their health care needs are being met, and that health concerns, when they arise, are being addressed. One service user, spoken to by the inspector, has been regularly monitored due to ongoing health concerns, and has been receiving regular visits from a district nurse. She expressed her satisfaction with the monitoring and care being provided by staff and with the treatment being provided. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 15 The home has a medication policy and procedures in place. The home uses the Monitored Discharge system for administering medication. All medications are kept in a locked cabinet in an area adjacent to the lounge. While any service user who wishes to take full responsibility for their own medication is (subject to a risk assessment) able to do so, none is doing so at the present time. Advice from a pharmacist concerning the home’s policy on the safe handling and administration of medicines is obtained on a quarterly basis. Four service users are currently taking controlled drugs. These are being stored separately from other medication in a locked metal cupboard in the office. A previous requirement, for all staff to receive accredited medication training, has been partly, but not fully met. The home has entered an arrangement with John Ruskin College to provide care staff with accredited medication training, the manager and 4 care staff having so far completed this. This training must be extended to all other care staff. The home adheres to a clear policy and practice with regard to ensuring service users dignity and rights are upheld in all matters associated with personal physical and medical care. Service users can see their GP in the privacy of their own bedroom and without the attendance of staff if they prefer. Views expressed by service users evidenced that staff are considerate and respectful of their privacy. Service users’ wish to spend time in their own rooms is respected, and staff were observed to knock on service users doors before entering. All service users have a lockable space in their bedrooms for storing personal possessions and valuables. The inspector spoke to a large number of service users during his visit and received positive feedback regarding respect for their privacy being observed. Service users indicated that relatives and friends are made welcome at the home and that they are able to accompany them on an outing or visit, if they wish, or to see them in private within the home. The inspector also spoke to one relative who was visiting a service user. He indicated that he felt very welcomed by the manager and staff when he visits, with privacy being respected, and spoke highly of the care being provided for his wife. The home is not able to specifically cater for the needs of older people who are terminally ill and who require nursing and palliative care. The home recognises that service users may pass away unexpectedly whilst in residence and this has happened in the past. The manager and staff are given all the necessary information through policies and procedures if such an event occurs. Service users and relative’s wishes in the event of death and funeral arrangement are duly noted in each file. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 16 There has been the death of one service user since the last inspection, and three deaths over the last 12 months. A recommendation from the previous inspection for the home to access training in loss and bereavement, has been fully met; this has assisted staff to develop coping strategies, and to acquire relevant skills with which to positively support service users throughout the bereavement process. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 to 11 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are being provided with a varied range of opportunities for recreational and social activity that is in accord with their social, cultural and religious needs. Service users are being encouraged to maintain contact with their family and friends, with visitors being made welcome at the home. While there are some opportunities for service users to develop and maintain links with the local community, these could be extended so as to provide more variety and choice. Service users are being assisted to exercise a significant degree of choice and control over their day-to-day routines and decision-making. Service users receive a wholesome and appealing diet, with choice being offered, in pleasant surroundings, and at times convenient to them. EVIDENCE: The inspector spoke to a large number of service users regarding their involvement in leisure activities. Feedback was positive with service users feeling that their needs in this area are generally being met. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 18 Service users are able to participate in a range of activities that includes a weekly music and movement session, bingo and manicure. A reminiscence session, which is held every 2-3 weeks, has proved popular. An entertainment, comprising of song, dance and performance, is provided three times a year by a group of entertainers called Troubartour- at Christmas, Easter and at the annual summer garden party to which relatives, friends and visitors are invited. Occasional outings to places of interest, such as garden centres and national trust properties, are also arranged. The inspector received feedback from two service users, which indicated a wish for more opportunities for outings. The inspector recommends that these are increased and varied so as to include occasional trips out to the theatre or concert hall, and to include occasional lunchtime visits to a country pub or tearoom. The home has access to a minibus that it is able to use for outings. Visitors are encouraged to visit and maintain contact with service users. From the views expressed by service users, and the feedback received from comments cards, relatives and other visitors are made to feel welcome at the home. Links with the community are maintained with a range of visitors to the home. Service users are able to go out to the shops, or elsewhere, providing they have been risk assessed as safe to do so. Dial-a-ride is available if required. The inspector found that service users are assisted to exercise a fair degree of choice and control in their daily routines. Feedback from a number of service users indicate that they feel supported in exercising choice in their daily routines and activities. The participation of service users in decision-making within the home is now being more fully evidenced with the minutes of service user meetings being evidenced on a regular two-monthly basis. The inspector noted, however, that there needs to be more detailed minutes so as to provide a brief summary of each issue discussed, with reference to individuals’ contributions to the discussion. A recommendation applies. A requirement was made, relating to the need for service users’ meetings to be held and minutes maintained. The inspector examined these and evidenced that while meetings are now being held, these are not being arranged on a sufficiently regular basis. A meeting on 14 July was next followed up with a meeting on the 29 September 2005, a period of about ten weeks. The manager was advised that meetings should be held every six to eight weeks and no longer than two-monthly. Feedback received from service users indicated that the food served is good and varied, and accommodating of individual tastes and preferences. No Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 19 special dietary needs were identified. The inspector examined menus provided over a three-week period. These evidenced a varied choice of food with fresh vegetables and fruit being included in the diet, and with an alternative main course being provided. Meals are served in a very pleasant dining room area, though service users are able to take meals in their rooms if this is their wish. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 to 18 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. While the home’s policies and procedures are helping to ensure that service users are safeguarded from abuse, their protection requires that statutory training in adult protection is extended to all care staff. The legal rights of service users within the home are being protected and promoted. Service users are encouraged and assisted to vote if they wish. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are encouraged to raise any concerns that they may have. EVIDENCE: The home has an appropriate complaints policy and procedure in place, which service users and relatives are made aware of. No complaints have been made since the last inspection. The inspector spoke to a large number of service users during his visit. Service users presented as safe and secure, and trusting of staff. No concerns were raised. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 21 The home has appropriate adult protection and whistle-blowing policies in place. No adult protection concerns have arisen since the last inspection. All service users are protected in this home and respect is given to each individual with regard to confidentiality. The service users are enabled to exercise their legal rights directly and to participate in the civic process of voting if they wish. The inspector was informed that an outstanding requirement from the last inspection for care staff to undertake Croydon’s statutory adult protection training has not so far been met. While all staff have been placed on a waiting list, no training dates have yet been offered. Given the importance of this training, in familiarising staff with adult protection procedures, it is imperative that there is no further delay. To this end, the registered manager was advised to chase this up with Croydon, or to obtain the services of an accredited Croydon trainer to complete the training with staff. No further extension beyond the present one can be agreed. The inspector has previously recommended that the new providers attend an accredited training course on adult protection such as ‘Training for Trainers’ a recognised course, which could then be cascaded down for the benefit of all staff. During the inspection, staff were observed to be respectful and caring in their interaction with service users. Feedback from individual service users indicated that they liked and trusted the management and staff, and that they felt settled and secure in their environment. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are evidenced to live in a safe, well-maintained environment, with access to safe and comfortable facilities. Sufficient bathing, washing and toilet facilities are provided with which to meet the needs of service users. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. While, generally, service users are being provided with the aids and specialist equipment they require to maximise their safety and independence, this needs to be assured with an assessment of the home by an occupational therapist. The home presents as clean, pleasant and hygienic. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 23 EVIDENCE: The accommodation provided for the service users was found to be safe, warm and comfortable throughout. The home has been externally redecorated, with all service users’ rooms having been redecorated. Paving around the home has been re-laid and levelled out to improve both appearance and safety. The garden areas have been re-planted, and there are plans to try to improve accessibility to the large upper garden at the rear of the home. Generally, the home is in a good state of interior decoration and the premises have been well maintained and comply with both fire and health and safety requirements. There has been re-carpeting of the ground floor corridors and communal areas, and of the top floor corridor and two service users’ rooms. Plans to re-carpet the first floor and all remaining service users’ rooms are planned. The communal areas provide a pleasant, homely environment. There are two lounges, one of which is for smokers. The lounges provide adequate space for the service users to sit, and were warm, comfortable and pleasantly furnished. The dining room provides a very pleasant area in which to take meals. A number of service users who were using these areas expressed their positive satisfaction with the environment and the facilities provided. The inspector completed a tour of the premises and found service users bedrooms to be pleasantly furnished and laid out, and reflective of the personal tastes and identities of their occupants. There are 11 single rooms and 2 double bedrooms, which meet the requirements for minimum size. There are two bathrooms, one with an ambu-hoist and there are sufficient bathing and washing facilities to meet service users’ needs. All the bathrooms and toilets had liquid soap and paper towels provided. Generally, adaptations have been made to various areas of the home so as to ensure the health and safety of the service users and maximise their independence. One bathroom has an ambu-hoist and grab rails are in place in the other bathroom. There is a passenger lift in place from the ground floor to the first floor. Handrails are in place on the staircases. Any adaptations or specialist equipment that is needed for service users is assessed by an occupational therapist on an individual basis as and when needed. The inspector felt, however, that a general assessment of the home by an occupational therapist would be beneficial in ensuring that all necessary aids and adaptations are in place with which to meet the needs of the existing service users; a requirement applies. Central heating can be controlled in each individual room. There is an emergency lighting system. Hot water temperatures are tested daily and Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 24 records indicate that these are within safety limits. All radiators within the home are either low surface temperature radiators or have been covered with appropriate guards. The home presented as clean and free from offensive odours at the time of the inspection. Following a previous requirement, all staff at the home have received infection control training. All but 3 staff and the manager, who are currently doing this, have completed food hygiene training. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 to 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. For the home to have sufficient numbers of of care staff with which to safely meet the care and support needs of the home’s service users, additional input of auxiliary cleaning support must be provided. The home has the skill mix of staff with which to meet service users’ needs. The home has appropriate recruitment policy and procedures in place. With the recent improvement in completing all the required recruitment checks, the home is now able to assure service users that they are being appropriately protected. Staff are being provided with the necessary induction and training with which to competently perform their work duties. EVIDENCE: Staffing levels are in accordance with the original agreement prior to the Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older people. This is subject to adjustment should the dependency of the service users increase or if a crisis occurs that would warrant an increase in staffing levels. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 26 The home has 11 care staff and 4 ancillary staff (3 cooks and 1 part-time cleaner). The deputy manager, who was not present for the inspection, is a registered nurse. The inspector examined staff rotas, which were indicated that there are two carers on duty during the day and two (one waking, one sleepin) at night. The staff rota only evidenced a cleaner for one half-day per week. The inspector was informed that care staff routinely undertake cleaning tasks as part of their duties. This is not satisfactory, as care staff should primarily be focussing on the care and support needs of the service users. A requirement is therefore made for the employment of a cleaner to cover cleaning duties for at least 18 hours per week, these duties to be spread throughout the week. Since the last inspection three new staff have commenced employment at the home. The inspector completed checks on staff files and found that all identity and recruitment checks had been completed, including obtaining up-to-date CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) certificates. A checklist is being included on each staff file, indicating all the checks and documentation required and the date when these have been obtained. The home has the skill mix of staff with which to meet service users’ needs, with staff possessing relevant qualifications and undertaking a wide range of training. The home currently has eleven care staff, of whom three have NVQ Level 3, and four have NVQ Level 2. The registered manager possesses an NVQ Level 4. The inspector was advised that four other care staff are shortly due to commence studies leading to an NVQ Level 2. The home provides a comprehensive programme of induction and foundation training, which is completed within the first three months of the staff member’s start date. A wide range of ongoing training is provided, which includes health and safety, moving and handling, medication, food hygiene, fire safety, first aid and infection control. There has also been recent training in bereavement and loss. The manager and three staff are currently doing food hygiene training, all other staff having completed this. The inspector was advised that all staff have been booked in for updated First Aid training. The home has developed and put in place a training profile for each staff member which details all the training completed and scheduled. A requirement for care staff to update their knowledge and access training, relating to the social and care needs of older adults, has been met. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The new registered manager/provider presented as a fit person to be in charge, with the necessary skills and experience with which to manage the home in the best interests of the home’s service users. The management approach was evidenced as being open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. Generally, the home is developing its quality assurance processes so as to demonstrate that the home is meeting its aims and objectives and that it is being run in the best interests of the service users. However, a development plan needs to be put in place. The home needs to demonstrate that it is being safeguarded by it’s accounting and financial procedures. Service users’ financial interests are being safeguarded. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 28 Generally, the home’s record keeping, policies and procedures evidence that the home is being run in the best interests of its service users. However, an appropriate incidents record is not currently being maintained. While, generally the health, safety and welfare of service users and staff are being appropriately protected, there are two safety checks that must be addressed. EVIDENCE: The registered providers, Mr and Mrs Pavaday, present as fit persons to run the home. Mrs Pavaday, who is the registered manager, has been undertaking studies leading to the award of the NVQ Level 4 and RMA (Registered Managers Award) management qualification. The management approach was evidenced as being open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. Feedback from service users was generally very favourable, with service users feeling that the home is being run in their best interests. This is also evidenced by favourable comments cards received from relatives, one of whom spoke to the inspector on this inspection. Following a previous requirement, the home has completed questionnaires with all service users. Questionnaires have also been developed for relatives and friends of service users, and for those who visit in a professional or voluntary capacity. The home needs, however, to compile a development plan to evidence that is meeting its aims and objectives and that it is being run in the best interests of service users. This is an unmet requirement and must be met within the extended time-scale. For the home to demonstrate it’s financial viability, the home’s providers need to obtain an audited set of accounts for the year ending 31/03/05 and put in place a business and financial plan. Requirements apply. The registered manager ensures that service users who wish to control their own monies are able to do so. The manager advised that the home does not act as an appointee for any service users in the home, and that either a relative or solicitor fulfils this role where the service user is unable to manage their own monies. The home maintains a record of receipts and expenditure on behalf of one service user for whom a solicitor makes periodic payments from the service user’s account. The record needs to indicate an authorised signature, by the responsible person, for each receipt and item of expenditure. A requirement applies. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 29 The inspector examined a sample of staff supervision notes. These evidenced that supervision is now being provided on a regular two-monthly basis. Following a requirement from the previous inspection, a new supervision format has been developed; this has been further revised so as to provide more space for agenda items and issues discussed. The supervision record is being signed and dated by the supervisor and supervisee. A system of appraisal is being developed, with staff completing a pre-appraisal self-evaluation prior to their appraisal session. So far five staff have completed their appraisals; this needs to be extended to all staff members. A requirement applies. The inspector examined a wide range of the home’s records, including staff and service users files, complaints, accidents/incidents logs, and records relating to the running and maintenance of the home. Generally, these were found to have been satisfactorily maintained, with service users’ best interests being protected. There was, however, a need for an appropriate incidents record to be maintained, for which a requirement applies. Generally, the inspector was satisfied that the health, safety and welfare of service users and staff are being appropriately protected. Fire and Health & Safety risk assessments were updated in January 2006. There were, however, safety concerns relating to the need for an updated inspection of portable electrical appliances (last done 2/6/04) and for evidence of legionella testing of the home’s water supply. Requirements apply. All other health and safety checks, including inspection of the fire equipment and alarm, emergency lighting and nurse call system (on 8/2/06) were found to have been completed within the last 12 months. Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 1 2 2 2 2 Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 31 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 OP3 Regulation 14(1) Requirement The registered manager must ensure that, for any patient being discharged from hospital, full information regarding the person’s mental state is obtained, prior to any decision regarding admission being made. The registered manager must ensure that all service users’ care plans are reviewed at least once a month. The registered manager must ensure that accredited medication training is updated for all staff. Partly but not fully met. The registered manager must ensure that all staff attend a (statutory) one day course in adult protection. Previous time-scale unmet. 5 OP24 12(1)(a), 23(2)(n) An assessment of the home by a qualified occupational therapist must be arranged, and any DS0000062807.V295225.R01.S.doc Timescale for action 30/06/06 2 OP7 15(2) 30/06/06 3 OP9 12(1)a b,(13),2,6 30/09/06 4 OP18 12 (1)a b,18 (1)a 30/09/06 31/10/06 Beechwood House Version 5.2 Page 32 recommendations for aids, adaptations or other measures, must be implemented. 6 OP27 18(1)(a) The home must employ a cleaner 31/07/06 to cover cleaning duties for at least 18 hours per week, these duties to be spread throughout the week. The registered providers must ensure an annual development plan is implemented for the home and send a copy of the plan to the CSCI, local office. Previous time-scale unmet. 8 OP34 25(1), (2) & (3) The home needs to demonstrate its financial viability and submit a set of audited accounts for the year ending 31/03/05. Previous time-scale unmet. 9 OP34 25(1), (2) & (3) 17(2), Sch.4, 9 A business and financial plan must be put in place, and then reviewed annually. The record of receipts and outgoings, which is being maintained for service users’ personal monies, and which details each transaction that has been agreed with the service user (or his/her nominated representative), must be signed by the responsible person, for each receipt and outgoing that takes place. The registered manager must ensure that annual appraisals are provided for all care staff. An appropriate record, of any incidents that occur, must be maintained. DS0000062807.V295225.R01.S.doc 7 OP33 24(1) 31/10/06 31/12/06 31/12/06 10 OP35 30/06/06 11 OP36 18(1a&2) 30/09/06 12 OP37 17(2), Sch.3, 3(j) & 30/06/06 Beechwood House Version 5.2 Page 33 Sch.4, 12(b) This does not include accidents, which are being recorded on a separate log. An up-to-date legionella check for the home’s water supply must be evidenced. An up-to-date inspection of the home’s portable electric appliances must be arranged. 31/07/06 13 OP38 13(4)(c) 14 OP38 13(4)(c) 31/07/06 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 2 Refer to Standard OP2 OP13 Good Practice Recommendations The statement of terms and conditions should be produced in large print so as to be more accessible for service users. The inspector recommends that the home extend its community activities for service users so as to include occasional outings to places such as the theatre, concert hall, country pub or tearoom. Service user meetings should be fully recorded so as to provide a summary of each issue discussed, and include reference to any individual contributions. The new providers should attend an accredited training course on adult protection such as ‘Training for Trainers’ a recognised course, which can be cascaded down for the benefit of all staff. The inspector recommends that a senior care worker is given the opportunity to undertake supervision training with view to assisting with the supervision of staff. A new job description and higher salary grading would need to be put in place to facilitate this. 3 OP14 4 OP18 5 OP36 Beechwood House DS0000062807.V295225.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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