Inspection on 14/01/08 for Beechwood Lodge

This inspection was carried out on 14th January 2008.

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 Lodge 29/10/09

Beechwood Lodge 03/11/08

Beechwood Lodge 30/06/08

Beechwood Lodge 29/06/07

Beechwood Lodge 26/04/06

Beechwood Lodge 28/09/05

Beechwood Lodge 11/04/05

Beechwood Lodge 30/12/04

Beechwood Lodge 13/08/04

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

CARE HOMES FOR OLDER PEOPLE Beechwood Lodge 148 Barnhorn Road Bexhill-on-Sea East Sussex TN39 4QL Lead Inspector Jenny McGookin Unannounced Inspection 14th January 2008 10:45 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 Lodge DS0000021046.V352853.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 Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechwood Lodge Address 148 Barnhorn Road Bexhill-on-Sea East Sussex TN39 4QL 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) 01424 844989 Beechwood Lodge Limited Mr Robert Jempson Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty (20). Service users must be older people aged sixty-five (65) years or over on admission. 29th June 2007 Date of last inspection Brief Description of the Service: Beechwood Lodge is a care home registered to accommodate a maximum of 20 older people. The premises are situated in a residential area of East Sussex near to Little Common and just over a mile from Bexhill-on-Sea. The Home is close to local shops and amenities and the coast is less than a mile away. Bedroom accommodation is situated on two floors, with a shaft lift to enable residents’ ease of access to each floor. There are twelve single rooms and four double rooms, all of which have en-suite facilities. In addition there are two bathrooms and six toilets. The Home has two lounges, a billiard room and a dining room to provide communal space and there is also a large garden. The Home welcomes prospective residents or their representatives to view the premises and discuss their needs with the Manager. The current fees range from £450 - £525 per week. Extra charges are payable for dry cleaning; entertainment off site; taxi services other than for medical, dental or ophthalmic appointments; clothing; private telephone; personal toiletries (such as perfumes); confectionary; personal alcoholic beverages; smoking requisites (though home has a no-smoking policy); writing requisites and postage Information on the Home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose/Service User Guide. There is no e-mail address for this home. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection site visit, which was intended to inform this year’s key inspection process; to check progress on matters raised for attention at the last inspection (June 2007), given all the timeframes set had run their course. It was also used to review findings in respect of the dayto day running of the home. The inspection process took 8¾ hours, and involved meeting with three residents over lunch, talking to two relatives (in one case over the phone), the owner/manager, and two care assistants. Interactions between staff and the residents were observed during the day. The inspection also involved a tour of four bedrooms and several communal areas, and the examination of a range of records. Three residents’ files were selected for case tracking. Regrettably, the owner/manager had not submitted an Annual Quality Assurance Assessment (AQAA) in advance of the site visit, as required. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. However, he was able to give a comprehensive account of the issues raised, which reflected provision fairly. What the service does well: This residential care home has been a family business for the past 35 years, and has clearly benefited by the shared vision and continuity of investment this implies. Feedback indicates it has long enjoyed a good reputation in the locality. The last inspection report (June 2007) featured an impressive list of favourable comments from residents’ relatives. The location of this home is judged suitable for its stated purpose and offers scope for some good community links. It has been furnished to an exemplary standard, and was tidy, clean and odour free. Some aspects of the environment exceed the National Minimum Standard. There are homely touches throughout. The health and personal care needs of the service users are being addressed to their satisfaction, and there is input from a range of healthcare professionals as required. This is a stable staff team, who report working flexibly to ensure there is good continuity of care. The standard of catering was judged very high. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 1, 2, 3, 4, 5 The home cannot robustly evidence that prospective residents and their representatives are being given any written information about the home, to help them decide whether this home will meet their needs. The home’s Statement of Purpose, Service User Guide and contract will require further attention to ensure they provide all the information prescribed by the National Minimum Standard, so that prospective residents and their representatives are fully informed. Prospective residents benefit by assessments carried out before their admission, to ensure that the home can meet their needs. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 9 EVIDENCE: The owner/manager has combined the home’s Statement of Purpose and Service User Guide, along with a colourful brochure, within a pack. Taken in combination, the pack usefully describes a range of facilities, services and service principles. However, this pack will require further attention to provide all the information prescribed by the National Minimum Standard, so that prospective residents or their representatives have all the information they need to reflect on, in order to make an informed decision. These matters were reported back to the owner/manager separately. When asked, residents said that the decision to apply to this home was in practice influenced more by its locality (i.e. close to where they or their relatives lived), and by its reputation, rather than by any public information produced by the home itself. The files selected for case tracking did not evidence the issue of this pack, or whether other languages or formats (e.g. large print or tape etc) were warranted. There was better evidence of the home carrying out preadmission assessments (matter raised for attention by the last inspection), to ascertain whether the home could meet residents’ needs. Prospective residents or their representatives are also encouraged to visit the home to judge it for themselves, before admission, though the residents spoken to on this occasion had not done so. They said they had felt able to trust the home’s reputation or the relatives choosing on their behalf. Although each resident would ideally have preferred to be able to continue living at home, they said were generally very happy there Each admission is subject to a 4-week trial stay before being confirmed by a contract. The home’s contract was judged largely compliant with the elements of the National Minimum Standard, but will require further attention to provide all the information prescribed. These matters were reported back to the owner/manager for attention. The files selected for case tracking did not evidence the issue of the contract, or whether other languages or formats (e.g. large print or tape etc) were warranted. On their admission, the home carries out further assessments and sets up a care plan (see next section). See sections on “Environment” and “Health and Personal Care” for a description of services provision; and the section on staffing for information on deployment and training. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 10 This home does not provide intermediate care. Should the home provide rehabilitation and/or convalescence, all the elements of National Minimum Standard 6 will apply Beechwood Lodge DS0000021046.V352853.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10 Anecdotal information indicates that residents benefit from the health and personal care they receive at this home, but records need to better reflect the level of care given. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Three residents’ files were selected for case tracking on this occasion, to represent the latest admissions (i.e. over the past year) and these were followed through with discussions with residents (where they were able and willing) and staff. The format of the assessments used by this home to inform the residents’ plans of care, properly identify a range of health and personal care needs in the first instance, and these are intended to be supplemented by documents which identify key objectives for staff instruction, daily reports, monitoring Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 12 charts (e.g. weight, medication) and records of access to a healthcare professionals. This process is subject to periodic review, which is designed to assess its overall effectiveness, the effectiveness of objectives set and any unmet needs or changes required. However, there were gaps in the information recorded, which will require addressing to better evidence practice. There was, for example, scant evidence of risk assessment in respect of each individual, their activities or their environment (on or off site). Although initial assessments would establish that many residents coming into this home would be able to care for themselves and would require minimal intervention, there is no system for reviewing each aspect of their care in any detail thereon e.g. where, for example, falls had been recorded, or where one resident is managing their own medication but refusing to keep it safe by locking it away. All these matters were raised for attention by the last inspection, and prevent the home obtaining more than an “adequate” quality rating for this section overall. Crucially, there was no evidence on record of residents and/or their representatives being involved in any stage this process, despite provision for their signatures on the records. The residents spoken to on the day of the inspection showed little or no understanding of care plans as such; but they each confirmed having been asked about their needs and preferences as part of the admission process, and on a daily basis thereon. Observed interactions between staff and residents were judged appropriately familiar and respectful, and residents confirmed this was representative. One relative said the owner/manager goes through the care plan with them annually, but said he couldn’t remember the last time. “If there is a problem we talk or Robert phones us”. The relative said that the care plan covered what his mother liked, didn’t like, what she wanted to do, and social activities. He said “staff all know us”. When asked about care planning, another relative said, “I’m not sure what you mean. They regularly talk with us about what is going on. In practice it works wonderfully well! They always let us know. At some time we mentioned that dad was sending us out for hearing aid batteries, they took note and this got incorporated”. See section on “Daily Life and Social Activities” for findings in respect of social care needs. All the bedrooms are currently being used for single occupancy and have ensuite facilities, so that personal care and medical interventions can be assured of some privacy. Records confirm that residents are being offered keys for their bedroom doors (this process is ongoing) and that, so far, they have invariably declined, which may well be a mark of their trust. Since the last inspection, lockable facilities have been bought and are scheduled for Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 13 installation, so that residents will be able to safe-keep medication and items of value, as required. Since the last inspection, records confirm that some staff have been given training in the care of medication. The home has acquired a medication trolley, which is properly kept secured to a wall, and access to it is restricted, to keep people safe. The home also has a cabinet for controlled drugs, which will require securing before use – though the home does not currently manage any controlled drugs on behalf of residents. The home’s record keeping appeared satisfactory – there were no apparent gaps (other than the recording of allergies) or anomalies. The home keeps a directory of medication for reference, but does not have a copy of the Royal Pharmaceutical Society Guidance. This is recommended, to ensure practice complies with best practice standards. The owner/manager said that the home’s medication arrangements are subject to periodic inspection by a local pharmacist, which is judged good practice, but the most recent report was not available for inspection. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15 Residents benefit from a life style of their choosing, and are provided with occasional social activities. Residents are supported to keep in contact with family and friends. Residents benefit from a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Although some reference is made in care plan assessments to social interests, hobbies and religion, there was an overwhelming health and personal care bias in the care planning documentation seen thereon. The residents and staff spoken to on this occasion were not able to give many examples of current activities at this home, and motivation appears to be a problem. There is no activities programme or co-ordinator – residents rely on staff and relatives to bring local events to their attention. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 15 A clothes show had been arranged for the following day and individuals from the community had from time to time come in to talk or entertain. Some residents are able to go out on their own. Two residents said they would like to go out more but would need assistance to do so, and did not want to be involved in group outings. There is a Roman Catholic Communion service on site every 4-6 weeks. Residents said that they were generally very content with their lifestyles in this home. The daily routines are as flexible as healthcare needs will allow. There is a good choice of communal areas (including a billiards room). Some of the residents clearly preferred their own company and would read, listen to the radio rather than join in with any group activities, and their choice is respected. One relative said his mother “likes her own space. She has breakfast in her room. One of the things we liked was that she could stay in her room. She is not the chattiest of people. She likes her own space. She likes to come down for lunch and will talk to people”. The home has open visiting arrangements, and meals can be provided for visitors. There is a communal landline telephone in one lounge, which can be used by residents at no cost (no matter what the distance). The lounge door can be closed for privacy. The main business line is hands-free, and the handset can be taken into bedrooms for residents’ use in privacy. Residents can also arrange to have their own lines installed at their own expense. Catering needs and preferences are properly established in the first instance as part of the admission process, and amended or updated thereon. There is a 4week menu, which is applied flexibly. Records and feedback confirm that the menu (generally, traditional English fare) is varied and alternative options are available. Some special needs (e.g. diabetic) are catered for. The residents spoken to on this occasion said they were generally very satisfied with the meals. A lunch was sampled and judged well cooked and presented. Some specialist equipment (such as large handled cutlery, plate guards and beakers) have been used in the past but are not currently warranted. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 16,18 The processes are in place to enable complaints to be taken seriously and investigated, to benefit residents. Residents need to know that there are independent agencies they can call upon to protect their rights. EVIDENCE: This home has a complaints procedure, which is detailed in its Statement of Purpose/Service User Guide. The owner/manager will need to remove its reference to the CSCI as the lead agency, once the new arrangements are publicised. Information supplied at this inspection visit indicated that no complaints had been registered over the past twelve months. This is not usually judged a realistic reflection of communal living, but for the high level of satisfaction expressed by residents on the day of this visit. The owner/manager said that no independent advocacy services are being to support the residents. Residents would need to rely on relatives or staff to represent their interests, where they are not able to do this for themselves. A directory of local advocacy services would be judged good practice. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 17 Previous inspections have established that the home has policies governing the protection of the residents, including whistle-blowing. But the home still does not have a copy of the local multi-agency protocols, to ensure a timely and coordinated approach, should an incident arise. This matter was raised for attention at the last inspection. In discussions with the inspector, staff confirmed their commitment to report any instances of adult abuse, though they each went on to say that this had not been warranted in this home. There was evidence (anecdotal and on record) of training for staff on safeguarding adults. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 19, 20, 21, 22, 23, 24, 25, 26 Residents benefit by this well-maintained and comfortable environment. The physical design and layout of the home generally enable residents to live in safety. EVIDENCE: The entrance creates a very favourable first and last impression of this home. The quality of furniture and fitments there signals a home, which has been likened by one relative to a superior, hotel standard. All areas of the home inspected were found to be comfortable, clean, adequately lit and maintained at comfortable temperatures. All radiators have guards or low surface temperatures, to keep people safe. The furniture tends Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 19 to be domestic in style. There were homely touches throughout. All the bedrooms, bathrooms and WCs seen had accessible call bells. There are pleasantly landscaped gardens at the front and back. The front is dominated by a gravel drive, which will need redressing to obtain a level surface, and there is parking space on site for up to 12 vehicles. There are good bus links within fifty yards of the entrance of the site to Eastbourne, Brighton, Pevensea and the south coast in one direction; and Bexhill, Hastings, Ashford in the other – with all the community and transport links that implies. The nearest train station is about 1 ½ miles away, with links to Ashford, Hastings and Victoria, London. The garden at the back has beds of mature shrubs cut into a lawn and is hedged on all boundaries. It provides a pleasant enough area to walk or sit in - there is some garden furniture. A raised patio area outside the Billiards room would benefit by handrails, as a precaution against the risk of accident (matter raised by the last inspection). Two impressive beech trees provide positive focal points. Accommodation is arranged over two floors. A shaft lift provides access for both the ground and first floor, and there is a short flight of three stairs to access five bedrooms on the first floor. There is a limited range of equipment and adaptation available in this home, as most residents come in with low dependency needs. They would have access to their own wheelchairs, Zimmer frames and other mobility equipment. When asked, the owner/manager said that a Loop system for use with hearing aids was not currently warranted. However, there have been no overall periodic audits by specialists such as Occupational Therapists. This is strongly recommended, as a couple of areas were identified as potentially hazardous, to ensure the home maintains its capacity to meet the needs of its residents. Residents currently have a good choice of communal areas. There are three lounge areas (including a Billiards Room) and a dining room. But residents were disappointed by the recent removal of soft furnishings from one landing area, which was being used to meet with visitors, following a fire officer’s inspection. The provision of fire resistant soft furnishings might be a good compromise, subject to the fire officer’s approval. See section on Daily Life and Social Activities for details on telephones and contact with families and friends. The bedrooms in this home are all very spacious and their standard of finish is very high. The smallest is said to be above 10 square metres – and would be the only one not suitable for use as a bedroom if this were a new registration. Four bedrooms are registered for use as potential double room, though they are all effectively being used as single occupancy. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 20 This home has WC and bathroom facilities on both floors i.e. reasonably accessible to all the bedrooms and communal areas. All bedrooms have their own en-suite WCs and wash hand basins, so that privacy can be guaranteed for personal care. Five also have their own baths or shower cubicles. There are no communal shower facilities (this is recommended so that all residents have a choice), but two bathrooms have High-Low bath seats, to facilitate access. Four bedrooms were assessed, and found to be generally compliant with the elements of the National Minimum Standards. Since the last inspection, lockable facilities have been purchased and are scheduled for installation. The owner/manager is in the process of ensure that the non-provision of keys is justified in each case by properly documented consultation or risk assessment. All the rooms seen were personalised and homely. The propping open of bedroom doors is being safeguarded by Dor-Guards linked to the fire alarm, which would slam close if the alarms are activated, to keep people safe. The washing machines in this home do not have sluice cycle. This is recommended, subject to advice from the local Environmental Health Officer (next visit expected in February 2008). Continence appears to be managed adequately at this home. There were no unpleasant odours. See schedule of recommended action for matters requiring attention or consideration. Beechwood Lodge DS0000021046.V352853.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30 Residents benefit from an adequate number of staff who care for, understand and anticipate their needs and wishes. But they are not fully protected by the systems within the home for staff recruitment and training. EVIDENCE: The inspector understands there are two care staff on duty every day. There is also a dedicated cook, and (on weekdays) ancillary staff to do the cleaning – staff are to be commended for the level of cleanliness found. At night there is one member of staff on waking duty, and there are on-call arrangements to cover emergencies. There is a deputy manager who works 24 hours a week, and the owner/manager is very involved in direct care, catering etc. as well as management duties. Staffing numbers and deployment complied with this statement on the day of this site visit, and are judged generally appropriate to the assessed needs of the service users, the size, layout and purpose of the home. However, staffing rotas were not requested for inspection for compliance with this statement on this occasion. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 22 The inspector relied heavily in this instance, on feedback from staff, residents and relatives, which invariably confirmed a high level of satisfaction with the staffing arrangements. Commitment, and professionalism were identified as key strengths. One member of staff reported having won “Healthcare worker of the year” earlier this year. One relative said “The care is thoughtful, committed. The staff are of a high calibre and totally trustworthy. They are unfailingly polite. The ambience is great. It’s almost like a genteel hotel. It’s a pleasurable experience to visit. They are always anxious to help”. Another relative said “It just feels like it’s a family. This is by far the best one I’ve seen…. If there’s a problem they’re straight on the phone…the best care and friendliness. I think it is genuine care. If it wasn’t, my mother wouldn’t be here”. An audit of four available personnel files confirmed that each had been subject to satisfactory CRB checks and, in two cases POVA first checks (to enable staff to start employment and work under direct supervision until the CRB is received). However, there were no interview notes, letters of appointment, Job descriptions or Job Specifications on file; and three did not have signed or dated contracts of employment on file to secure their terms and conditions of employment. Two did not have references and there were no health checks on file. This is judged poor practice, likely to put residents potentially at risk, and will be subject to a Statutory Enforcement Notice. The full extent of staff training could not be properly assessed on this occasion, for want of available documentation (matter raised at previous inspections). Induction checklists were missing from three out of four files inspected, although it accepted that the opportunity to redress this had been lost over time. Although records and feedback indicated that some training had been provided in 2006 and 2007 (e.g. in fire safety, safeguarding adults, and medication) not all the staff had been receiving all the mandatory training required i.e. as part of a rolling programme to keep them updated. This will require attention as a priority, to prevent practice becoming variable and to keep people safe. There was no record of any of the four staff having had training in care planning (this has been identified as a training need by staff) or dementia care at all; only one of the four appeared to have had training in challenging behaviour. Since September 2002 there has been a repeat requirement that the home developed a staff training and development programme that meets the Skill For Care training objectives. In the absence of documentation to evidence this, this will now be subject to a Statutory Enforcement Notice. All these Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 23 shortfalls combine to retain an overall quality rating of “poor” for this section, which is regrettable in the face of expressed opinions at each inspection site visit. At the last inspection (June 2007) the inspector found that three staff had obtained NVQ level 3 and the owner/manager had stated that all staff except one were undertaking NVQ level 2 or 3 courses. The inspector understands this position was unchanged at this inspection. Feedback confirms that the management style at this home is open, accessible and supportive to staff. However, see section on “Management and Administration” in respect of staff supervision records. Beechwood Lodge DS0000021046.V352853.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. 31, 32, 33, 36, 37, 38 Residents benefit by the management and administration of the home, which is based on openness and respect. But the owner/manager needs to have effective business and quality assurance systems in place, which can demonstrate how residents and their representatives can influence the way services are delivered. EVIDENCE: This home has been a family business for the past 35 years. Despite his active involvement in all aspects of its organisation, Mr Jempson has no wish to gain the necessary qualifications in care and care management that are required to be the Registered Manager. Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 25 The absence of a Registered manager is a matter, which has been outstanding since 2005, despite recruitment drives, and cannot be allowed to continue. This will now be subject to a Statutory Enforcement Notice Mr Jempson has responded positively to a number of matters raised at inspections. But some matters remain outstanding year on year, and must be attended to as a priority, and will now be subject to a Statutory Enforcement Notice. There are clear lines of accountability within the home. Team working and flexibility appear to be key strengths in this staff group. Feedback during the site visit indicates a sound level of satisfaction with the care given by staff. There was good evidence of residents exercising choices and control over their own daily routines. Records indicate, however, that the last quality assurance initiative carried out by this home for itself was in 2006. A feedback exercise carried out in 2007 did not generate sufficient responses. There were no annual financial statements available for inspection. Nor was there a current Business Development Plan. Mr Jempson was advised that there needs to be an annual development plan for the home, which conspicuously refers to the home’s quality assurance system and financial position. The views of all stakeholders should be central to this process, to properly measure the home’s success in meeting its aims, objectives and statement of purpose. Mr Jempson had not, moreover, submitted an Annual Quality Assurance Assessment (AQAA) in advance of the site visit, within the given timeframe as required (this is a legal requirement). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. However, he was able to give a comprehensive account of the issues raised, which reflected provision fairly. Notwithstanding findings in respect of the management ethos in this home (see section on “Staffing” above), there was no evidence of formal documented staff supervision meetings, to comply with the elements of this standard. This will require attention as a priority and is judged a major shortfall. This will now be subject to a Statutory Enforcement Notice. There were some risk assessments in place but not reliably in respect of each individual, their activities or the environment), to ensure the health and safety of residents and residents are being properly safeguarded. This matter has been raised for attention before, and will now be subject to a Statutory Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 26 Enforcement Notice. The inspector understands the home keeps no cash or valuables on residents’ behalf. Beechwood Lodge DS0000021046.V352853.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 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 3 4 4 2 3 STAFFING Standard No Score 27 3 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 1 X N/A 1 X 1 Beechwood Lodge DS0000021046.V352853.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 OP1 Regulation Requirement Timescale for action 29/02/08 2 OP7 3 OP26 9 OP33 5, 6, 4, 16 The home’s Statement of Purpose and Service User Guide shall comply with all the elements listed by the standard. 15 (1)(2) Care plans must fully reflect 31/03/08 residents’ changing needs. This is to be interpreted in the following ways: • They must provide adequate guidelines for staff providing care; • Care plans must record who is invited to participate and who participates in the decisions made, most notably the resident or their representative. 23(5) The registered person shall 29/02/08 undertake appropriate consultation with the authority responsible for environmental health for the area. 24 The registered person must be 29/02/08 able to demonstrate how the home provides a good quality service for residents and the measures necessary to improve the quality and delivery of the service provided in the home. DS0000021046.V352853.R01.S.doc Version 5.2 Beechwood Lodge Page 29 This includes the timely submission of its Annual Quality Assurance Assessment to the Commission. 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 OP1 Good Practice Recommendations The home could usefully include in its admission procedure a checklist to certify the issue of a Statement of Purpose, Service User Guide and contract; and whether other languages or formats were warranted. The home’s contract should be checked for compliance with all the elements of the National Minimum Standard. Staff should have ready access to a copy of the Royal Pharmaceutical Society Guidance, to ensure practice complies with best practice standards. Complaints procedure. The owner/manager will need to remove its reference to the CSCI as the lead agency, once the new arrangements are publicised. A directory of local advocacy services would be judged good practice. Property. The following matters are raised for attention / consideration: • Gravel drive needs redressing to obtain a level surface. • Raised semi circular patio outside billiards lounge French doors. Sharp brick work along edges and unguarded ramped descent onto lawn. Requires handrails as potentially hazardous. • Billiard lounge requires risk assessment, as it is also being used for storage pending completion of refurbishment / maintenance work • Main lounge carpet very stained, it is accepted that this is already scheduled for deep cleaning • Owner/ manager should consider introducing a variety DS0000021046.V352853.R01.S.doc Version 5.2 Page 30 2 3 OP2 OP9 4 5 6 OP16 OP17 OP19 Beechwood Lodge • • • • • • • 7 OP19 of dining room chairs to suit individual needs e.g. some with arms, sleigh bases, extra cushions Ranch doors between the kitchen and laundry room provide scope for contamination and should be replaced – subject to EHO advice. It is accepted that there is alternative access to the laundry, which staff have to use. External kitchen windows should have fly screens or there should be an insectocutor, to prevent the infestation of flying insects – subject to EHO advice Recommend sample 1st Aid kit readily accessible to catering staff within the kitchen. There should be a dedicated WC for kitchen staff close to kitchen with washbasin, soap dispenser, paper towels or air dryer. The only showers are in en-suites. Consideration should be given to providing shower facilities so that all residents have a choice. Consideration should be given to installing washing machines with a sluice cycle – subject to EHO advice All bedrooms should have lockable facilities (safes have been purchased and need to be installed) Periodic audits of the premises by specialists such as Occupational Therapists are recommended, to ensure the home maintains its capacity to meet the changing needs of its residents. It is recommended that a staff training matrix is developed in order to clearly evidence appropriate staff training has been undertaken. 8 OP30 Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beechwood Lodge DS0000021046.V352853.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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