Inspection on 29/06/07 for Beechwood Lodge

This inspection was carried out on 29th June 2007.

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 14/01/08

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 Helen Martin Key Unannounced Inspection 29th June 2007 1:40 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.V337083.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.V337083.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.V337083.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. 26th April 2006 and 17th October 2006 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. Weekly fees were requested by the CSCI but not provided by the home. Information about the service, including the Commission’s inspection report, is available from the Manager on request. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 29th June and 2nd June 2007. The inspection included speaking with the manager and three people who live in the home. Some judgements about the quality of life within the home were taken from observation and conversation. Some records were looked at. A tour of the premises was undertaken. Postal surveys from four relatives and one representative of residents have been received by the CSCI and this information has been used within this report where appropriate. The home has not provided the CSCI with a completed Annual Quality Assurance Assessment at the time of writing this report and therefore this could not be used within the inspection process. Currently there are fourteen residents accommodated, with all rooms being used for single occupancy. Comments received in postal surveys and by those spoken with at the time of this visit included: ‘Beechwood Lodge provides a superb environment for (my relative). The surroundings are spacious and dignified’ ‘Beechwood Lodge is always very clean, all residents seem to be happy and well cared for’ ‘Can’t see any way to improve excellent service’ ‘Beechwood lodge is excellent and it is hard to think of any areas which are lacking’ ‘I go out on my own, buses are frequent’ ‘I used to go to church, I would like someone to visit from the church’ ‘(My relative is) free to come and go as (they) wish, yet has help in everything that (they) need’ ‘Visitors are always warmly welcomed’ ‘Meals are of a good quality with individual needs catered for very well’ ‘You can’t choose the menu, they tell you what it is going to be, but the food is good’ ‘Staff are unfailingly polite and helpful’ ‘Staff are nice pleasant and polite, I have no complaints’ ‘(The owner is) to be highly commended for running a superb retirement home. Both (my relative) and we as his family are highly delighted with every aspect of (their) residence at Beechwood Lodge’ What the service does well: Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 6 Residents benefit from living in a friendly home, which is run by the owner and staff who aim to provide a good quality of life for older people. They benefit from an adequate number of staff who care for, understand and anticipate their needs and wishes. Individuals enjoy living in a warm, clean, homely and comfortable environment. Prospective residents and their representatives are able to look around Beechwood Lodge before they decide whether to move in. They are given written information about the home. Residents are treated with respect. Arrangements are in place to maintain their privacy and dignity. The views of residents and their representatives are listened to and receive appropriate consideration. Residents are able to exercise some choice over their lives. They enjoy their activities. Residents enjoy good quality food. They are able to keep in contact with their family and friends. What has improved since the last inspection? What they could do better: As a result of this inspection, thirteen requirements were made, six of which have been outstanding from at least the last two previous inspections. Nine recommendations were made, two of which have been outstanding for the last two previous inspections. Discussion took place with the owner about the home’s progress towards meeting outstanding requirements and potential further action by the CSCI. Residents are not fully protected by the systems within the home for staff recruitment and training, medication, food hygiene and fire prevention; they are at potential risk from a number of environmental issues. Residents’ personal, health and social care needs are not adequately reflected in preadmission assessments or care plans. Their quality of life could be improved by the provision of a qualified manager, a review of quality assurance, the adult protection procedure and the food choices available and some additional repairs and a review of locks and lockable facilities. The contract could be improved by minor amendment. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are given written information about the home, although the contract could be improved by minor amendment. Prospective residents are assessed prior to admission to ensure that the home can meet their needs, although they would benefit from this being undertaken and recorded in greater detail. EVIDENCE: There is a combined statement of purpose and service users guide, which includes a brochure, giving written information about the home. Since the last inspection residents’ views of the home have been included. Information regarding the facilities of the home is included; the owner stated that individual room sizes would be added. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 10 The owner stated that a standard contract, including the terms and conditions of accommodation was provided for all residents. An appropriate template was seen, although this did not include the number of the room to be occupied. The owner stated that residents are assessed before they moved in, in order to ensure that the home is suitable to meet their needs. All care files seen during this visit included recorded assessments. Since the last inspection these are now signed and dated. The current format used consists of a tick list with the facility for comments. Although including a section about food preferences the facility to record special diets or details about oral care, foot care, hobbies/interests or religious and cultural needs not contained within a dietary preference is not included. Current formats seen were not completed in detail and the personal safety and risk sections were blank. One did not record weight on admission. The owner stated that prospective residents and their families have the opportunity to visit the home, have a meal or stay overnight before they decide to move in. The owner demonstrated an understanding of the needs of individuals that the home could and couldn’t meet. The owner now writes to prospective residents to confirm that the home can meet their needs or to say why they are unable to be accommodated. Documentation was seen in care files of two newer residents. Whilst the home aims to care for people throughout all stages of older age, where this is not possible support is given until a more suitable placement can be found. Discussion took place about specific residents regarding the provision of some aspects of nursing care and care for those with increasing confusion. The owner confirmed that a new placement was being sought for one individual. The home does not provide intermediate care. Beechwood Lodge DS0000021046.V337083.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): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are treated with respect. Arrangements are in place to maintain their privacy and dignity. Residents’ personal, health and social care needs are not adequately reflected in care plans. Residents are not fully protected by the procedures in the home for the administration of medication. EVIDENCE: Previous inspection of April 2006 identified that there was no evidence that the care plans had been drawn up with the resident or that the information they contained reflected their changing needs. One individual did not have a care plan. No files contained recorded risk assessments after admission. One resident is becoming more forgetful and increasingly unsteady but had no record of a risk assessment and the support needed for her mobility was not explained in the care plan. Previous inspection of October 2006 identified that care plans seen did not include details of how to meet objectives or the specific care required. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 12 This inspection highlighted three care files. One individual had only become resident very recently within the last few days. Whilst it was acknowledged that a care plan was in the process of development, it was observed that no ongoing notes about the care they received or any observations had been recorded since their admission. The owner explained that ongoing notes are not recorded on a daily basis. Current care plan formats have the facility to record objectives and an action plan for sensory and communication, physical wellbeing, psychological wellbeing and activities of daily living issues. Those seen are not detailed, some are incomplete in places and do not provide adequate guidelines or information for staff providing care. For example, there are no objectives recorded for one resident with severe confusion, whilst there is an action plan, this does not include any guidelines as to how to keep the individual and others safe; there has been no review since March of this year. One care plan contains no information about psychological wellbeing and activities of daily living. One resident does not have a care plan for their current behaviour. There is no evidence of risk assessments within care files. The Home supports residents in caring for themselves as far as they are able: the owner indicated that many of the residents at Beechwood Lodge needed minimal help with their personal care. Discussion took place about specific residents regarding the provision of some aspects of nursing care and care for those with increasing confusion. The owner confirmed that a new placement was being sought for one individual. It was stated that health professionals are accessed as required, such as GPs, district and psychiatric nurses. It was noted that this was recorded in residents’ ongoing notes. Staff stopped recording one individual’s weight in 2005; the owner said that this was because they became non-weight bearing; no record of any other observations, a nutritional assessment or detailed food and fluid monitoring have been put in place. One individual has poor mobility and pressure sores; the owner explained that specialist equipment is provided. Although district nurses are available, the home’s records do not reflect the details of the care required or given. For example, ongoing notes do not identify which areas are dressed; there is no record of the application of cream advised by district nurses previously for the month of June as this is crossed out on medication records, with no explanation or signature; the care plan does not contain a detailed assessment or risk assessment for pressure sores or, although numerous falls are recorded, for falls, mobility or moving and handling. Previous inspection of April 2006 identified issues regarding one resident who self-medicated. Previous inspection of October 2006 highlighted that although a lockable safe had been put in the room, there was still no written evidence that an assessment had been undertaken to ensure the individual is taking Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 13 responsibility for their medication within a risk management framework. This inspection identified that although a risk assessment had been recorded for lockable storage facilities, evidence of agreement by the GP and relatives to this course of action continued to be unavailable. Records showed that this individual self-administers controlled drugs. The care file for one recently admitted resident states that they also self-administer medication; the owner said that they assume they do this, although staff have not been able to verify this as yet; there is no evidence of a risk assessment. The resident confirmed that they kept tablets to help them sleep at night. Arrangements are in place for the home to administer medication and an easily monitored system is used wherever possible. Whilst most medication is kept within a specially designed cabinet, some is stored in a wooden cupboard. There are no designated storage facilities or records for controlled drugs. The owner stated that currently the home does not keep any drugs that require refrigeration. Residents and their relatives spoke highly of the staff team and felt that staff respected their privacy and dignity. During the inspection, staff were seen to attend to their needs in privacy and respond quickly when asked. Residents are able to make and receive telephone calls in private. It was said that individuals could have their own phones in their rooms; there is a designated residents’ phone in the dining room and the home also has a cordless phone. The owner confirmed that residents are now addressed by their preferred name. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise some choice over their lives. They enjoy their activities and the owner intends to provide an increased number to choose from in order to enhance their quality of life. Residents enjoy good quality food, although they would benefit from a review of the choices available. EVIDENCE: Residents are enabled to be as independent as possible; they are able to make choices within the constraints of group living and their own capabilities. Some are able to go out independently when they wish; the routines of the home are generally flexible. During this inspection, the owner explained that current residents preferred to choose their own individual occupations over those organised by the home; many go out independently; one goes into the town centre daily; some go for walks or do crosswords. It was stated that of all the quality assurance questionnaires returned last year, two residents mentioned that they would Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 15 like to have more activities than were already available and that these have been provided. The home has different lounge areas, providing space for residents to meet together, watch television or sit quietly to read or listen to music. Previous inspection identified that there is a library of videos and a selection of records available. The owner explained that musical entertainment and library books are provided regularly. There is also a room with a billiard table for residents to use, although this is not easily accessible presently. There are large gardens that are accessible surrounding the Home. One resident was enjoying watching the wild rabbits in the garden at the time of this visit; in addition several residents and visitors were enjoying watching Wimbledon in the television room. The owner said that the home had provided a Christmas party and taken some residents to shows. It was also mentioned that several other activities and events provided by the home had been poorly attended and unsuccessful. The owner indicated that, in order to extend the opportunities available for residents, they had recently contacted a specialist organisation who would assess each individual with regard to their lifestyle and activities and that further activities would be developed from the results. It was mentioned that they would contact the church for one resident who requested this. Residents are encouraged to keep in contact with their relatives and friends if they wish. Visitors are welcome in the home at any reasonable hour. Residents spoken with said that they enjoyed regular visits from members of their family. A new cook has recently commenced employment at the home. All comments received stated that the food at the home was good; comments were mixed about the choice of meals offered. Although overall the menu appeared varied and nutritious, there are no alternatives recorded for main meals and breakfasts are not included. The owner indicated that despite what is on the menu, residents can ask for alternatives they may prefer, although these are not recorded in the food diary kept by the home. Fresh fruit and vegetables are evident and meals can be eaten in a pleasant dining room or in the resident’s own rooms if they prefer. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The views of residents and their representatives are listened to and receive appropriate consideration. Residents are not fully protected from potential abuse due to poor staff recruitment procedures. They would benefit from a review of the adult protection procedure. EVIDENCE: At the time of this visit, residents were at ease talking with staff and the owner who listened to their views. There is a written complaints procedure available. All complaints are now recorded together with any investigations and action taken. Previous inspection identified that staff were trained in Adult Protection in October 2005. The home has whistle blowing and adult protection procedures, although the latter does not include any reference to social services. The owner indicated that they would obtain a copy of the local authority procedures for the home. Poor staff recruitment procedures have been mentioned under the Staffing section of this report. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents enjoy living in an attractive, warm, clean, homely and comfortable environment, although some additional repairs and a review of locks and lockable facilities could improve their quality of life. Residents are at potential risk from a number of environmental issues. EVIDENCE: Beechwood Lodge is located on a main road leading out of Little Common. It consists of a detached property and has a gravel frontage providing parking space for several cars and level access to the front door. The main entrance hall is spacious and there are several lounge areas and a dining room all on the ground floor. One room has a billiard table for residents to use, with a quiet area at one end and the home has its own hairdressing room. The home is comfortable and homely. Decoration, furnishings and fittings throughout the Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 18 house are of good quality. There is a large attractive garden that can be accessed from two of the lounge areas. It was evident at the time of the site visits that residents did not frequently use the lounge at the back of the property housing the billiard table, as many items were stored there. The owner explained that this was because of the ongoing maintenance and improvement to the home currently underway and would be removed soon. The manager stated that, although presently there were none, they would provide handrails for the ramps leading from this lounge door to the garden. It was noted that the ceiling had come down over one first floor landing area; the owner stated that this had happened very recently and was due to the heavy rain over the last few days. It was said that the roof had been repaired and that arrangements were in progress to make repairs internally. The owner stated that the two patches of damp in the dining room had appeared after recent successful structural work and redecoration of the area; it was stated that contractors would be contacted. Previous inspection identified that windows did not have restrictors. Previous inspection of October 2006 highlighted the need for window restrictors as a potential risk to residents. The owner confirmed that either a risk assessment of each area, and the residents that had access to that area, would be undertaken, in order to demonstrate there is little or no risk, or that restrictors would be fitted. A request to notify the CSCI once work had been undertaken was made. During this inspection the owner said that five restrictors had been fitted; it was stated that no more were needed, although there continues to be no written evidence of this risk assessment. The previous inspection of October 2006 highlighted that the area used previously for storing equipment had been cleared whereby it did not pose a risk to residents. This visit identified that although this continued to be the case and a portable cordon had been provided, doors to areas in the process of major renovation were either propped up or unlocked. Discussion took place regarding the varying needs of current residents; whilst it was acknowledged that most residents would not go past the cordon, some with severe confusion and displaying wandering behaviour might; there is no evidence of a written risk assessment. Although registered for twenty people, there are fourteen residents accommodated, with all rooms being used for single occupancy. The owner stated that there are four rooms that could be shared, but that this would only be for those who made a positive choice to share such as married couples or partners. Resident’s bedrooms seen were furnished and equipped to assure comfort and privacy. Individual rooms reflect the occupants’ personalities and Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 19 have personal effects. All have en suite toilets and some have shower and/or bathing facilities. Previous inspection of April 2006 identified that there were not locks on bedroom doors whereby residents can have their own key, and no lockable facilities within the rooms. Previous inspection of October 2006 highlighted that residents could have the opportunity to have their own key and the availability of lockable space within their rooms; the owner agreed that in future new residents would be asked on arrival and the outcome of the conversation would be documented. During this inspection the owner stated that four residents have keys to their rooms whilst others either don’t want or are not able to have this. It was said that although mini-safes had been purchased, more were needed and none had been installed yet. Care files continued not to reflect residents’ needs and choices regarding door locks and lockable facilities. Accommodation is arranged over two floors. A shaft lift provides access for both the ground and first floor. It was noted that three stairs in the corridor from the lift access five bedrooms on the first floor. The owner assured the inspector that all residents accommodated in these rooms are able to manage these stairs. It was said that most residents were mobile and the majority were able to go out of the home on their own. The owner explained that there are no residents who need a wheelchair and although the home has two hoists available, these are not currently needed. The home is warm and well lit and rooms are naturally ventilated. Previous inspection of April 2006 highlighted that there had been a Requirement made since September 2002 that the potential risk to residents from high surface temperature radiators was reduced; although radiator guards had been fitted in most bedrooms, residents found that these prevented the heating their rooms sufficiently; the owner had ordered low surface temperature radiators to be fitted throughout and anticipated these would be installed within three months; communal areas continued to have unguarded radiators. Previous inspection of October 2006 identified that although the situation remained the same, the owner’s aim was to change radiator guards for low surface temperature radiators within the next three to four weeks; the owner was requested to inform the CSCI when work had been completed to provide either radiator guards or low surface temperature radiators in all areas that were accessible to residents. During this visit the owner stated that all radiators in areas accessible to residents were now either guarded or low surface temperature except ten, one in the lounge and some in hallways; it was said that further low surface temperature radiators were awaiting installation; all radiators would either be guarded or low surface temperature within four weeks. The owner explained that delays had occurred because of problems with fitting. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 20 The owner stated that the home was equipped with pre-set valves to reduce the risk of scalding from hot water. Hot water temperatures are regularly checked and recorded. It was noted from records that one outlet has been running persistently high since May 2006; the manager indicated that this would be looked into and the valve adjusted. All areas seen were clean and tidy and free from any odours. The owner stated that they were in the process of making arrangements for the repair and/or replacement of the kitchen floor due to a recent Environmental Health Officer’s visit, which identified a small uneven area where the existing lino had cracked. The report from the visit was not available. Although the kitchen and laundry areas are individually maintained in a hygienic manner, it was noted that only low ‘saloon’ style doors separate these. The owner assured the inspector that clothes that needed washing would be brought to the laundry by way of a second door to the corridor. Although washing machines do not have a specific sluice cycle, the owner explained the systems in place for the maintenance of infection control. It was mentioned that bed linen and table clothes are sent to an external laundry. The home has a clinical waste contract. Beechwood Lodge DS0000021046.V337083.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): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents benefit from an adequate number of staff who care for, understand and anticipate their needs and wishes. They are not fully protected by the systems within the home for staff recruitment and training. EVIDENCE: All residents and their relatives praised the qualities of the staff highly. As with past inspections, care staff were seen to be courteous, caring and knowledgeable in the way they approached the residents and as many of them have been at the Home for some years they have gained experience in assessing and meeting basic individual needs. Currently there are fourteen residents accommodated. As found at previous inspections, in addition to the owner, there are two carers rostered to work during the day with one waking night staff. This was adequate for the number of current residents at the time of the site visits. Previous inspection identified that the owner often assists with the daytime care of residents and, as they live nearby, are accessible at night if needed. Previous inspection identified that agency staff were employed if required. During this inspection the owner explained that they were currently recruiting for one night shift and twenty-four hours per week during the day. It was said Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 22 that although agency staff could work during the day with other staff or at night alone, they endeavoured to get the same agency workers for continuity of care for residents. Agency staff also cover for permanent staff sickness. The owner explained that a designated cook was available every day with domestic staff on weekdays. The written roster is a planned template and does not include the full names and allocated duties of staff. The owner stated that a separate record is maintained for these details, specific dates and the hours actually worked. Previous inspection of April 2006 identified that staff files were unavailable, although three Criminal Record Bureau (CRB) disclosures were; neither a CRB nor written references for a new member of staff who started nine days previously had been received; this practise had been evident in past inspections; the value of applying for a Protection of Vulnerable Adults First (POVA first), to enable staff to start employment and work under direct supervision until the CRB is received, was discussed. Previous inspection of October 2006 highlighted the progress made with obtaining CRB checks, it was said that all staff in post had disclosures; as at the last inspection the recent appointment of a new staff member had been made without undertaking a CRB; as there continued to be no other staff recruitment information on site, it was requested that staff files be formulated as a matter of urgency and the CSCI informed once work had been completed. During this inspection four staff files were looked at and it not possible to evidence that all the required pre-employment checks had been undertaken. For example, one individual had provided two references, although one was not from their most recent employer and although an employment history was supplied, this was incomplete. One Worker Registration Certificate contained the details of a previous employer. Contracts of employment evidenced that the date two individuals commenced employment was before the receipt of a POVA First and CRB check. It was noted that the staff application form does not contain the facility to record a self-disclosure regarding any police cautions. No evidence of proof of identification or health statements was available. The owner confirmed that they had not received a POVA First, CRB or references for a new ancillary member of staff who commenced their employment last week, although they were supervised constantly. Previous inspections have identified that although new staff received an informal induction into the home there had not been a formal induction and foundation programme for them to follow. Previous inspection of October 2006 highlighted that again there were no training records available on site and no programme in place; although the owner hoped to be reviewing some information from the Independent Providers Forum and would consider adopting that; there had been a Requirement that the home developed a staff training and development programme that meets the Skill For Care training objectives, since September 2002. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 23 During this inspection, the owner stated that an induction programme that meets Skills for Care training objectives has been used within the home since February of this year, although there continues to be no documentation or records available to evidence this. Previous inspection in April 2006 identified that staff had undertaken courses in moving & handling and Fire. Food hygiene training was planned for May 2006 and health & safety, including the control of infection, was being arranged; first aid was included in the NVQ training, but the owner confirmed that this had not been arranged for other staff. During this inspection, the owner stated that fire training had been updated in May of this year and medication training had been undertaken in 2006; it was said that three staff out of six had now completed a first aid course; food hygiene and infection control training had not yet been arranged but would take place within the coming few months. Some training certificates are kept in staff files, although no individual records or training matrix are available. Because of the nature of the documentation available it was not possible to evidence that core courses had been updated appropriately. It was said that, of the four senior staff members who have been working at the home for between five and eleven years, three have obtained NVQ level 3 and one is currently undertaking the course. The owner stated that all staff except one were undertaking NVQ level 2 or 3 courses. Beechwood Lodge DS0000021046.V337083.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): 31, 33, 35, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a friendly home, which is run by the owner and staff who aim to provide a good quality of life for older people. This could be improved however, by the provision of a qualified manager and a review of quality assurance. Residents’ protection would be enhanced by some improvements to the systems for food hygiene and fire prevention. EVIDENCE: Beechwood Lodge has been owned by the same family for many years and continues to be managed by the current owner. Previous inspection of September 2005 and April 2006 identified that the owner did not wish to gain the necessary qualifications in care and care management that are required to be the Registered Manager. They would prefer to utilise their current Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 25 qualifications to return to an unrelated profession; the owner acknowledged that they needed to implement a different management option and anticipated a solution being found within three months. Previous inspection of October 2006 highlighted that, although the situation remained the same, the owner aimed to be clearer about the feasibility of recruiting a new Manager within four weeks with a view to having someone in post within three months; the owner was requested to inform the CSCI when the recruitment process started. During this inspection, the owner stated that, although they had placed advertisements with agencies, they had been unsuccessful in recruiting a new manager. It was said that, of the four senior staff members who have been working at the home for between five and eleven years, three have obtained NVQ level 3 and one is currently undertaking the course. The owner said that they sent quality assurance questionnaires out every year to residents and their relatives, the last being undertaken within the last eight weeks. CSCI postal surveys have also been sent out, although the owner stated that they had not yet sent back the Annual Quality Assurance Assessment to the CSCI as they had not had time to complete it. It is however a legal requirement to return it to CSCI within the given timeframe. It was said that currently residents’ meetings are not held, as staff discuss issues with individuals on a one-to-one basis; the owner stated that these would be reintroduced. A range of polices and procedures are available. Staff supervision and appraisal records were seen in some staff files. The owner assured the inspector that ongoing supervision was now undertaken regularly for all staff. The owner stated that the home keeps no cash or valuables on residents’ behalf. Records of accidents and incidents are recorded appropriately. The owner stated that they had not been notifying the CSCI of significant accidents or incidents recently. Other records looked at as part of this visit have been mentioned elsewhere within this report where appropriate. The home’s fire logbook evidences regular fire alarm checks, although there are no records for the testing of emergency lights. The owner stated that this would be recorded in future. The report from the recent visit to the home by the Fire Officer was not available, although the owner stated that the recording of emergency lights tests and the replacement of the hairdressing salon door with a fire door needed addressing. The owner stated that self-closing devices are fitted to the doors of residents’ rooms who wished these to remain open. All fire doors seen during the visit were either closed or fitted with a device designed to close the door automatically, should the fire alarm sound. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 26 Dried and refrigerated food is stored in an appropriate manner. Fridge and freezer temperatures are checked regularly and recorded, although cooked hot food temperatures are not. Issues regarding staff training, the safety of the environment, window restrictors and radiator surface temperatures have been mentioned previously within this report. Beechwood Lodge DS0000021046.V337083.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 3 2 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 3 3 3 3 2 2 2 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 1 1 Beechwood Lodge DS0000021046.V337083.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 OP3 OP7 OP8 OP37 Regulation 15 (1)(2) Requirement The Home must use the information gathered during the pre-admission assessment (and assessments from other agencies) to formulate a plan of care for daily living and longerterm outcomes. In that, A review must be undertaken to ensure that pre-admission assessments are fully completed with adequate detail. Care plans must fully reflect residents’ changing needs; documentation must provide adequate guidelines and information for staff providing care; risk assessments must be recorded; records must fully reflect the monitoring of residents health care needs for nutrition, pressure sores, falls, mobility and moving and handling. This outstanding Requirement has been Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 29 Timescale for action 29/06/07 repeated from the previous last two inspections in April 2006 and October 2006. 2 OP9 12 (4) 16 (2)(l) There must be a current Risk Assessment and lockable storage, for any resident who wishes to self-medicate. In that, all residents who selfadminister medication must be provided with a lockable facility and associated risk assessment; assessments must be undertaken to ensure that individuals are able to take responsibility for their medication within a risk management framework. This outstanding Requirement has been repeated from the previous last two inspections in April 2006 and October 2006. 3 OP19 23 (2)(b) The registered person shall ensure that the premises are of sound construction and kept in a good state of repair externally and internally. In that, the owner must complete their stated intention to repair the ceiling over one first floor landing area, the areas of damp in the dining room and the kitchen flooring as advised by the Environmental Health Officer. 4 OP19 OP25 OP38 13 (4)(c) Radiators must be guarded (or 29/06/07 have a low surface temperature), window restrictors must be fitted and the area of the home used for storage must be cordoned off, to maintain the safety of the residents. DS0000021046.V337083.R01.S.doc Version 5.2 Page 30 29/06/07 31/08/07 Beechwood Lodge In that, Risk assessments must be undertaken and recorded for all windows that do not have restrictors and residents who have access to these areas; action must be taken if necessary. A risk assessment must be undertaken and recorded for residents with severe confusion and displaying wandering behaviour regarding accessing the areas in the process of major renovation behind the portable cordon; action must be taken if necessary. All radiators not assessed as a low risk to residents, must either be guarded or be low surface temperature. This outstanding Requirement has been repeated from the last eight previous inspections. Part of this Requirement has been met. 5 OP25 OP38 13(4)(c) The registered person shall ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. In that, hot water must be supplied at an appropriate temperature from all outlets. 6 OP26 OP38 23(5) The registered person shall undertake appropriate consultation with the authority responsible for environmental health for the area. DS0000021046.V337083.R01.S.doc 17/08/07 17/08/07 Beechwood Lodge Version 5.2 Page 31 In that, the owner must liaise with the Environmental Health Officer to review the separation of the kitchen and laundry room by low ‘saloon’ style doors and the testing and recording of hot food temperatures. 7 OP29 OP37 OP18 17 (2) Legislative requirements must be 29/06/07 in place when recruiting staff. In that, all the required preemployment checks must be undertaken for all staff; a POVA First check must be undertaken before new staff start working in the home; staff applicants must provide a reference from their most recent employer, a full employment history, proof of identity and a health statement. This outstanding Requirement has been repeated from the last three previous inspections in September 2005, April 2006 and October 2006. 8 OP30 OP37 18 (1)(a)(c) A suitable induction and foundation programmes must be implemented to enable staff development. In that, the owner stated that an induction programme that meets Skills for Care training objectives has been used since February 2007, although there continues to be no documentation or records available for inspection to evidence this. This outstanding Requirement has been repeated from the last seven previous inspections. Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 32 29/06/07 9 OP30 OP37 18 (1)(a)(c) The registered person shall ensure that at all times suitably qualified, competent and experienced people are working at the home and that they receive training appropriate to the work they perform. In that, a review must be undertaken to ensure that staff are receiving appropriate and updated training to meet residents’ needs; this must include the provision of food hygiene, health & safety and infection control training. There is insufficient documentation or records available for inspection to fully evidence that staff are receiving appropriate training to meet residents’ needs. 31/08/07 10 OP31 9 (1)(2)(b) The Proprietor/Manager must ensure there is an appropriately qualified manager in post. In that, the owner stated that, although they had placed advertisements with agencies, they had been unsuccessful in recruiting a new manager. This outstanding Requirement has been repeated from the last three previous inspections in September 2005, April 2006 and October 2006. 29/06/07 11 OP33 24 On request, the registered person shall supply a report to the Commission, which includes how the home provides a good quality service for residents and the measures necessary to DS0000021046.V337083.R01.S.doc 17/08/07 Beechwood Lodge Version 5.2 Page 33 improve the quality and delivery of the service provided in the home. In that, the owner must return a completed Annual Quality Assurance Assessment to the Commission. 12 OP37 37 The registered person shall notify the Commission without delay of the occurrence of the death of, serious illness of or serious injury to a resident; infectious disease, any event which affects the wellbeing of residents, theft, burglary or accident, any allegation of misconduct by the manager or staff. In that, the owner must inform the Commission of any significant events. 13 OP38 23(4) The registered person shall, after 17/08/07 consultation with the fire and rescue authority take adequate precautions against the risk of fire including arrangements for containing fires and the testing of fire equipment at suitable intervals. In that, the manager must complete their stated intention to replace the hairdressing salon door and test and record emergency lights regularly following advice from the Fire Officer. 17/08/07 Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 34 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 OP2 Good Practice Recommendations It is recommended that the number of the room to be occupied should be included within residents’ terms and conditions of accommodation. It is strongly recommended that, with regard to preadmission assessments, records should include, wherever possible, information about: 1. 2. 3. 4. 5. Oral care Foot care Hobbies/interests Religious and cultural needs Personal safety and risk 2 OP3 OP37 Issues regarding pre-admission assessment were identified during the last two previous inspections in April 2006 and October 2006. 3 OP9 It is strongly recommended that, with regard to medication: 1. All medication should be stored within a specially designed cabinet 2. Controlled drugs should have designated storage facilities and records 3. Amendments to medication administration records should be signed, dated and confirmed in writing by the prescribing GP 4 OP15 It is recommended that a review should be undertaken to confirm that all residents are offered a choice of meals and that any alternative provided is recorded. It is strongly recommended that, with regard to adult protection: 1. The home’s written procedure should be reviewed to Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 35 5 OP18 include reference to social services where appropriate 2. The owner should obtain a copy of the local authority procedures 6 OP19 It is strongly recommended that the owner should complete their stated intention to provide handrails for the ramps leading to the garden from one lounge door. Residents should have the opportunity to have a key to their room and should have lockable space within their room for medication, money and valuables (unless their risk assessment suggests otherwise). In that, four residents have keys to their rooms; one has a mini-safe for their medication; other mini-safes have been purchased but not fitted; no recorded risk assessments have been undertaken. This outstanding Recommendation has been repeated from the last two previous inspections in April 2006 and October 2006. 8 OP29 OP37 It is strongly recommended that, with regard to staff recruitment: 1. Worker Registration Certificates should be reviewed to ensure that they contain the appropriate employer details. 2. Application forms should include the facility to record a self-disclosure regarding any police cautions. 9 OP30 OP37 It is recommended that a staff training matrix is developed in order to clearly evidence appropriate staff training has been undertaken. 7 OP24 Beechwood Lodge DS0000021046.V337083.R01.S.doc Version 5.2 Page 36 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.V337083.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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