Inspection on 15/11/07 for Beechwood Nursing Home

This inspection was carried out on 15th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beechwood Nursing Home 14/09/09

Beechwood Nursing Home 07/10/08

Beechwood Nursing Home 28/11/06

Beechwood Nursing Home 16/03/06

Beechwood Nursing Home 29/11/05

Beechwood Nursing Home 14/10/04

Beechwood Nursing Home 22/04/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

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

CARE HOMES FOR OLDER PEOPLE Beechwood Nursing Home Romanby Road Northallerton North Yorkshire DL7 8FH Lead Inspector Anne Prankitt Key Unannounced Inspection 15th November 2007 09:30 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 Nursing Home DS0000028024.V348506.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 Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechwood Nursing Home Address Romanby Road Northallerton North Yorkshire DL7 8FH 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) 01609 777733 01609 780692 carole@premiernursinghomes.com Premier Nursing Homes Limited Ms Carole Agnes Hardy Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (60) Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28/11/06 Brief Description of the Service: Beechwood is a purpose built home. It is registered to care for up to sixty people who have dementia and who need nursing or personal care. It is located close to the centre of the County Town of Northallerton and is convenient for the shops and other facilities. The home has its own enclosed garden area, and there are parking facilities provided at the front. It was opened in October 2000. The accommodation is on two floors. People who need nursing care live on the first floor. Those people living on the ground floor have been admitted because they need personal care only. A passenger lift provides level access to the first floor. The registered manager confirmed on the day of the site visit that the current weekly fee is £430. This excludes the Registered Nursing Care contribution paid to people where this is applicable. Extra charges are made for hairdressing, chiropody and toiletries. Before people are admitted, they are provided with a copy of the home’s brochure, the service users’ guide and a summary of the last inspection report. A copy of the Statement of Purpose, and the full inspection report are available in the main entrance of the building. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit, the registered manager, Ms Carole Hardy, returned a self assessment called an ‘Annual Quality Assurance Assessment’, which provided information about Beechwood Nursing Home. Surveys were sent to a selection of people who live at the home, their families, and some visiting professionals. A record has also been kept about what has been happening at the home since the last key inspection took place. All of the information, including that which was gathered at the site visit, was used as part of the key inspection. Five hours preparation took place before the site visit, which lasted for eight hours. The registered manager was available throughout, and feedback was provided to her and her area manager at the end. The site visit consisted of an inspection of the communal areas, and a sample of private bedrooms. Kitchen and laundry services were also looked at. A selection of documents were looked at, including a sample of care plans, health and safety records, and staff records. The way that the manager collects information to check the quality of the home was also discussed. Some staff and people living at the home were spoken with, and observations were made to see how staff interacted with people, some of whom are not able to express their needs and wishes clearly. All of the information was used to get an impression about what it is like to live at Beechwood Nursing Home. What the service does well: People can be given information about the home in a variety of ways before they are admitted. This helps them and their families decide whether the home will be a suitable place for them to live. One person said ‘It’s alright here. I enjoy it’. Another commented they had not had enough information about the home, but added ‘I think my family thought that it was the right place for me’. Another said ‘Generally I can say that I am in the right place here. The staff are very good’. Help is asked for from the appropriate health professionals where staff have identified that they need advice so that people’s health can be maintained. Families and friends can visit the home, and can stay when people are not well. This helps to maintain important links between them. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 6 People all agreed that they knew how to make a complaint. One person said ‘I don’t have a complaint at all’, and a relative commented that they have never had to make a complaint. Staff will take action when they think that a person is not being treated properly. This helps to keep people safe from harm. The environment is kept maintained, and is clean and tidy. People have the benefit of single bedrooms with en suite facilities. This helps to protect their privacy. One person said that the home ‘always looks bright’, and a relative said that it was ‘always clean and tidy’. Staff are recruited properly, and are given appropriate training. This helps to make sure that people receive care from suitable staff who will know how to give care in a safe way. The registered manager is keen to hear from people and their families about where she could make improvements to the service which would benefit the people who live there. The staff at the home spoke positively about her input. One said ‘Carol (the manager) is brilliant and easy to talk to’. Another said that she was ‘strong’ and ‘very approachable’. Another said ‘She’s an excellent manager’. A relative commented about the ‘good communication’, stating that they were ‘always given plenty of time and information’, and that people living at the home were ‘treated as individuals and shown respect and kindness’. What has improved since the last inspection? What they could do better: Staff could write about people’s care in a more personal way, so that risks to their wellbeing, and their lifestyle preferences, social needs, and preferred activities can be clearly understood and acted upon. The activities provided for people could be made more personal, and extra activity hours would help to achieve this. A comment was made that ‘the Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 7 activities are always the same’. People’s privacy and dignity could be better protected if information about their health needs was not displayed in public areas, and if they were not weighed in a communal area. The checks that take place to make sure that people’s medication is stored, recorded and handled correctly could be improved so that avoidable errors are minimised. The way that staff record when they have checked bed rails could be improved, so if problems arise, it is clear which equipment is faulty. This will make sure that the problem is quickly resolved. Thought could be given, and action taken, to make the environment more enriched, stimulating and interesting for those who live there. To reduce the risk to people from the spread of fire, fire doors could be kept shut. When assessing the quality of the service that people get, the views of visiting professionals could be asked for, so that they have the opportunity to comment upon the service that is offered to their clients, and where they think that it could be made 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 Nursing Home DS0000028024.V348506.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 Nursing Home DS0000028024.V348506.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): 3 and 6 People who use the service experience good quality outcomes in this area. They can be confident that their needs will be assessed before they are admitted. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager makes sure that she visits each person referred to the home before they are admitted so that she can check what their needs are, and whether the home will be able to meet them. She writes down the information that she has collected. Staff use this information as the basis on which people’s care plans are developed. People are also invited to look round the home. Where this is not possible, their relatives or representatives are welcome to look round on the person’s behalf. This helps them to decide whether they like the home, and if it will be suitable for them. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 10 Six out of the ten people who returned their surveys said that they received enough information about the home. But the registered manager thought that people who have been recently admitted would have a more positive view. This is because more information is now available to people moving into the home than was the case in the past. For instance, they are now sent pictures of the bedroom that they will accommodate, and other areas of the home, so that they can see what it looks like. One person said ‘It’s alright here. I enjoy it’. Another commented they had not had enough information about the home, but added ‘I think my family thought that it was the right place for me’. Another said ‘Generally I can say that I am in the right place here. The staff are very good’. Staff agreed that the registered manager gets good information which helps them to understand people’s needs, so that the care that people get is right from the offset. The home does not provide intermediate care, so standard six does not apply. Beechwood Nursing Home DS0000028024.V348506.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 and 10 People who use the service experience adequate quality outcomes in this area. People’s health care is generally well catered for. But individual wishes and risks associated with their care could be better monitored to make certain that avoidable shortfalls in care delivery do not happen. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The health and personal care plans are developed from the pre admission assessment of need, and from information subsequently collected from people’s families or representatives where the person is not able to explain what their care needs are. The plans showed that help from health professionals outside the home is requested when the staff need advice. The services of the district nurse are requested where people admitted for personal care need this service. This will help to maintain people’s health, and makes sure that they have continued access to the health care services that they are entitled to. One care plan stood out from the rest, because it gave a good sense of the person. It not only explained the person’s physical needs, but it also showed that staff had given thought as to how the person’s well being may change Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 12 depending on what was happening in their life at the time, and what contact they had with others. This helps staff to make care more personal, so that they can give good emotional support at times when this is needed. The other plans seen focussed more on tasks that staff have to do to maintain people’s physical health and personal hygiene. The registered manager had already identified that this was the case, and has plans to carry out further work to identify individual social and psychological needs, and how staff can meet them. This will help to make the plans more person centred. The plans contain risk assessments, which are normally reviewed monthly. Staff need to make sure that activities, such as monitoring people’s weight, and assessing whether pressure relieving equipment is needed, are more closely linked to the risk assessment and care plan. This will make sure that marked weight loss, or an increase in risk from pressure sores, is discussed at the earliest point. A formal decision can then be made and recorded about whether a referral to the dietician, or the provision of pressure relieving equipment, is needed. This had not happened in two people’s care plans, although staff could explain why the person had lost weight, or why equipment had not been provided. The registered manager intends to take advice about whether those who have suffered weight loss need some extra input from the dietician. Staff spoke to people with respect. Whilst one person said that they would ‘like more support’, other comments were positive. They included ‘I am happy to stay here’, ‘they (the staff) are extremely good with everything. They are lovely’, ‘The staff are very good’. However, there was information about people’s continence needs displayed in the bathroom area, and people were being weighed in the communal sitting area. This does not uphold people’s dignity, nor does it respect their right to confidentiality. Trained nurses look after and administer the medication for people who receive nursing care. The medication is locked away safely in appropriate facilities. The staff keep good records about what medication people have received. This helps to reduce the risk from errors. People receiving personal care only have their medication looked after by care staff who have received training in the safe handling of medication. Their medication is kept in a separate trolley on the ground floor. One person who is prescribed a certain medication once a week had not been given this on two occasions. The registered manager said she would look into why this had happened. Where the dose of a certain medicine varied, staff did not record how many tablets they had given so it was not clear about how much medication the person was having. Staff currently flush odd discarded tablets away. The registered manager should check with the pharmacist whether this practice is acceptable. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 13 The fridge used for storing medication which needs to be kept cold had not been checked since 03/08/07. This should be checked daily so that it can be assured that people’s medication is being stored at the correct temperature. Beechwood Nursing Home DS0000028024.V348506.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 and 15 People who use the service experience adequate quality outcomes in this area. Important links between people and their families are respected, and their choices are considered. But further attention to the activities on offer and menu choice could help to make people’s lives more interesting. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Activities are advertised for the forthcoming week. Links are forged with representatives of different denominations to help meet people’s spiritual needs. On the day of the site visit a religious service was held, which was well attended. People sang and joined in with the prayers. They said that they enjoyed it. With money obtained from a government grant, the registered manager has recently developed a sensory room where people can go to relax. One relative commented that it was ‘very good’. The registered manager has also provided a visitors room, so that families, who want to be close to their relatives when they are poorly, can stay overnight. This helps people to maintain good contact with people close to them when they need them. There is also a kitchenette where visitors are invited to make drinks for themselves and their family when they visit. This helps them to feel included. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 15 The activities hours are limited to one and a half hours on each floor from Monday to Friday. The activities person concentrates mainly on group activities, which people are welcome to join. However, they do not have to if they do not wish to, and people are free, where they are able, to walk around. This means that they have freedom of movement in their home. There is only limited time for staff to spend with people who remain in their rooms. Staff said that they try to chat to people and spend quality time with them when they give personal care, and, after liaising with the family, have organised taped music to meet the tastes of people who stay in their room. Staff said that they are also introducing memory recall books. This may help to stimulate conversation which interests the person to whom the memories belong. Whilst two of the people surveyed thought that there were always activities available, one thought that this was never the case, with the remaining seven stating that they were ‘usually’ or sometimes’ available. A comment was made that the activities were ‘always the same’. Extra activity hours would help to make people’s lives more interesting, and further information in the care plans about people’s individual social and recreational needs and wishes would help to tailor activities so that they are more person centred. The care plans showed that consideration had been given to personal choices. For instance, people had been asked about when they liked to get up and go to bed. Staff said that they do try to make the routine at the home as flexible as possible to accommodate people’s choices, where they were able to make these independently. People are offered three meals each day. Supper is also provided, and staff have access to food in the chef’s absence so that they can prepare a snack at any time if people are hungry. There is some choice provided at lunch time. There is no alternative for tea, which the cook prepares, but which is served by general assistants. Staff were unclear what would happen if people did not like the tea time meal on offer. This could be a problem if they did not like it. However, the registered manager is looking into how extra choice can be offered to people. One person commented that there was ‘no shortage of food’, whilst another said that the meals are ‘exceptionally good’. But one person said ‘Occasionally certain meals are not as per my wish’. A relative though that the home ‘could improve on the meals and vary the diet’. The chef knows who needs a special diet, because the staff provide her with this information. She said that nobody had special dietary needs because of their cultural or religious background. But she was aware of people’s likes and dislikes, and of those who were having support from the dietician. She was satisfied that she gets sufficient budget to allow her to provide a wholesome and nutritious diet, and she takes the opportunity to ask people whether they like the food that she has prepared. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 16 Staff sometimes have to assist more than one person at a time at mealtimes. Ways in which staff are allocated at mealtimes should be reviewed, so that it can be made more of a social occasion for people. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. People are protected by staff who will listen to and act upon their complaints. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed on each floor of the home. This helps to make sure that everybody has equal access to information about how to make a complaint. People all agreed that they knew how to make a complaint. One person said ‘I don’t have a complaint at all’, and a relative commented that they have never had to make a complaint. One complaint had been looked into by the home since the last key inspection in November 2006. This involved issues about staff attitude. The registered manager had kept good records of the investigation undertaken, and had taken action to conclude the matter. Not all of the staff at the home had received training in abuse awareness, and the abuse policy for the home said that the company would give information about unsuitable workers to the Commission for Social Care Inspection to see whether they should be referred to the Protection of Vulnerable Adults list. This is not correct, and must be amended to clearly indicate the provider’s responsibility in making sure that people who are found not fit to work with vulnerable adults are referred. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 18 Despite these shortfalls, the staff and the registered manager were very clear about their responsibilities in reporting their concerns to the appropriate person if they suspected a person living at he home was being abused. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. Although improvements have been made to benefit people, the environment could be made more interesting for them, and they could be better protected from the risk from fire if fire doors were always used as intended. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The accommodation is situated on two floors. People who live on the first floor have been admitted because they have nursing needs. Those on the ground floor need help with their personal care. Everyone has their own single bedroom, and en suite facilities. Recent improvements include the provision of extra hoists which are kept on the ground floor. This means that people who live on this floor no longer have to wait for staff to get equipment from the first floor should they fall. A new assisted bath has also been installed, and the registered manager was waiting for the company to provide training so that staff knew how to use it safely. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 20 One person said that the home ‘always looks bright’, and a relative said that it was ‘always clean and tidy’. There is a garden area, which is enclosed. It looked very pleasant and well kept. The registered manager has secured extra hours for a gardener so that when the weather improves better access to the garden can be provided for people who use a wheelchair. There is also plenty of space at the front of the building where people visiting the home can park. The environment was clean and tidy, and it smelled pleasant. But it was sparsely decorated in places, and could have been made more interesting for people to live in. There were twelve bedroom fire doors propped open at the site visit. This means that they would not close if a fire broke out. This is unsafe, and puts people at risk from the spread of fire. The registered manager arranged for them to be shut straight away, and has reminded staff that this practice must cease. This will help to keep people safe. There are adequate facilities to help make sure that people’s clothing is properly laundered. The registered manager was pleased that staff had managed to contain an outbreak of diarrhoea and vomiting so that the number of people affected was kept to a minimum. Gloves and aprons are provided for staff, who have training in infection control. This will help to reduce the risk to people from cross infection. Beechwood Nursing Home DS0000028024.V348506.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 and 30 People who use the service experience good quality outcomes in this area. Checks are made on how staff numbers meet people’s needs, and new staff are properly recruited to protect people from unsuitable workers. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: On the day of the site visit, there appeared generally to be sufficient care staff available. During the afternoon, staff had some time to spend with people. A staff member commented that staffing was usually ‘pretty good’, and allowed them to give care in a flexible way. Another said that more carers would be nice, but that by keeping busy they could remain flexible in their approach. Eight of the ten people who returned their surveys thought that people were either always or usually available when they were needed. One thought that this was sometimes the case, with one believing that this was never the case. This information was passed onto the registered manager, and should be kept under review. However, she already sends people and their families a questionnaire, when she asks their views about staff availability, so she can monitor where any improvements need to be made. She is also in negotiation with the company to see if she can have more staff allocated for peak times. As stated in ‘Daily Life and Social Activities’, it would be beneficial for people if the home was allocated more activities hours, so that their recreational activities could be more personal, and based on their previous interests. The Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 22 registered manager agreed, and is negotiating with the company to see if this would be possible. The registered manager was also aware that the mealtimes could be improved upon if additional staff were available at these times. This would help to make sure that people are given assistance individually, and could reduce the need for staff to help two people at once. Ways in which the current staffing arrangements could be reorganised were discussed, and the registered manager has agreed to look at this further. For instance, an extra staff member could be freed up should the General Practitioner think it acceptable for medication to be given out separately to meals. This would also make the mealtime more of a social occasion. The home employs three Registered Mental Nurses and the registered manager tries to employ general nurses who have experience in caring for people with dementia. The company is looking at ways to fill gaps in staff knowledge about the needs of people with dementia, and is providing a training programme, which has been updated to include training about the Mental Capacity Act. This will help to inform staff about the law, and how people can be supported in make decisions about their care. Care staff are also encouraged to work towards National Vocational Qualifications in care. This training will help to make sure that they provide good care. Trained nurses also have opportunities to develop and update their skills. The home operates a thorough recruitment procedure. This helps to protect people from unsuitable workers. The registered manager confirmed that two written references are always obtained before a staff member is recruited, although the date on which references are received needs to be recorded. Due to exceptional circumstances, and the need to recruit quickly, one staff member who the registered manager said has no contact with people living at the home was recruited after a POVAFirst check. However, the registered manager confirmed that the Criminal Records Bureau check had since been applied for. New starters have an induction into the running of the home. They also receive supervision, although some staff were not clear that this was the case. The company is in the process of introducing an induction programme which the area manager confirmed meets the ‘Skills for Care’ standards. This will help to make sure that staff are well trained from the offset, and that they understand the philosophy of the home, and the way that people are to be cared for. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 23 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 and 38 People who use the service experience good quality outcomes in this area. The registered manager runs the home in a professional way, taking into account the interests of the people who live there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager has good experience in the care of older people. She is a Registered Mental Nurse, and has worked at the home in a management position since it opened, so she has a good insight into the facilities available in the area which are available to support people. She has a diploma in health and social care, and has completed the Registered Managers Award. The staff at the home spoke positively about her input. One said ‘Carol (the manager) is brilliant and easy to talk to’. Another said that she was ‘strong’ and ‘very approachable’. Another said ‘She’s an excellent manager’. A relative commented about the ‘good communication’, stating that they were ‘always Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 24 given plenty of time and information’, and that people living at the home were ‘treated as individuals and shown respect and kindness’. The registered manager is looking at ways in which people’s views about the home can be collected, so that she can check that it is running in their best interests. This includes regular residents and relatives meetings. She also sends out satisfaction surveys to people’s families so that she can see what areas they are pleased with, and where they would like to see improvements. This keeps people included, and helps to make sure that the home is run in the best interests of the people who live there. The registered manager explained that the most recent survey identified that people and their families were very happy with the level of communication and care provision. Visiting professionals are not currently surveyed. It would be good practice to get their perspective also, so that the registered manager can be sure that they are satisfied with the service offered to their clients. The registered manager also carries out monthly audits of each department, so that she can check that they are running smoothly. Accidents are also monitored, when she looks to see if there are any ways of protecting people better. It is the policy of the company that the home does not look after people’s personal monies. Any money received from relatives is sent straight to head office, and kept in the individual’s account. The information provided before the site visit confirmed that the building is kept maintained so that it is a safe environment for people to live in. The water system was due to be checked to confirm that people are not at risk from the way that hot water is stored. Staff receive regular mandatory training in moving and handling, fire safety, food hygiene and infection control. All qualified staff are first aiders. This means that there is always a suitably qualified person on duty to give assistance in the case of an emergency. The kitchen was a little disorganised, because action was being taken to carry out the improvements recommended by the environmental health officer on their last visit to the home. Some of the matters identified related to shortfalls in staff practice, and cleaning programmes. The registered manager was satisfied that there were now systems in place to make sure that the kitchen cleaning rota was better organised. The maintenance man checks the bed rails weekly. There were no recent records available, and it was difficult to see which rooms had been checked. The registered manager agreed to find the missing records, and to organise a better way of recording which rail belonged to whom. She also agreed to check Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 25 all bed rails straight away in case this had been overlooked. This will help to keep people safe. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A X X 3 Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement To make sure that avoidable errors in practice are picked up and addressed at the earliest point, the audit of the medication must be reviewed to include checks that: • Timescale for action 30/11/07 2 OP19 13 People receive their medication when prescribed. • Medication which needs to be kept cold is stored at the correct temperature. • Where the dose of medication varies, a record is kept of what is given, so that the General Practitioner can have better information when this is reviewed. • The way in which medication is disposed of is safe and can be audited. To protect people from the 15/11/07 spread of fire, fire doors must be kept shut unless agreed otherwise by the fire officer. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 28 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 OP7 OP12 Good Practice Recommendations So that care can be more person centred, people’s social and recreational needs and wishes, and personal strengths, should be given more attention when writing their care plans. Checks made to assess people’s current health needs should be more closely linked to the risk assessments and care plan. This will mean that risks to their health such as weight loss and pressure area care can be discussed and reviewed with the appropriate professionals at the earliest point where this is deemed necessary. To protect people’s dignity, and to maintain confidentiality: Personal information about people’s health needs should not be displayed in public areas. • People should not be weighed in public areas. Serious consideration should be given to the provision of more activities hours so that everyone has access to a range of both individual and group activities to meet their personal needs. An alternative menu should be provided at tea time so that people have more choice available. The way that staff are allocated at mealtimes should be reviewed, to assist in making the experience more of a social occasion for people. So that people can be assured that proper action will always be taken: all staff should complete training about their responsibilities in safeguarding adults. • the policy at the home should be amended to explain the responsibility of the provider in referring unsuitable workers to the Protection of Vulnerable Adults list for consideration of inclusion. Thought should be given, and action taken to make the environment more enriched and interesting for those who live there. When assessing the quality of the service that people get, the views of visiting professionals should also be asked DS0000028024.V348506.R01.S.doc Version 5.2 Page 29 2 OP10 • 3 OP12 OP27 OP15 OP15 OP27 OP18 4 5 6 • 7 8 OP19 OP33 Beechwood Nursing Home 9 OP38 for, so that they have the opportunity to comment upon the service that is offered to their clients, and where they think that it could be made better. The way that bed rail checks are recorded should be made more clear, so that where faults occur the equipment can be easily identified. Beechwood Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Nursing Home DS0000028024.V348506.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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