Inspection on 28/11/06 for Beechwood Nursing Home

This inspection was carried out on 28th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 15/11/07

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 John McGarva Key Unannounced Inspection 28th November 2006 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.V320899.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.V320899.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.V320899.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th March 2006 Brief Description of the Service: Beechwood is a purpose built home and registered to care for up to 60 residents who are suffering from dementia and require nursing or personal care. It was opened in October 2000 and is brick built and on two floors including the ground floor. The first floor is designated for 32 nursing cases and the ground floor for 28 residents requiring social and personal care only. There is an eight person vertical lift providing level access to the first floor. It is located close to the centre of the County Town of Northallerton and is convenient for the shops and other facilities. The area surrounding the home has been redeveloped with new housing and the home has its own enclosed garden area to the rear and south side with parking provided at the front, west-facing elevation. The pre-inspection questionnaire (PIQ) submitted by the home dated 11-07-06 indicated that the fees charged are £395 - £505 per week. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection, which took place on Tuesday 28th November 2006, and the manager; Ms Carole Hardy was available to assist with the process throughout. This is a good home, which is well run, and the care staff well motivated. The home has new owners and some changes have been introduced in regard to management procedures, which have put more responsibilities onto the manager. The inspection Commenced at 10.00hrs until 15.30 hrs, 5.5 hours in total. There were 60 residents (full) in residence, 32 nursing and 28 in the ground floor residential unit. The inspection focused on the key standards and issues raised at the last inspection. An inspection of some of the resident’s rooms, lounges, bathrooms and showers took place. Discussions took place with the manager, nurses and care staff. The residents are unable to give a coherent account of their experiences given their mental debility but they looked well cared for and appeared content. There were no distressed or noisy residents, which can occur with this client group and testifies to the careful and considered management of their care. What the service does well: The home continues to provide a good standard of care for the very vulnerable, needy and sometimes challenging group of residents. The staff have an ethos of giving their very best to help ensure the residents needs are identified and met. Ms Carole Hardy the manager is well qualified, experienced and regarded by all to whom the inspector has spoken, including the nurses, care staff as well as the general practitioner who visits the home. Her exchanges with the inspector continue to be open, honest and comprehensive with all queries being answered readily and with candour. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 6 Conversations with the care and nursing staff again confirmed that they are committed to doing all they can to make the lives of the resident’s fulfilling and comfortable. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident’s needs are sufficiently assessed thereby providing the foundation on which the care plans can be developed. EVIDENCE: Individual ring folders are available for each of the home’s residents and into which all information pertaining to them is kept. The information includes admission details, assessment, care plans, daily statements, nutritional assessments and weight charts. The assessment documentation inspected is of consistently good quality and includes sufficient information so that their needs are identified and upon which information the care plans are developed. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 9 Information recorded regarding their social, mental and physical needs was relevant and accorded with the resident’s mental status. The home does not provide intermediate care. (Standard 6) Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good standard of care is being provided by staff that is well-motivated. EVIDENCE: The level of dependency of the residents continues to increase and in addition to dementia they have other associated physical disabilities. Forty-two are incontinent of urine and thirty-nine doubly so The care staff on the first floor nursing unit of 32 residents felt that there should be six (presently 5) care staff on duty during the morning and afternoon shifts so that they can work in pairs and more efficiently address the resident’s physical needs. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 11 The residents looked well cared for and although unable to express a view of their care due to their debility there were none who were noisy or displaying any symptoms of distress or discomfort. There were two residents who were rather poorly, one of whom is bedfast. The care plans are specific to the individual resident and identify all pertinent issues, which helps ensure that all health and social needs are met. There is a place for the resident or relative to sign to evidence that they have seen and been consulted about the care plan. The local Primary Care Trust (PCT) no longer provides pressure-relieving mattresses and the home now provide their own. Staff spoken to felt that duvets would be more satisfactory for the resident’s beds. The manager has informed us that several of the residents have duvets and that consideration will be given to providing more to enable them to have a choice of bedding. The staff endeavours to establish personal choices and wishes on behalf of the residents and they were observed to knock on room doors prior to entering, thus helping to maintain their dignity. At present only the nurses and senior care staff write in the daily records and the advantage of all care staff contributing to the written records was discussed with the staff and manager. The storage and administration of medications is managed in accordance with good practice. There is a 28-day blister pack system in use and this appears to be working satisfactorily. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality of the meals provided is good with the staff spoken to confirming this in conversation. The resident’s wishes are respected and contact with relatives and friends is encouraged. EVIDENCE: The home has an activities programme, but the activities organiser only works fifteen hours per week, sharing 1.5 hrs per day, Monday to Friday on each floor. This matter was discusssed at the last inspection but no further movement has taken place yet. The home recently changed its ownership and this may explain the delay in addressing this issue. There may appear to be little to do to assist many of the residents due to their increasing debility and lack of coherence, however many are mobile especially in the ground floor residential unit and would benefit from additional stimulation and diversion. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 13 Staff said that there had been no trips out this year. Visiting arrangements are flexible so that the residents are able to see relatives and friends whenever they wish. During the inspection, a member of the public who was considering placing her relative in the home arrived for afternoon tea so she could meet the staff and look at the accomodation. From the observations of the staff it seems that the the food provided is of good quality and there is a heated bain marie which delivers the meals to the first floor nursing unit. Thirty-five of the residents require assistance with eating and this can present a challenge for the staff at mealtimes. Many of the nursing cases are on pureed food. For this reason the care staff on the first floor nursing unit of 32 residents believe that an additional member of care staff during this period would help ensure that the feeding of the residents could be achieved in a shorter time frame. The manager informed us that the home now utilises the services of volunteers who include previous members of care staff, Millennium volunteers, work placement students and NVQ trainees on placement at the home. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a relevant complaints procedure and the staff has received abuse awareness training. EVIDENCE: The complaints procedure of the home meets the required standard. The care staffs are aware of how to respond to any complaints made by either the residents or their representatives. The residents cannot be made aware of how to complain, but their relatives and representatives are informed of how to access advocacy groups and other avenues for the resident’s rights to be exercised and protected. There have been no complaints made about the service, either to the home or the CSCI in recent times. There are records to show that there has been recent training of the care staff in abuse issues and their responsibilities in this regard. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environmental standards of the home are good. Some refurbishment in the bathrooms and provision of modern moving & handling equipment should be considered. EVIDENCE: Being purpose built in the year 2000 the environmental standards are generally good with all bedrooms being single, 12 square metres in size and with en-suite toilet facilities provided. The communal lounges and dining areas are spacious and well decorated. There is a full time decorator employed who endeavours to keep the fabric of the building intact and who has an interest in the recommended qualities that an environment catering for the client group needs. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 16 Each resident’s individual room has a lockable door and drawer provided so that they or their relative or friends can secure their valuables in a dignified way. Some issues identified at the last inspection have been attended to including : The water pressure in the bathrooms has been improved. Grab rails have been provided in the bathrooms and shower rooms. The recommendation to have toilets in the bathrooms has not been actioned although commodes have been made available. This is not an ideal solution and the manager indicated that this would be brought to the attention of the new owners who routinely refurbish their newly acquired homes. A power assisted ‘Stand-aid’ has been provided for the first-floor nursing unit. There are two mobile mechanical / hydraulic hoists, which need to be ‘pumped up’ by hand on the nursing unit. There are no mobile hoists on the ground floor. Although this is the residential unit, the physical dependency of the client group is becoming greater and similar hoisting and Stand-aids aught to be made available there. The staff confirmed that should a resident fall in the ground floor unit they have to go upstairs to the nursing unit for a hoist. More up-to-date power-assisted hoists should be provided for both the nursing and residential units to help ensure safe practice. Staff felt that since the new owners had taken over that things had improved, including the provision of clinical bins, bedding, artificial flowers on the dining tables and improved decoration with better colour schemes. The garden area is grass with no other features such as raised or flowerbeds to provide interest for the residents and no paths created for the wheelchair cases. The manager said that there were plans to create a sensory garden in the future. There were also plans to create a ‘snoozle’ light & sound room’. There are six height-adjustable profiling beds provided in the nursing unit and more will be required to cope the increasingly frail and sometimes bedfast cases. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory recruitment practices are followed. There is sufficient staff to provide personal care, however more activities hours would improve the resident’s quality of life. EVIDENCE: The numbers of staff employed appears to be sufficient but the staff on the nursing unit in particular feel they need an six instead of five care staff on the morning and afternoon shifts so that they can work in pairs and also to address the hiatus in activity especially at mealtimes when so many require assistance with feeding. There are currently only two RMN trained nursing staff, one on at night and the other on daytime duties. This is an issue the manager is trying to address but there is some difficulty in recruiting these specialist staff. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 18 The home have managed to access funding from the Social Skills Council for NVQ training for care staff who are over 25 yrs old and in consequence the numbers of staff trained to NVQ Level 2 or above is twenty, representing 51 of the care staff. Additionally, another nine have been enrolled and three more are due to start in November 2006. When all have completed training, and no-one leave, 74 will be so trained. The records confirm that the home have robust recruitment and screening procedures for the employment of new staff. These include Criminal Records Bureau checks (CRB), and adequate references are obtained prior to employment. There are records to show and the staff spoken to confirm that they are provided with sufficient training opportunities to help them provide safe and satisfactory care for the residents. Routine training takes place in matters relating to Health & Safety, Moving & Handling, Fire Safety, Food Hygiene, POVA / Abuse, Dementia, Managing conflict and First Aid. The nursing staff confirmed that they are offered training opportunities regularly including at the local hospital and this has recently included Terminal illness, Catheter care and surgical dressings. There are plans to access distance learning Dementia Care courses. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management of the home is focused on benefits to the residents and there is a caring ethos in the home. EVIDENCE: The manager is a First level psychiatric nurse (RMN) who has many years of experience in caring for the elderly who suffer from dementia. She has a Diploma in Health and Social care and has the NVQ Level 4 Managers award. The care and nursing staff spoken to all had very positive things to say about the manager and her management style. She provides “very good support, professional but friendly”. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 20 Feedback from professional sources, including Social services and the Medical staff in the local practice testify to their confidence and respect for her high standards and commitment in the management of the home. There is now a deputy manager in post who also has the Management award and this appointment has helped in reducing the numbers of agency and bank staff deployed in the home. The staff confirmed that received statutory training in Fire Safety, Moving & Handling, Health & Safety and First Aid at the recommended intervals. Quality assurance questionnaires are routinely sent out to the relatives or representatives to help the home determine whether the care they are providing is equal to their wishes and expectations. There are sufficient policies and procedures, compliance with which should ensure a safe environment for the vulnerable residents. The resident’s relatives or representatives on their behalf arrange the management and control of their personal monies and in consequence there is no need for the home to be involved in these transactions. There is an annual development plan for the home, which is shared with the staff. Staff confirmed that regular meetings are held with them to enable them to express their views on developments in the home. Exit interviews are held with staff that leave and this is an additional source of information, which can assist in identifying possible areas for improving care in the home. The records of servicing of the gas equipment, lifts and other infrastructure were seen and are kept in a tidy and well-ordered manner. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 21 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 2 2 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 4 4 Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP8 OP12 OP19 Good Practice Recommendations All care staff should be encouraged to record their interventions in the resident’s notes. The provider should consider providing more activities person hours. Paved access should be provided for wheelchair cases in the garden. More features should be provided and the home’s planned sensory feature should be actioned. The provision of toilets should be considered for the bath and shower rooms. More up-to-date power assisted hoists should be provided for the bathrooms in both units. Power assisted hoists should be provided in both units. A ‘Stand aid’ should be provided for the residential unit. 4 5 OP21 OP22 Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 23 6 7 OP24 OP27 Additional adjustable height beds should be provided for the nursing unit. The provider should consider providing additional care staff in the nursing unit especially at mealtimes to help the staff meet the resident’s needs. The provider should endeavour recruit more RMN trained nurses so that the residents psychological and psychiatric needs can be identified and addressed. Beechwood Nursing Home DS0000028024.V320899.R01.S.doc Version 5.2 Page 24 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.V320899.R01.S.doc Version 5.2 Page 25 - 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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