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Inspection on 29/11/05 for Beechwood Nursing Home

Also see our care home review for Beechwood Nursing Home for more information

This inspection was carried out on 29th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a good quality of care in a homely and professional manner. There are good systems of documentation in relation to care planning and policies and procedures. Conversations with the care and nursing staff demonstrated that they are committed to doing all they can to make the lives of the resident`s fulfilling and comfortable. Some of the staff has worked at the home for some time and this provides the necessary continuity and support for the residents and new staff equally. Ms Carole Hardy, the new manager of the home has managed to establish herself in a positive and open manner with the staff, enjoying their support in turn. She endeavours to support the staff in their role, recognising the particular pressures upon them caring for such vulnerable people. Her exchanges with the inspector were open, and all queries were answered readily and with candour.

What has improved since the last inspection?

More training, particularly in the area of elder abuse and the management of conflict has been provided and is of especial relevance in the care of the vulnerable group of residents that the home cares for. Staff turnover has been reduced thereby reducing the dependency on agency staff, which was quite prevalent in recent times. The care staff appear less inhibited in proclaiming their views and is an aspect that should be encouraged as this can only be of benefit for the residents.

What the care home could do better:

Additional activity/ diversionary therapy hours should be provided as some of the resident`s can easily become bored and unsettled if left alone too long without sufficient stimulation. Some upgrading of the facilities in the bath and shower rooms should be considered. The provision of toilets should be considered for these rooms.

CARE HOMES FOR OLDER PEOPLE Beechwood Nursing Home Romanby Road Northallerton North Yorkshire DL7 8FH Lead Inspector John McGarva Unannounced Inspection 29th November 2005 10:00 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.V265139.R01.S.doc Version 5.0 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.V265139.R01.S.doc Version 5.0 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 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.V265139.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th October 2004 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. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 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 29th November 2005, and the manager Ms Carole Hardy was available to assist with the process throughout. A new deputy manager is commencing duty the following week and this will permit the manager to focus on the strategic matters relating to the running of the home, including training. The inspection Commenced at 10.00hrs until 15.00 hrs, 5 hours in total. There were 58 residents in residence with two vacancies on the ground floor residential unit. The inspection focused on all the key standards, which CSCI have identified as important issues for the inspections during 2005 / 2006. An inspection of some of the resident’s rooms, lounges, bathrooms and shower took place. Discussions took place with the manager, nurses and carers. 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. What the service does well: The home provides a good quality of care in a homely and professional manner. There are good systems of documentation in relation to care planning and policies and procedures. Conversations with the care and nursing staff demonstrated that they are committed to doing all they can to make the lives of the resident’s fulfilling and comfortable. Some of the staff has worked at the home for some time and this provides the necessary continuity and support for the residents and new staff equally. Ms Carole Hardy, the new manager of the home has managed to establish herself in a positive and open manner with the staff, enjoying their support in turn. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 6 She endeavours to support the staff in their role, recognising the particular pressures upon them caring for such vulnerable people. Her exchanges with the inspector were open, and all queries were answered readily and with candour. 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. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 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.V265139.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 6. The resident’s needs are assessed and met in a professionally planned and programmed manner. 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 was good and included sufficient detail so that their needs are identified and upon which information the care plans are developed. 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.V265139.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. The physical and health needs of the residents are identified and appropriate care plans are created to ensure they are met. EVIDENCE: The residents looked well cared for with clean and well-pressed clothes and appeared content with the care they were receiving. The care plans inspected demonstrated that there was ample information on which to ensure that all their needs and wishes were addressed. There is a place for the resident or relative to sign to evidence that they have seen and been consulted about the care plan. Pressure relieving mattresses are provided when required by the local Primary Care Trust (PCT) and the district nurse has to come and do an assessment and supply the equipment indicated following the assessment. It is not easy to elicit the views of the client group in the home in regard to whether their privacy and dignity is protected, but from observation and Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 10 discussion with the staff it is evident that they, the staff, endeavour to establish personal choices and wishes on their behalf. The care staffs were observed to knock on room doors prior to entering although some individual room doors are kept locked during the day due to residents wandering into each others rooms. 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. The controlled medication stock of one resident was checked against the records and found to be correct. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. The resident’s wishes are respected and contact with relatives and friends is encouraged. The dietary needs of users of the service are met with a varied menu being offered that satisfied service users tastes and choices. EVIDENCE: The resident’s routines of daily living are tailored to their perceived needs and choice. There is an activities organiser who works 15 hrs per week, 1.5 hrs on each floor from Monday to Friday and helps provide social activities for the residents. Given the mental debility of the resident’s, perhaps more hours of such support would be of benefit to them and the care staff. Visitors can attend the home at any time they choose, day or night with drinks provided for them routinely and also meals when required. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 12 The home is flexible in relation to allowing the residents to bring in their own items of furniture and other personal possessions. The resident’s personal monies are managed either by their relatives or representatives and the home has no responsibility for any resident’s monies at the present time. The meals are of good quality and the inspector sampled lunch during the inspection. There is a choice of two main courses at lunchtime and the staff utilise different strategies to elicit the residents wishes in this regard. Vegetarian meals are also proffered for known vegetarians. Alternatives are also available should the set menu not be to the personal liking of anyone. The timings of the meals are: Breakfast 8am, Lunch 12.15, Tea 4.30 pm. The spacing between meals seem a little compressed, but the manager believes that they accord with the residents preferred routine. Care staff said that there is always food available for the residents in the kitchen for out of hours snacks when required. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The provision of relevant complaints procedures and staff’s knowledge of adult protection issues safeguards the residents from abuse. EVIDENCE: The home has a complaints policy with time-scales for the resolution of these and this is included in the Statement of Purpose. There are robust Adult Protection and Whistle Blowing procedures available to protect the residents. The staff confirmed that they had received training on ‘No Secrets’, the North York’s County Council document on the issue of abuse and there is also training given on the home’s complaints procedure. Abuse is also a subject dealt with during the NVQ Level 2 training for care staff. The issue of obtaining staff signatures to evidence that they have seen and understood the homes policies was discussed with the manager. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 and 24. The environmental standards of the home are generally satisfactory. Additional equipment and grab rails for the bathrooms are indicated. EVIDENCE: There is a garden area to the rear, (east) and south side of the home but the grass is rather overgrown and ‘lumpy’. It does not appear to have been used recently. Being purpose built in the year 2000 the environmental standards are generally good with all rooms being single 12 square metres in size and with en-suite toilet facilities provided for each. The communal lounges and dining areas are spacious and well decorated. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 15 Some corridors have recently been decorated with further decoration planned and areas of stencilling have been added to provide interest along the rather long and previously bland surfaces. 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. Careful management of the design and colour schemes in buildings can assist people suffering from dementia. The Sterling University “Dementia Services Development Centre” was discussed in this context and the inspector agreed to provide the Website of this resource organisation. (http:/www.stir.ac.uk/dsdc) 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. There are two bathrooms and two shower rooms provided on each of the two floors of the home. One of the downstairs’ bathrooms is used for storage of equipment and bed linen. The staff mentioned that the baths are slow filling and therefore this can take some time. Showers are used more often than the bathrooms. As the client group being admitted are increasingly frail, the layout and provision of facilities in the bathrooms would benefit from some improvements: There are no grab-rails provided in the bathrooms and only one on each floor has benefit of a hoist. The bath hoist is a water pressure powered ‘swing-seat’ device and the resident has to be transferred onto it by a mobile mechanical / hydraulic ‘Oxford’ hoist, which needs to be ’ pumped up ’ by hand. There was no mobile hoist in the downstairs bathroom from which transfer to the ‘swing seat’ from a chair could be affected. Ideally both bathrooms should have power assisted hoisting facilities or a hoist tracking system provided so that bathing can be undertaken with the minimum of effort for the staff or residents. There are no toilets provided in the bath or shower rooms and as this can present practical problems prior to bathing, this is something that should be considered. There appears to be sufficient space for toilets to be installed and the staff confirmed that this would help them in their work. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 16 The shower rooms have some grab-rails around the actual shower area and extending this to around the whole room would be of benefit to the staff and residents alike. Some turntables to facilitate the transfer of residents from one seat to another have recently been provided, as have slide sheets for easy movement whilst in bed. Six height adjustable profiling beds are provided for the nursing cases that require them. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. The residents receive a good standard of care from sufficient staff who are appropriately trained and supervised EVIDENCE: The home complies with the staffing letter of the previous regulatory authority. The home have managed to access funding from the Social Skills Council for NVQ training for care staff who are over 25 yrs so that they can benefit from this training traditionally only provided free for staff younger than this. Sixteen of the care staff has achieved NVQ Level 2 training standard or equivalent, including the five Batchelor of Nursing nurses from the Philippines who are working as care assistants until their registration procedures are complete. The number of care staff with such qualifications is therefore 46 of the total at present. Additionally, fourteen of the care staff are currently undergoing NVQ Level 2 training and three have achieved NVQ level 3 standard with another one about to embark of this level of training. When the current cohort of trainees has completed their courses, the 50 recommended standard for care staff with such qualifications will be met. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 18 The recruitment procedures at the home meet the required standard and all Criminal Record Bureau (CRB) checks have now been done for all staff. The care staff receives training which meets the National Training Organisation (NTO) standards. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 and 38. The home is well managed with staff that is kept informed about developments in the home. There are systems in place to ensure that the Health & Safety of the residents and staff are protected. 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 in 2004 completed the NVQ Level 4 Managers award. The staff confirmed that received statutory training in Fire Safety, Moving & Handling, Health & Safety and First Aid at the recommended intervals. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 20 Other training is available, including a recent venipuncture, (taking blood) training episode at the local hospital for the nursing staff. Quality assurance questionnaires have recently been 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. A system of obtaining the signatures of the staff to evidence that they have seen and understood the homes policies and procedures should be instituted. This was discussed with the manager who agreed to take this thought forward. 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 and a further meeting is planned for 15th December 2005. It emerged during discussion with staff that they had not seen the last CSCI inspection report and the manager was asked to make these more easily available for the staff and visitors alike. Exit interviews are held with staff that leave and this is an additional source of information and intelligence, 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.V265139.R01.S.doc Version 5.0 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 x x 3 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 2 3 x 3 x x STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 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 OP12 OP15 OP21 Good Practice Recommendations The provider should consider providing more activities person hours so that the residents can have more diversionary or other therapy. The care staff, residents & representatives should review the timings of the meals so that they accord with the preferences of the residents. The water pressure supplying the baths should be improved. The provision of toilets should be considered for the bath and shower rooms. Grab-rails surrounding the bathrooms should be provided. Additional grab-rails should be provided in the shower rooms. More up-to-date power assisted hoists or tracking systems should be provided for the bathrooms. The provider should endeavour to have 50 of care staff DS0000028024.V265139.R01.S.doc Version 5.0 Page 23 4 OP22 5 OP28 Beechwood Nursing Home 6 7 OP32 OP33 trained to NVQ Level 2 standard. The CSCI inspection reports should be made openly available for the staff, residents or relatives to see in the home. The manager should introduce a system of obtaining signatures of the staff to evidence that they have seen and understood the home’s policies and procedures. Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beechwood Nursing Home DS0000028024.V265139.R01.S.doc Version 5.0 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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