Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Beechwood Nursing Home Romanby Road Northallerton North Yorkshire DL7 8FH The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Bridgit Stockton
Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 23 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home
Name of care home: Address: Beechwood Nursing Home Romanby Road Northallerton North Yorkshire DL7 8FH 01609777733 01609780692 carole@premiernursinghomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Carole Agnes Hardy Type of registration: Number of places registered: Premier Nursing Homes Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 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. 0 0 Over 65 60 60 Care Homes for Older People Page 4 of 23 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The purpose of this inspection was to assess the quality of the care and support received by the people who live at Beechwood Care Home. The methods I used to gather information included a visit to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. Someone called an expert by experience also accompanied me on this inspection and some of her findings have been included in this report. The home had also returned to the Commission an annual quality assessment audit. This gives a lot of information about the home including what changes and improvements have been made since the last inspection and what is planned for the home in the forthcoming year. Care Homes for Older People
Page 5 of 23 We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: The expert by experience said that she had spoken to a lot of service users and visitors to the home. these are some of her observations made whilst at the home. I visited the Kitchen and spoke with the Cook. I asked about the choice of food offered to the residents and if they were offered a cooked breakfast beside cereals or toast. Breakfast was from 8.00a.m. onwards with lunch at 12noon or shortly afterwards and at 4.30.p.m. a further cooked meal was offered. I was assured that residents who wished to have a cooked breakfast were given one. The cooked breakfast was usually egg, bacon, sausage, mushrooms or any combination of these items. I asked to look at the menus being provided this week and was shown a copy and was offered a Photostat of it. It was evident that there was quite a good choice of meals within the week and each day there was a choice of two different cooked dishes for main meals and puddings at lunch time. The later meal was either a cooked meal or sandwiches together with home baked cakes each day. Soup was also given as an alternative to sandwiches. Ice cream, fresh fruit and yoghurts are always available. Menus are run on a four weekly basis. I observed that every resident had a fresh jug of water in their room and I was told by a resident that it is changed every night in case they were thirsty during the night. I observed several staff feeding those residents who were unable to feed themselves. They also accommodated a resident who did not want to sit in the dining room because she found it too noisy, preferring to sit in the lounge with a small table. I observed the Staff member offering this resident a choice of which meal she preferred by her bringing the meals to the resident to show her what was being offered. When the resident chose her meal, the Staff member returned to cut up the meal so that the resident was able to manage to feed herself. This service was offered in a very kind and thoughtful manner. The kitchen looked clean and organised. There was a notice on the kitchen door instructing Staff that they must wear their uniforms at all times. There was a similar instruction for Care Staff that they must wear their uniforms. When I asked about this I was advised that it was to stop any cross infection between Care Staff and Kitchen Staff. I visited the Laundry and spoke with the laundress. I observed that every resident had a pigeon hole where the laundry once it had been washed and ironed, was placed until it was taken to the residents room later in the day. All the residents clothing has their name on their garment, thus avoiding residents either wearing other residents clothing or clothing placed in wrong rooms. Clothing appeared to be nice and clean and well ironed. I visited several bedrooms and found them all to be very clean, with en-suite facilities also very clean and without any odours. I spoke with the cleaning Staff and they assured me that they really enjoyed the work they did. They should be congratulated on the cleanliness of such a large Home. I spoke with a resident who told me that she had been a resident for four years and that she was very happy in the home. This lady felt that she was treated with respect and that the Staff was always very kind to her. She told me that she was able to have a bath at any time she wished. She felt her privacy and dignity was respected. I asked if she was able to follow her religion because she told me she had previously enjoyed Care Homes for Older People Page 7 of 23 going to her church - she confirmed that this was so. Relatives she told me are always welcome and her two daughters visit her often. She also confirmed that she was able to make a telephone call from the Office if she wished. She also told me that when her daughters phoned then Staff brought the telephone to her. She also told me that she thought it was very important that she was able to vote in an election and she did this too. This lady felt it was important that she did as much as possible for herself and kept her independence she cited such things as she dressed herself, went on visits with her daughters, had her hair cut and set when she wanted to do it. I asked her about what activities she had enjoyed before she became a resident within the Home. She said that she had always enjoyed sewing and would like to do a little of that again. She said that there were not many activities offered, but she did not mind Bingo. I asked if she could think of any activities she would like the Home to provide and she said she would like sing a long to some of he old songs from the first and second world wars. I spoke with a relative who told me that her mum had been in another home and hospital but that Beechwood had been a really good choice for not only mum, who had a severe form of dementia, but also for the rest of the family because they were near enough to be able to visit often. This relative was very happy with the care that was provided. She told me that when she had raised an issue, then it was attended to straight away. This relative said that she felt she was always welcome in the Home and also confirmed that visiting relatives were able to make themselves a cup of tea or coffee and that there was a fridge provided where they could put a sandwich etc. to have whilst they were visiting. I spoke with several members of Care Staff and without exception they described themselves as being very happy working with all the other Staff members, and were extremely happy with their Manager who unfortunately, at the moment, is ill but who they hope will be returning to work later in the year. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 23 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 23 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that they are properly assessed prior to admission to the home. Evidence: The care plans I looked at showed that comprehensive pre-admission assessments had been carried out before offering someone a place. This is to make sure that the home can meet the person’s needs. A senior member of staff usually the manager visits the person at home or in hospital to discuss their care needs. Social Services assessments are also used to determine this as well; these were also available to look at. A relative told me that they had come to look around the home before their relative had been admitted. they said that the staff had been very friendly and they had been given lots of information about the home to help them with the decision. Care Homes for Older People Page 11 of 23 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of detail in peoples care plans coupled with poor practice in the administration of medication could potentially put some peoples health and welfare at risk. Evidence: I looked at four care plans of people who live at the home. They were not written in sufficient detail to ensure that peoples identified needs were being met fully. For example, one person had lost a considerable amount of weight over a short period of time, this had been documented in the daily evaluation, but the actual plan of care had not been altered to instruct staff on how to manage this or what interventions were required to keep them from loosing any further weight. I looked at how medication was administered at the home. Each unit in the home has its own medication trolley for the storage of medication. In one of the trolleys I found that some tablets had been put into a medicine pot and hidden within a box of other tablets, this is very poor practice. All staff who administer medication at the home need further training in the safe handling of medication. In addition to this some prescribed creams were left in peoples bedrooms. Given the diagnosis of the people
Care Homes for Older People Page 12 of 23 Evidence: who live at the home and the potential risk of harm if ingested, I asked for the creams to be locked away immediately. Staff were seen to be treating people with respect and dignity, they knocked on bedroom doors and were respectful and sensitive towards people when they were carrying out care duties. Care Homes for Older People Page 13 of 23 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social and recreational needs are well catered for. Choice and Independence is promoted whenever possible. Evidence: The home had a very warm and welcoming atmosphere. Visitors were in the home throughout the inspection. They all said how friendly the staff were and that they were always made to feel welcome.Since the last inspection an activities organiser has been appointed at the home. Social events and activities are organised and people could choose to take part if they wished. A varied program of activities was displayed. People were able to sit and chat in the communal lounges and some people were watching television in their bedrooms. There were magazines and books provided in the communal areas for people to read. Everyone said the food was lovely one person said I really like the puddings they are really nice. People could either take their meals in the communal dining area or else in the privacy of there own rooms. Care Homes for Older People Page 14 of 23 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse Evidence: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirm they were aware of these. Staff knowledge of these help ensure that they were able to address any issues or anxieties of the residents, relatives and visitors to the home. People who live at the home told me they would speak to any of the staff if they had any concerns or complaints. One person said I had some concerns about my mother. I spoke to the manager, she was lovely and sorted things out straight away. If I had any other problems I would not hesitate in speaking with her again. Staff told me that training has taken place in the protection of vulnerable adults in abuse. I looked at four personnel files and found that staff recruitment procedures were adequate and staff were employed and deployed following appropriate checks. The staff team were clear and confident in the protection of vulnerable adult procedures. Care Homes for Older People Page 15 of 23 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, comfortable, well maintained and homely environment. Evidence: All the bedrooms that I saw reflect the person’s individual preferences and taste. There is a program of re-decoration for the bedrooms, as well as for the rest of the home. The maintenance man was busy painting peoples bedrooms. He said that he continually painted bedrooms and corridors to keep the place looking fresh and tidy. He also said that people could choose what colour they wished their bedrooms to be painted. The bedroom doors all have locks, and there is a lockable storage space in the rooms. This means that people can keep their belongings private and secure. The home is fresh, clean, comfortable and well looked after. Everyone who commented agreed that the home is always well kept. All the bedrooms that I saw reflect the person’s individual preferences and taste. The fire and rescue services inspect the home, there were no outstanding issues from the last inspection. All work that was outstanding from the last inspection regarding the propping open of some doors with unautherised equipment had been completed. New devices have been fitted to the doors which allows them to remain open but on activation of the fire alarm the doors will close automatically.
Care Homes for Older People Page 16 of 23 Care Homes for Older People Page 17 of 23 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that staff are trained and on duty in sufficient numbers to meet their assessed needs. Evidence: The rotas and staff numbers suggest that there are enough staff on duty at all times to meet the needs of the people who live at the home. I looked at a selection of staff files. They all included completed application forms and two written references. The files showed that satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks have been obtained. I was assured that no new member of staff starts work until a POVA register check had been completed. Then, if the CRB check had not been received, they would work only under the supervision of an experienced staff member. The manager makes sure that staff have the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. Care Homes for Older People Page 18 of 23 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well managed and people who live and work at the home can contribute to the decision-making processes. Evidence: The manager has the qualifications and the skills to manage the home effectively. Currently she is away from the home. A manager from another home is overseeing the home. The staff said that they miss the manager very much as she has always been a great support to them and a very good manager. Staff are trying very hard to maintain the standards of care within the home whilst she is away from the home. Residents and relatives meetings are held, although they are not very well attended. The home sends out questionnaires to relatives, in order to gain information about how people view the service and what improvements they would like to see. The operational manager visits the home and carries out audits, to make sure the home is
Care Homes for Older People Page 19 of 23 Evidence: operating to company policy. I looked at the records held at the home regarding people’s personal allowance. All transactions are recorded correctly and receipts are kept. One person’s money was counted and matched the total on the record. Policies and procedures are kept up to date; to make sure they provide relevant information to guide staff on how to act in every situation. All the regular health and safety checks for the home are carried out in a timely manner. Staff have basic health and safety training. All these measures make sure that the health, safety and welfare of the people who live at the home is promoted and safeguarded. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be written 09/01/2009 in sufficient detail to instruct staff on how people needs are to be met to ensure people receive proper planned care 2 9 13 medication must be stored administered and recorded correctly. All staff who deal with peoples medication need to have refresher training in the homes policy and procedures surrounding medication To minimise the risk of harm to people and to keep people safe. 09/01/2009 Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 22 of 23 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
