Inspection on 11/01/07 for Beechwood Place Nursing Home

This inspection was carried out on 11th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beechwood Place Nursing Home 21/06/07

Beechwood Place Nursing Home 14/07/06

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Beechwood Place Nursing Home 50-52 Welham Road Norton Malton North Yorkshire YO17 9DP Lead Inspector Anne Prankitt Key Unannounced Inspection 11th January 2007 09:15 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 DS0000066170.V327045.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. DS0000066170.V327045.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechwood Place Nursing Home Address 50-52 Welham Road Norton Malton North Yorkshire YO17 9DP 01653 692641 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) Bleak House Limited Mrs Ann-Marie Medd Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places DS0000066170.V327045.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th July 2006 Brief Description of the Service: Beechwood Place is a privately owned nursing home for up to thirty-five service users who require physical nursing care. It is situated in a quiet area in the town of Norton. The accommodation is on three floors with lift access. There is a level approach to the centre of Malton, where there is access to shops, the post office and cafes. The home changed ownership in January 2006. It is now owned by Bleak House Limited. The rooms vary in size and some have en suite facilities. There is parking to the side of the home and pleasant gardens to the rear and side of the property. The registered manager informed the Commission on 11 January 2007 that the range of fees is currently between £442 – 585 per week. Additional charges are made for hairdressing, chiropody, newspapers, magazines and taxi fares. Prospective service users are given the home’s Statement of Purpose, which provides them with information about what the home provides. DS0000066170.V327045.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit, the registered manager, AnnMarie Medd, returned a completed questionnaire to the Commission. It provided information about any changes that had happened at the home since the last site visit in July 2006. The inspector has also kept a record about what has been happening at the home since the last inspection. Of the surveys sent out, one health professional, twenty-two residents and nineteen relatives replied. Six hours of planning took place before the site visit, which lasted for approximately eight and a half hours. All of the information collected was used as part of the ‘key inspection’. The site visit was spent talking with the registered manager, residents and staff, and watching the general activity at the home. Some records were looked at, including some care plans, staff records, health and safety documents and financial records. The way that medication is managed was looked at, and the way that the registered manager assesses the quality of the service was discussed. The registered manager was available throughout the day. She was provided with feedback at the end. What the service does well: Wherever possible, the registered manager visits all residents before they are admitted to make sure that the home can meet their needs. They make sure that they collect information about the person’s current needs, so that they can be sure that they can be met by the home. Each resident has a care plan, which gives staff good up to date information about the care that residents need, and how it should be provided. Care is given in private, so that resident’s dignity is maintained. Residents are referred to their doctor when needed. Comments from relatives included ‘Medical care is exceptional when a resident is seriously ill’. There are group activities for residents who want to join in. The activities organiser makes sure that she visits residents, who cannot, or do not wish to, leave their room, and who enjoy her company. The home is clean and tidy, so that it is pleasant for residents. Staff are encouraged to attend a range of training to help them provide care safely and with understanding. DS0000066170.V327045.R01.S.doc Version 5.2 Page 6 The registered manager asks relatives, residents and professionals what they think about the home, so she knows where improvements needs to be made, and areas of excellence. Residents comments included ‘I like it here. It is nice and warm’. ‘Home from home’, ‘Couldn’t wish for a better place’, ‘Staff treat me with respect’. ‘I cannot fault the staff. They are so kind and cannot do enough for you’. ‘I couldn’t be better off anywhere else’. Relative comments included ‘Excellent place where one knows people get the care they need’, ‘It is a home with a family atmosphere. You are made to feel part of it’, ‘You couldn’t wish for better staff. They are always pleasant and helpful’, ‘We are very pleased with the care given’, ‘The new owners are very good. They advise me of any problems directly’ One visiting professional commented ‘The staff are extremely helpful and obliging’. What has improved since the last inspection? There have been good improvements made by both the owners and the registered manager of the home since the last key inspection. The system for labelling of eye drops, storage and disposal of medication, supply of dressings, and storage and cleaning of emergency suction equipment is now more organised. This means that medication belonging to residents is properly stored, and given in date. Residents now see their General Practitioner in the privacy of their room. Staff are now properly vetted before they are allowed to provide care. This means that residents are kept safe from unsuitable workers. The company has carried out extensive work to meet the recommendations of the fire officer. This will provide extra protection for residents from fire. An extra member of care staff has been provided each morning, and an additional communication system introduced so that staff can alert each other quickly when residents need help. Bed rails are checked regularly to make sure that they are safe for use. Hazardous substances which could cause harm to residents are now kept locked away, and hot water temperatures are checked regularly to make sure that they are not too hot so that the risk from scalds is minimised. Food in the freezer is now labelled so that staff know when it is to be used by. DS0000066170.V327045.R01.S.doc Version 5.2 Page 7 A number of health and safety matters have been attended to. The gas boilers have been serviced, and the emergency lighting and passenger lift repaired. The registered manager confirmed that the tea cook has now undergone food hygiene training. Records about residents’ care are now kept together, and are much easier to follow. The registered manager is introducing individual staff files, which keep a record of what training they have received. She is also arranging supervision, to help staff have a common understanding of the purpose of the home, and residents to receive consistent care. Several communal areas of the home have benefited from redecoration, new floor surfaces and new furniture. The bedrooms are being decorated where needed. Some of the windows have been replaced. Lastly, the registered manager has completed her Registered Managers Award. What they could do better: Risks to service users could be further explored, and all complaints made by service users investigated fully, to check that there is no further advice and support available to them and the staff who care for them. Amendments to medication instructions must be clearly documented on the medication administration record so that risks to service users from receiving inappropriate medication are minimised. All staff need to know the role of the local authority in the investigation of matters, which may affect the vulnerability of service users. Comments from relatives included: ‘It seems that they don’t have enough staff on because there have been several times when the residents need to go to the toilet and they haven’t been taken while I have been visiting’, ‘Extra staff could help especially when some of them are poorly, or any other similar crisis’. Another commented about ‘…the unacceptable length of time that residents are kept waiting when they need to use the toilet’, Residents comments included ‘You do not have enough staff. They are very busy’. To this end, when surveying residents and relatives, the registered manager should ask whether they are satisfied with the numbers of staff that are available, to check whether there are any common areas where shortfalls are perceived. In addition to the above, it is recommended that the registered manager should look at ways in which staff may be able to spend extra social time with service users. There were some health and safety matters which needed attention: Fire doors must be kept shut; fire alarm tests must be carried out and recorded on a DS0000066170.V327045.R01.S.doc Version 5.2 Page 8 weekly basis; staff must make sure that the footplates attached to wheelchairs are used safely; the registered person must obtain a current certificate to evidence that the gas appliances at the home have been serviced and are satisfactory; the registered person must obtain a certificate of chlorination, or provide evidence that checks are made to ensure that the stored hot water is maintained at a temperature above 60°C; the kitchen chopping boards must be replaced. 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. DS0000066170.V327045.R01.S.doc Version 5.2 Page 9 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 DS0000066170.V327045.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. Prospective service users are assessed before they are admitted, to help make sure that the home will be able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager makes sure the needs of prospective service users are assessed before they are offered a place at the home. She also visits them wherever possible. This helps both the home and the service user to decide whether it will be a suitable place for them to live. Staff use the information collected to develop the service user’s care plan after admission. The home no longer provides intermediate care, so standard 6 is not applicable. DS0000066170.V327045.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. Service users receive care from staff that understand their needs. But there is potential for further improvement to be made should the advice from other professionals be sought wherever problems relating to care remain unresolved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager explained that she was introducing new improved care plans. Information about all areas of service users’ care is now kept together. This makes understanding their needs easier. The care plans seen gave information about service users’ care and social needs, and they included information about where the advice from other professionals, such as the General Practitioner and dietician, had been sought. The plans, along with associated risk assessments, are reviewed regularly to make sure that needs have not changed. DS0000066170.V327045.R01.S.doc Version 5.2 Page 12 The following points were discussed with the registered manager: Two isolated risk assessments were missing. The registered manager said that this would have occurred when the care plans belonging to the two particular service users had been reviewed. One related to the assessment for measuring the risk from pressure sores. However, there was a record in the care plan about the treatment that was being provided, and a mattress had been supplied to reduce the risk from further damage. The second related to a service user who chooses to self medicate. Both assessments need to be reintroduced, and the registered manager gave assurance that they would be completed straight away. The weight of one service user who has been subject to a special diet had not been recorded for five months. This record must be reinstated, so that progress made can be monitored, and to make sure that the equipment available in the home which may be subject to weight restrictions can continue to be safely used. The registered manager has taken steps to ensure that a service user who suffers from recurrent falls is protected from unnecessary risks. She was advised that a referral to the falls assessor should be requested for advice to see if there is anything more that can be done to reduce the falls that the service user suffers from. Risk assessment has been completed for a service user who presents staff with behaviour which challenges them at certain identified times. The registered manager should request a multi disciplinary review, to see if there is any further advice and support available to assist staff in better meeting the service user’s needs. None of the service users who returned their surveys thought that their needs were never met, with the majority stating that their needs were always or usually met. All relatives who responded said that they were satisfied with the overall care. Comments from service users at the site visit included ‘I am very happy here. I have no complaints’, ‘The staff come to me when I need them’, ‘Home from home’. Staff were busy, and had limited time to sit with service users, but they provided care in private, and spoke to service users with respect. They now make sure that General Practitioner consultations take place in private. One relative commented ‘The staff are up to the job!’. Another stated ‘You couldn’t wish for better staff. They are always pleasant and helpful’ Improvements have been made to the storage, labelling and disposal of medication since the last inspection. Emergency suction equipment is now kept in a central place so that staff know where to find it. The system is audited, and is also spot-checked by the registered manager. Medication is DS0000066170.V327045.R01.S.doc Version 5.2 Page 13 now provided to the home in individual blister packs. This should reduce the risk from errors occurring. Controlled medication is stored appropriately, and recorded in a separate book when it is administered. Staff keep an up to date record of medication prescribed for service users who choose to self medicate. It is good practice that service users have had a pharmacy review. The following matters were discussed: The General Practitioner had changed the dose of medication for one service user. The staff member who amended the medication record had neither signed nor dated the amendment that they made to the medication chart, which was not clear. It was not clear from the records whether one service user should, or should not, be receiving a medication, which was still prescribed, but which it was stated was not currently required. Where service users are able to tell staff when they need their ‘when required’ (prn) medication, this should be recorded in the care plan. The medication records should then be signed when the medication is actually administered. Where the service user is not able to decide, and staff are making a decision on their behalf about whether or not they need their medication, then the home should record on each occasion why the medication has, or has not, been administered. Attention to these matters will help to make sure that service users receive the right amount of medication when required, and at the correct dosage. DS0000066170.V327045.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. The social and spiritual needs of service users are considered, and they are able to maintain important links with friends and family. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activities organiser works at the home each weekday afternoon. They advertise forthcoming events. A copy of the advertisement is provided to each individual service user. This gives service users the opportunity to decide in advance whether they would like to attend. The care plans gave details about both group and individual activities that had been provided. Thought is given to those service users who are hard of hearing. For example, the television in one room provided subtitles. There are currently no service users at the home who have diverse spiritual needs. A monthly Church of England service is held at the home, and the priest visits individual service users separate to this at their request. The registered manager has links with the local Catholic priest, who will also visit. DS0000066170.V327045.R01.S.doc Version 5.2 Page 15 Visitors are welcomed at the home. At Christmas, a number joined their relatives for lunch. The registered manager had kept a record of one commendation from a visitor following the event. Another commented about the home ‘You are made to feel part of it’. Staff said that they try to give service users choice in their daily lives. They thought that the routine of the home was now more flexible. Over three quarters of service users who returned their surveys thought that staff listen and act on what they say. Those spoken with at the site visit agreed that they were able to make some choices. One service user had enjoyed a lie in, and was offered breakfast once up and dressed. Another stated ‘I don’t want to get up late. I think that it would be OK to get up later, but staff have some routine that they have to stick to’. The bedrooms seen were individualised, and contained personal belongings. Fresh meat, fish and vegetables are delivered to the home on a regular basis. The cook also provides home baking, and offers fresh fruit to service users each day. Cold drinks are available in communal areas throughout the day. Night staff have access to the kitchen so that they can prepare snacks for service users who may feel hungry during the night. Overall, service users were generally satisfied with the meals on offer. A service user commented ‘We get plenty of lovely food’. Whilst another stated ‘Everyone says they like the food here. They are obviously not used to good quality food’. There is a choice available at lunch and tea. The kitchen staff try to accommodate minor changes to the daily routine, so that service users can be assured that they will receive a hot and appetising meal. They keep a record of comments about the food, so that they know where any amendments are needed. They cater for special diets, including diabetic and reducing. Soft diet is served in separate portions so that it looks more appealing. One relative commented ‘Excellent nutrition with attention to individual diets’. The kitchen staff explained that all cooks have now completed training in nutrition and health. They are provided with information about the likes and dislikes of service users, and, following a complaint made that a service user had not been provided with a meal on more than one occasion, they now have a tick list which they complete at each meal to make sure that all service users are catered for. Records are kept as evidence that food is stored at and cooked to the correct temperature. Cleaning records are also kept. Although there were plenty of staff available at lunchtime, it was noted that desserts were served before main courses had been completed. This may result in service users feeling rushed, and should not happen. DS0000066170.V327045.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. Service users cannot be entirely assured that their complaint will always be taken seriously and acted upon fully. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is clearly posted in the main entrance of the home, with contact details of the owners, and the Commission for Social Care Inspection. There has been one anonymous complaint made to the Commission since the last key inspection. This was referred to the provider to investigate. Details of the complaint are included in outcome areas ‘Environment, Staffing, and Management and Administration’. One service user commented that the responsible individual visits them regularly. They said ‘I would go to staff with any complaints, but I don’t have any’. ‘AnnMarie (the registered manager) is good’. A relative commented about ‘The speedy resolve of problems’. There have been two complaints made direct to the home by service users. One complaint about food, as detailed within outcome group ‘Daily Life and Social Activities’ was dealt with to the satisfaction of the service user. Discussion took place with the registered manager about the second complaint, where a service user alleged that a staff member had thrown an item at them. DS0000066170.V327045.R01.S.doc Version 5.2 Page 17 The documentation highlighted that the matter had not been fully investigated, or discussed with the ‘safeguarding adults’ team. The registered manager thought that this was partly because such accusations were not uncommon. However, she has agreed that she will request a review of the service users’ needs, so that they receive all the necessary support that they require, and so that the ‘safeguarding adults’ team are aware of any allegations that have been made. Comment cards from service users identified that not all were sure how they should complain. Although those spoken with said that they would be happy to talk to the staff, the registered manager is advised to include this potential shortfall within the next quality assurance service user questionnaire. All staff spoken with understood their responsibility in reporting alleged or suspected abuse. They knew that they must not keep secrets. The registered manager intends to provide a training refresher to a senior staff member who was not clear about the role of the local authority in the investigation of ‘safeguarding adult’ matters. DS0000066170.V327045.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. Service users live in pleasant surroundings, which are subject to a programme of refurbishment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One aspect of an anonymous complaint made to the Commission for Social Care Inspection alleged that the home was not kept clean, and that there was an insufficient supply of linen. At this site visit, the environment was warm, clean and tidy, both in communal areas and in those individual rooms seen. The owners have made numerous improvements at the home since the last site visit in July: DS0000066170.V327045.R01.S.doc Version 5.2 Page 19 Communal areas have benefited from redecoration, and refurnishing. This makes the environment pleasant for service users. Bedrooms are being refurbished as required, when they become vacant. The owners have almost completed an action plan of works recommended by the fire officer. This will help make service users are safer in the event of fire. The fire safety risk assessment has been updated to include reference to the ‘stay put’ policy in place on a night, which the registered manager stated had been discussed with the fire officer. It is recommended on completion of the works, that a request be made for the fire officer to revisit to check that he is satisfied with the results. There has been a new walk in or wheel in shower fitted on the second floor of the home, to replace a bath, which could not be used. This means that service users have the option of an extra facility. Those who live on this floor do not now have to go to another floor to bathe. Imminent plans also include the refurbishment of the bathroom to the first floor, to provide a bath which will be wider, and which will be fitted with a hoist suitable for all service users who currently live at the home. New laundry equipment has been ordered to replace the existing washers and driers. Staff are supplied with gloves and aprons to minimise the risk from cross infection, and are directed to the office for information about what to do in the case of spillages. DS0000066170.V327045.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. The registered manager takes steps to make sure that service users are cared for safely by staff who are properly vetted and trained, but service users need to be confident that there will be sufficient staff to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An extra member of care staff is now provided each morning, to help make sure that service users’ needs are attended to more quickly. The registered manager has also provided an additional form of communication so that staff can call each other for help more quickly when they need assistance. Comments from service users about staff provision varied. From the comment cards returned, 41 percent thought that staff were always available, whilst another 41 percent thought they were usually available, with 14 percent believing that they were only sometimes available. Some thought that there were not enough staff, and thought that they had to wait too long before they were provided with assistance. Service users’ comments included: ‘You do not have enough staff. They are very busy’. Some staff felt that, in the case of sickness, staff shortage was not always covered. DS0000066170.V327045.R01.S.doc Version 5.2 Page 21 42 percent of relatives believed that there were not enough staff. Their comments included: ‘It seems that they don’t have enough staff on because there have been several times when the residents need to go to the toilet and they haven’t been taken while I have been visiting’, ‘Extra staff could help especially when some of them are poorly, or any other similar crisis’. Another commented about ‘…the unacceptable length of time that residents are kept waiting when they need to use the toilet’. It was observed on the day of the site visit that, although staff did not appear to be rushed, the time that they had to spend sitting with service users was limited. It is recommended that the registered manager make further enquiries with service users about staffing as part of her quality assurance work at the home, and take the necessary steps where shortfalls are identified. Staff are encouraged to complete NVQ training, at least to level 2. Some are waiting to enrol on the course, whilst 59 have already achieved accreditation. The way in which staff are recruited has been improved upon since the last inspection. All files seen evidenced that staff are properly vetted before they begin to work at the home. This helps protect service users from unsuitable workers. Statements of competency have been completed for staff who have been employed at the home for a long time, and for whom references at that time were not obtained. The home has an equal opportunities policy. New staff complete an induction in house. A training company also provides them with induction training. Staff receive a range of training which will help them to provide good care. All staff spoken with had completed their statutory training, and were satisfied with the opportunities offered to them. Staff said that they receive formal fire safety training once a year. The registered manager has made arrangements to restart the supervision programme, and has developed staff files so that she can see what training staff have had, and when it is next due. The home provides placements for student nurses, who work at the home for experience as part of their training. The registered manager said that this helps staff keep up to date with current nursing trends. DS0000066170.V327045.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. Service users can be assured that the registered manager and providers will actively seek their views, and will take steps to help make sure that they live in a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the registered manager has completed the registered manager’s award. She and the registered providers are now working towards achieving the ‘Investors in People’ award. She is provided with lots of training opportunities to help her keep up to date with current practice. She also maintains links with professionals in the community. Staff made positive DS0000066170.V327045.R01.S.doc Version 5.2 Page 23 remarks about the registered manager, which included ‘AnnMarie is very good. Staff have a sense of purpose’, ‘Staff are content’, ‘The management are supportive’. A relative commented ‘The manager is highly efficient and very approachable’. To help recognise where improvements are needed at the home, the registered manager has introduced a quality assurance system, which seeks the views of service users, staff and professionals who work in the community, but who have an interest in the home, such as General Practitioners. A relative commented about ‘…the feeling that the home is well run’. In house audits include checks of the medication system; care plans, training and kitchen area. The responsible individual visits the home on a regular basis. They should leave a copy of their regulation 26 report (a self assessment report by the provider) at the home, so that the registered manager can refer to and act upon the action plan that is produced following the visit. The home can keep personal allowances for service users if this is their wish. It is kept safely locked away, and records and receipts are kept of incomings and outgoings. There were a large number of health and safety issues that needed to be dealt with following the last site visit. Good progress has been made in meeting these: The registered manager has now developed a robust system to make sure that bed rails are kept properly fitted. This will help protect service users from unnecessary injury. A record is kept of the checks made. The registered manager confirmed that, where overlay mattresses are fitted, higher bed rails are now provided. Sluice rooms are now kept locked, and hazardous chemicals are kept locked away, including denture cleansing tablets for service users who are unable to manage them safely. Hot water temperatures accessible to service users are now checked monthly to make sure that they are kept at a safe temperature. This helps reduce the risk to service users from harm. The emergency lighting and lift has been repaired. However, at this site visit: There was a bedroom fire door that was being held open by unauthorised means. The room contained a supply of oxygen. The door was closed immediately, and written assurance has been received since the site visit to confirm that all staff have been reminded that fire doors must be kept shut. A service user was brought into the dining area without the footplates having being put into use. This is not safe practice. DS0000066170.V327045.R01.S.doc Version 5.2 Page 24 The fire alarm test was due for renewal. There were gaps in the records, which suggested that the weekly check to the fire alarm system was not being maintained. The chopping boards in the kitchen were badly scored, and would benefit from replacement. The gas boilers have been serviced. However, there was no evidence to confirm that the gas appliances themselves had. In response to a requirement made following the last site visit, a plumber has visited the home and has checked the temperatures of the boilers. Two were not maintained above 60°C, but no remedial action had been taken, and no system devised so that the temperature at which hot water is stored can be checked on a regular basis. The registered manager must seek further advice from an appropriately qualified person, to establish how service users can be adequately protected from the risk from Legionella. Confirmation has been received from the registered manager that these shortfalls are being attended to. DS0000066170.V327045.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 DS0000066170.V327045.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13, 15 Requirement The Registered Manager must make sure that important care plan risk assessments are not overlooked. The Registered Manager must seek further advice with regards to the service user who suffers from recurrent falls. The assessment to measure the risk from pressure sore damage must be reintroduced. A record of weight must be kept for the service user who has been provided with a special diet. 3 OP8 OP18 12, 13 The Registered Manager must seek further advice with regards to the service user who presents with behaviour which challenges. A review must be requested to make sure that the allegation made by a service user is looked into, and appropriate support and advice obtained for the service user and staff. The registered manager must DS0000066170.V327045.R01.S.doc Version 5.2 Page 27 Timescale for action 11/01/07 2 OP8 12, 13, 14 17(1)(a) Schedule 3(n) 31/01/07 31/01/07 make sure that all staff are aware of the role of social services in the investigation of ‘safeguarding adults’ matters. 4 OP9 13 Amendments to medication instructions must be clearly documented on the medication administration record. Fire doors must be kept shut. Fire alarm tests must be carried out and recorded on a weekly basis. Staff must make sure that the footplates attached to wheelchairs are used safely. 6 OP38 13 The registered person must obtain a current certificate to evidence that the gas appliances at the home have been serviced and are satisfactory. The registered person must obtain a certificate of chlorination, or provide evidence that checks are made to ensure that the stored hot water is maintained at a temperature above 60°C. Timescale of 14/08/06 not met The kitchen chopping boards must be replaced. 31/01/07 11/01/07 5 OP38 13, 23 11/01/07 DS0000066170.V327045.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Where service users are able to tell staff when they need their ‘when required’ (prn) medication, this should be recorded in the care plan. The medication records should then be signed when the medication is actually administered. Where the service user is not able to decide, and staff are making a decision on their behalf about whether or not they need their medication, then the home should record on each occasion why the medication has, or has not, been administered. 2 OP15 To avoid service users feeling rushed, and so that their meal is sufficiently warm, staff should wait until they have finished their first course before serving them their second course. A request should be made that the fire officer revisits once the upgrade of the fire safety systems have been completed, to make sure that they are satisfied with the actions taken. A copy of the regulation 26 report carried out by the registered provider should be left at the home. The registered manager should look at ways in which staff may be able to spend extra social time with service users. The registered manager should seek the views of service users about staff availability as part of their quality assurance audit, to check whether there are any common areas of dissatisfaction. 3 OP19 4 5 OP26 OP27 OP33 DS0000066170.V327045.R01.S.doc Version 5.2 Page 29 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 DS0000066170.V327045.R01.S.doc Version 5.2 Page 30 - 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. 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