CARE HOMES FOR OLDER PEOPLE
Beechwood Residential Care 65 Portsmouth Road Woolston Southampton Hampshire SO19 9BE Lead Inspector
Christine Walsh Key Unannounced Inspection 11th April 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beechwood Residential Care Address 65 Portsmouth Road Woolston Southampton Hampshire SO19 9BE 02380 421164 02380 436880 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) G & A Investments Projects Ltd Mrs Linda Kay Sansome Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21) of places Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Beechwood House Residential Homes cares for and supports elderly people with dementia. The home has recently change ownership to Mr Allan of Green & A Investment Projects LTD in November 2006, the previous registered manager and 90 of the staff still continues to work in the home. Beechwood House is situated in Woolston a small village on the outskirts of Southampton City, and is situated to local community facilities. The fees range from £420 - £440. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit formed part of the key inspection process and by Mrs C Walsh regulatory inspector. The visit commenced at 09:30 and ended at 17.00 and the home did not know we were visiting. As part of the process Mrs Walsh met with the registered manager, staff, spoke with residents and a visiting relative. Eight weeks prior to the visit the manager was provided with comment cards for residents, relatives, staff and health care professionals, these form part of the key inspection process and assists the inspector to form an overview of the standard of care provided within the home, however none were received. What the service does well:
Beechwood House does well to ensure that it can meet the needs of new residents to the home by undertaking a thorough assessment prior to the them moving in, it then continues to monitor and assess their needs to ensure they can continue to support them. Each resident has a personal plan that details their specific health and welfare needs, identifying their strengths and the areas of support they need. The plans also include their hobbies, interests, social and spiritual needs providing staff with information to provide a continuity of care. Each resident’s health care needs, including historical, current medical and mental health care needs are well met and clearly recorded in their personal plans. The home is well supported by health care professionals including GP’s, community psychiatric nurses (CPN’S) and the preferred memory clinics. A resident said: “When I am not feeling well the home will call my doctor for me” A relative said: “The home has been very good to mum, when she has been unwell they have always let us know and makes sure she gets the right care”. The home supports residents with their medication, providing a safe place for it to be stored and administered by trained staff. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 6 The residents are supported to maintain contact with family and friends and visitors are made very welcome. The residents have access to a phone and can call their family and friends when they wish or have a staff member do this on their behalf. The home has a designated cook who cooks all meals from fresh; the meals are wholesome and well balanced. The residents have their nutritional needs assessed and special diets are catered for. A resident said: “The meals here are lovely” A relative said: “There always appears to be something good on the menu and it smells good too!” The people who use the service live in a spacious, bright, airy and wellmaintained environment. The bedrooms are spacious and in the main are single rooms, some which have en suite facilities. The bedrooms are personalised and reflect the character of the person who uses it. The garden is large, secure and well used in the warmer months. The home has enough staff to meet the current numbers and needs of the residents. Staff are encouraged to improve they’re skills by undertaking a National Vocational Qualification (NVQ) and are provided with regular mandatory training such as the fire safety and food hygiene. A member of staff said: “We receive regular and good training here”. The people who use the service are safeguarded against potential abuse by good recruitment procedures and checking that prospective staff do not have a criminal record or have been placed on the Protection of Vulnerable Adults (POVA) register. The home is in the process of a number of significant changes that will improve the quality of service for the residents, this includes seeking the joint and individual views of residents, relatives and staff, appropriately safeguarding they’re finances and as far as feasibly possible providing a safe environment for the residents to live. In order to meet these responsibilities the manager is deploying some of them amongst her staff. This is seen as good practice and will allow the manager to focus her responsibilities such as supervising and appraising staff and will give the staff a sense of empowerment. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
Beechwood does well to obtain important and specific information on the residents but it could do better to fully complete them and make the information more accessible for staff. The home has good systems in place for the administration of medication, however the failure to safely store topical lotions and to check they are still usable following a certain date places the residents at potential risk of harm. Despite good evidence recorded in care plans for promoting the residents’ independence, dignity, privacy and respect, residents saying they felt well cared for and staff feeding back the right way to treat the residents, there was little evidence in the performance of staff that this was being carried out. Authoritive tones, limited communication and inappropriate actions of some staff are of a concern, this was discussed with the manager at the time of the visit. The manager was informed that she must consider how she can assure herself that staff are carrying out they’re roles and responsibilities as required using best practice and safeguarding approaches at all times. The home offers a range of activities for the residents including board games and inviting outside entertainers into the home. But to ensure the residents receive appropriate stimulation that meets their needs, their lifestyles and preferred choices and expectations the home must consider using additional forms of stimulation tailored to their individual needs and choices. The home has a robust policies and procedures on dealing with complaints and provides the people who use the service with a complaints procedure. But the home must consider how residents with moderate to severe dementia can have their concerns heard and actioned upon. A stair lift, hoists and other mobility aids assist the residents to move safely around the home. But the lack of communication aids and thought of the needs of residents with dementia the promotion and maintenance of their independence is restricted.
Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 8 In the main the home protects the residents from the risk of cross infection and contagious diseases, but lack the lack of cleaning hours and the poor standard of cleanliness places residents at potential risk of ill health. Despite the manager undertaking good recruitment procedures and providing basic training for them staff the manager does not appropriately induct new staff and must provide her with sufficient and specific training in dementia care, challenging behaviour and abuse awareness which is required in the respect of the residents the home supports. The new changes have taken some of the manager’s focus away from the dayto-day running of the home and supervision of her staff allowing some bad practices to go unnoticed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechwood Residential Care DS0000069020.V332303.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 Beechwood Residential Care DS0000069020.V332303.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): 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service currently do not have up to date contracts detailing their terms and conditions under the new provider. The home assesses the needs of prospective residents prior to them moving into the home to make sure it can meet their personal needs. The home does not provide intermediate care. EVIDENCE: As part of the inspection process assessment plans for three residents were viewed, and the manager, relative, resident and staff were spoken with. The manager said that the new provider will issue each resident with a new contract in the very near future, the contracts are currently under review and waiting approval by the new providers solicitor.
Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 11 Three assessment records were viewed and the manager talked through the process of gaining and recording the information. The document includes obtaining personal information on the resident’s health, welfare, physical and psychological needs and indicates where the area of support is required. In addition the manager has worked with a community psychiatric nurse (CPN) and developed a specific dementia assessment document which focuses on the residents behaviours, routines and life history, however the manager is advised to consider detailing the residents personality and life history on the front page in place of the residents particular behaviours as this detracts from the person. The manager discussed the assessment process from referral to the resident visiting the home, which includes the family and the family being advised to bring in familiar items to assist the residents transition. The manager also said that she will call upon health care professionals to assist with the assessment of the resident if required. A relative said that she recalls her mother being assessed prior to moving into the home and reassessed following a long hospital confinement. She went on to say that following the reassessment the home made specific environmental arrangements and altered the residents personal plans to reflect additional needs. The home does not provide intermediate care. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. The basic health and welfare needs of the residents are generally met, however some improvements to the administration of medication is needed. Residents’ rights, respect, privacy and dignity are not fully upheld by those working in the home. EVIDENCE: As part of the inspection process the personal plans and medication records of three residents were viewed, the manager and her staff were observed going about their daily duties and the manager, a relative, two residents and staff were spoken with. Three residents personal plans were viewed and provide information and detail of the residents’ strengths and needs, clearly informing the staff how the resident wish to have their care needs provided for. The planning documentation requests information on the resident likes, dislikes, social, spiritual and hobbies and interests. Although in the main this information was
Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 13 completed the manager must ensure all areas of the plans are fully completed to ensure staff have an awareness and understanding of the holistic needs of the residents. A resident said: “The staff know what I can do for myself and are very good at helping me when I need help”. The residents’ personal files contain valuable information but the day to day information the staff require to assist them to support the residents is lost within other documents and is not easily accessible for staff. To ensure a continuity of care is consistently provided the manager must consider how to make the care plans more accessible to staff. The home has good systems in place for the safe administration and storage of medication. The home uses a monitored dossett system provided by a wellknown high street pharmacy. Records demonstrate that staff are administering medication to the right person, at the right time and dose. Staff said and their training records confirmed that they had received training from the dispensing pharmacist. Through the course of touring the home a number of topical creams were found left out and dated 2005 and 2006, to ensure the safety and wellbeing of the residents the manager must ensure all medicines including topical medications are safely stored away at all times and must check the life span of creams with the pharmacist. The manager was informed that she must have “as required” (PRN) care plans in place to ensure staff are only administering medications when the resident requires it, this is especially important for residents with dementia and those who present with challenging behaviour. The residents care plans are written in a way that informs the staff to consider the rights, privacy and dignity of the residents. A resident and relative said they are treated with respect: A resident said: “The staff are lovely they always treat me with kindness and respect” A relative said: The staff are very good. They are always polite and helpful” However this practice was not observed through the course of the visit. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 14 In one residents care plans it stated the resident was keen on home cooking, daily notes recorded how the same resident became agitated and abusive when she could not go into the kitchen, a risk assessment had not been completed to confirm she would be at risk if she entered the kitchen, therefore the residents wish and right to enter the kitchen is being denied. The same resident was spoken to very loudly and in a dictatorial fashion to sit down and wait for lunch like every one else. The carer later reported that the same resident had pushed her. This approach denies the resident the right to express their individuality and demonstrates that the home is not considering the diverse needs of the residents. Staff spoke loudly to residents when asking if they wished to use the bathroom. This denies the residents their privacy and dignity. A member of staff proceeded to undress a resident in the lounge in front of others. Again this denies the resident the right to privacy, dignity and respect. It was later established that the member of staff had been working in the home for two weeks but an in house induction had not fully taken place, the second element in the induction programme focuses on the importance of dignity, privacy, respect, choice and independence. A resident was asked in an authoritative manner to stand up, whilst the carer stood over her putting on disposable gloves. No explanation was given why she had to stand up or that a doctor had come to see her. This demonstrates no regard or respect for the resident. Personal information of residents was left in easy reach of others. These areas of concern were discussed at length with the manager who said she would deal with the concerns as a matter of priority. However the manager must consider how she will ensure her staff are fully aware of the consequences of their actions and how she intends to monitor staff performance in the future. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 15 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, and15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home supports residents to maintain contact with their family and friends and receive a wholesome and well balanced diet. But the home currently does little to provide experiences that reflect the lifestyle residents had before moving into the home, including social, cultural, religious and recreational interests. Residents have limited opportunities to make choices, which limits the control over their lives. EVIDENCE: As part of the inspection process information (Pre inspection Questionnaire) provided to the Commission for Social Care Inspection by the home prior to visiting the home was viewed, including menu plans and activity arrangements. These were also viewed at the item of the visit as well as observing the daily routines, speaking with residents, staff and relatives.
Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 16 The home offers a number of activities for the residents, which includes outside entertainers and activites organised by staff such as board games and hand massages. Some of the ladies had newly painted nails and said they enjoyed this time with the staff. The manager said how she is planning to introduce an activity co coordinator amongst the staff so better planned and organised activites could take place. The residents personal plans provide information on the residents preferred activities and how they would like to spend they’re day, but there was little evidence to demonstrate that the preferred activites were taking place as demonstrated earlier when the resident was denied access to the kitchen and through an hours observation after lunch residents were only being stimulate by a local radio stations that was loud and did not appear to appeal to the residents. But the home currently does little to provide experiences that reflect the lifestyle residents had before moving into the home, including social, cultural, religious and recreational interests. Residents have limited opportunities to make choices, which limits the control over their lives. Staff did not engage with residents within this period except to tell them to sit down or they couldn’t do something. Residents can spend the day in their room and eat in their meals in room if they wish. The manager said they do encourage the residents to spend time in the communal areas of the home as well. A resident said: “The staff are very kind, they come and see if I am alright and spend time with me if they can”. A relative said: “The staff are very good and do what they can but I would like to see more activity taking place with the residents, the residents just don’t seem to be stimulated enough”. Of the three residents plans viewed only one stated the residents preferred choice of religion, a resident and relative who was spoken with said they could not recall being asked what their and their relatives choice of religion was. The concerns identified at the time of the visit were addressed and discussed at length with the manager. The manager must use a person centred Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 17 approach when planning activities and providing choices, taking into account they’re needs and wishes and they’re level of cognitive and sensory function. The residents sensory and cognitive disabilities in some cases prevents them from making choices about such matters such as, how they would like to spend their day, what they would like to do and when, what to wear and eat. The home currently does not fully assist residents to make choices as limited communication methods and the environment does not empower residents to do so. The manager must consider how this can be improved and ensure her staff receive training. During the visit the residents were observed recieving regular hot and cold drinks, snacks and enjoying a chicken casserole at lunchtime. The residents receive four meals a day, which includes supper. The home has recently employed a new cook who enjoys cooking foods from fresh and dislikes using packet foods and sauces. The cook said she will in time get to know all the residents likes and dislikes but currently is relying on staff to let her know. She said that she is aware of the needs of residents with special diets such as diabetes or soft diets but again will always speak with staff to clarify this. There was evidence that residents receive a nutritional assessment and staff undertake training in nutrition for the elderly and food hygiene. A resident said: “The meals are very good here, I enjoy them very much”. Another said: “The staff know I am not a big eater so they don’t overload my plate”. The manager said the cook will be attending a refresher training in food hygiene and there is on going training for staff in the area of food hygiene, safety and nutrition. The manager was advised of the importance of keeping the kitchen clean and checks on temperatures of food stored and cooked kept. All cupboards, fridges, draws and the cooker hood are in need of a thorough clean and tidy to reduce the risk of contamination. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. In the main the people who use the service are confident that they have their complaints listened to and acted upon. But the home must consider the cognitive and sensory disabilities of those residents who have dementia. In the main the home protects the people who use the service from the potential risk of harm, but staff need further training to fully understand they’re roles and responsibilities. EVIDENCE: As part of the inspection process the homes new complaints procedure and staff training records were viewed and residents, relatives, the manager and staff were spoken with. The manager provided documentation and policies to demonstrate that the home has sound procedures in place to follow in the event of receiving a complaint. The manager said she has since learnt how to appropriately deal with complaints following a serious complaint and makes herself available at all times. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 19 The staff spoken with at the time of the visit said they know what to do if they receive a complaint and would report it instantly to the manager. The manager said staff have recently been informed of and shown the new documentation on recording the nature of the complaint, the complainant, the action taken and outcomes. A relative who was spoken with said that the home complaint procedures had appeared to improve, and residents who were able to converse said they would speak with a member of staff or the manager if they were unhappy about something. The home has policies and procedures on the protection of vulnerable adults and there is evidence that staff have received training. But through the course of the visit, observation and a discussion with a member of staff, it appeared the staff are not fully aware of what constitutes abuse and how to support residents who challenge, therefore the manager must consider how she can make sure her staff are fully aware of the various types of abuse and are carrying out their roles and responsibilities to safeguard the residents from potential harm. The member of staff did not consider her actions earlier in the day when she spoke to a resident in an authoritative and loud tone as wrong. This was brought to the manager’s attention who said she would deal with it as a matter as priority. The manager was also reminded to consider if this is what is happening when she and an inspector is around what might be happening when she it not. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 20 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, 22, 23 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service live in a comfortable well furnished and well maintained home. But limited sensory equipment and poor cleaning practices inhibits independence and places residents’ health at risk. EVIDENCE: As part of the inspection process a tour of the building was done with the support of the manager, a number of residents rooms were sampled and residents were spoken with about their views of they’re bedrooms. The home has recently been purchased by a new provider who has plans to refurbish the building throughout, new carpets, furniture and soft furnishings
Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 21 have already been laid and placed on order, this is seen as a positive move as many of the rooms are in need of decoration and refurbishment. The home is spacious, and large windows provide a bright and airy feel to communal and residents bedrooms. The home has two lounges; a separate dining room and ample toilet and bathing facilities within easy reach for the residents and has a large secure garden, which is widely used in the warmer months. The first floor is accessed by a stair lift and the home has specialist equipment to assist residents to access toilets and bathrooms. But the home has paid little attention to the cognitive and sensory needs of residents with dementia, which prevents residents from maintaining their independence. The home has good policies and procedures for minimising the risk of cross infection and staff have received training. Staff are issued with appropriate clothing and antibacterial gels and paper towels are in use throughout the home. The manager said that they are asking relatives to kindly bring in liquid soap to avoid using bars which have been identified as a potential source of cross infection. The home has twelve single rooms, three with en suite facilities and four double rooms that do not have en suite facilities. All the rooms are personalised with the residents personal belongings and although neat and tidy some of the rooms are looking tired and in needs of redecoration and refurbishment. The manager confirmed that this was on the agenda and new furniture, curtains and carpets are on order. The poor standard of cleanliness of the home such dusty and dirty radiators, skirting boards, hoisting equipment and an unclean and untidy kitchen were brought to the manager’s attention. The manager said that the home had been without a cleaner and the staff were currently carrying out the cleaning chores, but a newly appointed cleaner would be starting soon. The home does its best to prevent unpleasant smells and works with a continence advisor for advice on managing continence needs. But the manager must consider alternative floor coverings in the bedroom identified at the time of the visit to minimise the risk of bad odours occurring. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. The people who use the service have they’re needs met by sufficient numbers of staff who receive regular training and who have been recruited using robust procedures. However given the staff’s poor performance in respect of maintaining residents dignity and privacy and understanding the complex needs of the residents the staff would benefit from further and specific training in dementia care and the principles of care. EVIDENCE: As part of the inspection process the staff duty rota, recruitment and training records were viewed and the staff and manager were spoken with. At the time of the visit there were three carers, the manager and a cook on duty and the duty rota showed that there would be three carers in the evening and two at night. The staff were observed going about they’re roles and responsibilities in an unhurried and relaxed way, however there was evidence of an over firm manner and severe tone when talking to residents that demonstrates a lack of competency to meet the needs of the residents beyond physical care.
Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 23 Later in the day staff were observed interacting with the residents, but further interaction with residents could have been made after the lunchtime meal where the residents were observed left alone for approximately fifteen minutes before a carer entered the room, this carer did not interact with the residents but to check everything was okay. The manager said in the main she has had a static staff team for approximately two years who are very hard working and dedicated to the residents. The homes staff team is mainly made up of European staff who speak good English and only allowed to speak English whilst working. A resident said: “The girls are lovely, they are very hard working” A relative said: “They all seem very nice and mum seems to like them”. 90 of the staff have a national vocational qualification (NVQ) in care and some carers have a nursing qualification obtained in their home country but are none practicing. The manager said she and the company are dedicated to ensuring their staff have the right qualifications to support the work that they do including regular mandatory training which includes moving and handling, first aid and food hygiene. Staff also receive service specific training such as abuse and dementia. But through observation throughout the day it was identified that residents would benefit further from staff receiving specific training in dementia care, challenging behaviour, dignity, privacy, respect and abuse awareness. A member of staff said: “We receive regular training and it is good, we recently had fire training followed by a full evacuation”. The home has an induction programme to support new staff to gain awareness of their roles and responsibilities using a time scaled approach and in line with the Skills for Care Council. The induction details for a new member of staff identified that they had only been shown fire safety systems despite working in the home for several weeks, the second page of the induction programme provides staff with information of the principles of care including the values such as privacy, dignity and respect. The manager was informed she must ensure that the induction is carried out as authorised by the Skills for Care Council.
Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 24 The manager said she has recently employed a carer and a cleaner but was currently waiting for their protection of vulnerable adults (POVA) and criminal record bureau (CRB) checks to come through, this demonstrates that the manager undertakes a good recruitment process and ensures records are in place before staff commence working with the residents. This was also confirmed by staff who recalled completing an application form, attending an interview and providing references. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 25 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, 36 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are generally safeguarded. Residents live in a home that endeavours to meet their needs, however the manager must improve the competency and attitude of staff through training and supervision to ensure residents needs are met in full. Resources specific for those residents with dementia including environment, social activities and interests must be improved. EVIDENCE: Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 26 As part of the inspection process health and safety records, records of residents’ monies held and homes quality auditing documentation were viewed and the manager and staff were spoken with. The manager spoke of the recent take over of the new provider and the implantation of new documentation and polices and procedures. The manager spoke positively of the changes and the level of support she is now recieving, but also of the time constraints and how some areas of her responsibilities have lapsed recently such as staff supervisions. The manager spoke of a recent meeting she has had with her senior staff and how she is now planning to discharge some of her responsibilities to them, such as fire marshalling, the administration of medication from ordering to returning unwanted medications and an activity coordinator to name a few. This is seen as good practice and will allow the manager more time dedicated to inducting and regularly formally and informally supervise staff, which she admitted to falling behind with. The manager said as part of her responsibilities she is currently quality auditing the service with the use of a comprehensive quality audit tool, this includes carrying out residents meetings, staff meetings, staff supervision and appraisals and undertaking a quality questionnaire with the residents. With the assistance of the new providers the manager has developed a yearly plan detailing the actions with specific timescales of works and administration duties to be done. The home will support and provide a safe place for resident’s personal spending money to be held. Records seen demonstrate that the manager is very careful to ensure all residents monies are kept safe and accounted for at all times. The home does not have appointee ship for any one living in the home and prefers that resident’s relatives/representatives manager their financial affairs. The home takes seriously the need to ensure that it provides as far as feasibly possible a safe environment for the residents to live. Staff undergo health and safety training including fire safety, food hygiene, infection control, moving and handling and first aid. The manager provided evidence that all serviceable utilities are regularly checked and serviced and fire fighting equipment and drills are undertaken as required by the fire safety regulations. The manager is aware of the new fire safety legislation and produced evidence that a recent risk assessment had been undertaken. Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 27 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X 2 3 X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement To ensure the people who use the service are safeguarded from potential risk of harm medications such as topical creams, these must be safely stored away. The life shelf of opened creams must be checked with the pharmacist. Care plans must be in place for all residents who receive “As required” medications to ensure staff know when to give it. 2 OP10 12(4)(a) To ensure the people who use 30/05/07 the service are treated with dignity, privacy and respect at all times. To ensure people who use the service are afforded their rights and have their preferred lifestyle respected the home must provide opportunities for stimulating group and individually based activites and experiences.
DS0000069020.V332303.R01.S.doc Timescale for action 30/05/07 3 OP12 OP14 12(3) 16(2)(m) 30/06/07 Beechwood Residential Care Version 5.2 Page 29 4 OP16 22(2)(6) People who use the service with cognitive and sensory disabilities must be provided with support and appropriate information in an excessive format to assist them to express their concerns. To ensure the people who use the service are safeguarded from abuse the manager must make sure staff receive additional training and she must regularly observe practices in the home. To enable the residents with dementia to move independently and safely around the home the manager must review their needs and adapt the environment appropriately. 30/06/07 5 OP18 13(6) 07/05/07 6 OP22 23(1)(a) 23(2)(a) 31/08/07 7 OP19 23(1)(d) 16(2)(j) People who use the service must 07/05/07 be provided with a clean and tidy environment to live in. Including the kitchen, moving and handling equipment and the guarded radiators. Arrangements must be made to eliminate offensive odours occurring in the room identified at the time of the visit. Staff must receive training in managing challenging behaviour and further specific training in dementia to improve on the care they deliver. Staff must receive a comprehensive and wellmanaged induction programme as set out by the Skills for Care Council before working independently with residents. Staff must receive regular support and supervision to
DS0000069020.V332303.R01.S.doc 8 OP26 16(2)(k) 30/05/07 9 OP30 18(1) (c)(i) 30/06/07 10 OP30 18(1) (c)(i) 30/05/07 11 OP36 18(2) 30/05/07
Version 5.2 Page 30 Beechwood Residential Care ensure they are fully aware of they’re roles and responsibilities. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beechwood Residential Care DS0000069020.V332303.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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
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