Inspection on 18/11/08 for Homebeech

This inspection was carried out on 18th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Homebeech 27/07/09

Homebeech 08/01/07

Homebeech 31/01/06

Homebeech 09/08/05

Homebeech 26/01/05

Homebeech 01/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Homebeech 19/21 Stocker Road Bognor Regis West Sussex PO21 2QH Lead Inspector Sheila Gawley Unannounced Inspection 18th November 2008 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 Homebeech DS0000024153.V373306.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. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homebeech Address 19/21 Stocker Road Bognor Regis West Sussex PO21 2QH 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) 01243 823389 01243 841295 homebeech@saffronland.co.uk www.homebeechltd.co.uk Homebeech Ltd Mrs Sarah Boote-Cook Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Physical disability (PD). The maximum number of service users to be accommodated is 66 . Date of last inspection 8th January 2007 Brief Description of the Service: Homebeech is a care home registered to provide accommodation and nursing care for up to 66 people in the categories older people and physical disability. Homebeech Limited owns the home and the responsible individual is Rebecca Jane Page. Mrs Sarah Boote-Cook is the registered manager in charge of the day-to-day running of the home. Homebeech is located in Bognor Regis, close to the seafront, shops and other amenities. It is a large extended property. The majority of rooms have ensuite facilities and are for single occupancy. There is a separate unit forming part of the home known as the Daffodil Suite, which is purpose built for the physically disabled. It has its own communal space, living accommodation and staff complement. Catering and laundry facilities are shared with the main home. Homebeech has two passenger lifts. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This site visit as part of the inspection process was carried out on 18/11/08. A lead inspector from the Commission for Social Care inspection who was accompanied by an Expert by Experience undertook the inspection. An Expert by Experience is a person who, because of their experience of using services, visits a service with an inspector to help give us a picture of what it is like to live in or use the service. Prior to the visit all files held by the commission, complaints and safeguarding issues were reviewed. The home had sent us their Annual Quality Assurance Assessment for the inspection, which gave us the information we needed on the home. We were in receipt of surveys and people who use the service, relatives and staff were spoken to on the day. One person who uses the service stated, They are marvellous here; another stated, The staff are magnificent but are very busy. Several people who use the service have the perception that the home is understaffed and sometimes have to wait when they have rang their call bells. One relative stated, We are happy with the care here Another commented on the lack of care and attention to gastric feeding. One survey commented that there is not enough communication. Several people who use the service commented that the laundry service is not to their satisfaction in that the clothes get damaged or go missing. Staff spoken to on the day stated that they were happy working in the home. Five people who use the service were case tracked during the inspection and all records relating to them were inspected and they were spoken to. The premises were toured. The registered manager facilitated the inspection and any documents required on the day were made available. The atmosphere within the home was peaceful and relaxed and the staff carried out their duties in a respectful manner taking into account the dignity and privacy of residents. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The statement of purpose needs to be updated. Staff supervision is not up to date. Some carpeting need to be replaced and the paintwork in places is scuffed. People who use the service are generally dissatisfied with the provision of food, items going missing in the laundry and the speed at which call bells are answered. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 7 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. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 8 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 Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 9 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): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service experience good quality in this outcome area because needs are assessed prior to admission but information available needs to be updated. Intermediate care is not provided EVIDENCE: There are new and comprehensive preadmission assessments in place and the registered manager confirmed that all people who use the service are assessed prior to admission. The assessment covers health, personal, medical, nursing and social needs Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 10 There is a statement of purpose in place, which needed to be updated with the new registered managers details. A welcome pack handed to all the people who use the service during the inspection needed to be updated with the name and contact details of the Commission. This was done on the day. Homebeech DS0000024153.V373306.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): 7-9,10 People who use the service experience adequate quality outcomes in this area because needs are assessed, set out in a plan and met, but sometimes there is error or delay in meeting needs. People who use the service are treated with respect. Medicines are handled safely according to policy. This judgement has been made using available evidence including a visit to this service EVIDENCE: All residents had a plan of care. Five people who use the service were case tracked, their care plans were inspected and these contained information on health, personal, nursing and social need. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 12 The care plans are drawn up following an assessment of needs. This included personal hygiene, mobility, skin and pressure areas, continence and elimination, mental health, physical and social need, dietary needs, mobility, hygiene, continence, and daytime routines. There are plans to update the care planning to a computer system. Risk assessment was seen in relation to the use of bed rails. People access health services via the local general practitioner. People have the aids and equipment they need such as wheelchairs and hoists, some rooms have overhead track hoists. One relative commented on a survey that staff sometimes are unaware that his relative in the home should be fed via a gastric tube and is offered food orally. This is unsafe. This was not witnessed on the day of the inspection and was discussed with the registered manager who said she and been aware of this occurring and that staff have since then been given training on nutrition and gastric tube feeding. The survey also stated that the machine used to administer the feed is not always clean. Machines observed on the day were not dirty. The home has policies and procedures in place for the safe handling of medicines. There are also the guidelines of the Royal Pharmaceutical Society and the Nursing and midwifery Council available. The home is supported in this by the local pharmacy who carries out audits and provides training. There were no requirements from the pharmacy inspection of 26/06/07 which was carried because concerns had been raised with the Commission on the handling of medicines in the home. On this occasion medicines were found to be received, stored, administered, recorded and returned correctly. Medicine administration charts were up to date. Two fridges are available for medicines, one was found to have food in it, which the registered manager had removed immediately. Care needs are met with respect and dignity, The expert by experience reported that she observed staff knocking on doors, treating the residents with respect, moving people safely using footplates and one carer asked a resident to fold his arms whilst using a wheelchair, so they would not get knocked in the corridors. Some people who use the service told us that they sometimes have to wait when they use their call bells. Another told the expert by experience that We have a moan at meetings but there is no sort of improvement. Another person who uses the service stated sometimes they’re very quick, sometimes it’s a long time.’ the expert by experience was told by a person Sometimes the bells are not answered for 20 minutes. She also observed One resident who had asked to ‘go to the loo’ after lunch but had to wait for 30 minutes before two carers could assist her. These delays were discussed with the Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 13 registered manager who stated that these delays occurred typically at handover and that she would address this with staff. Homebeech DS0000024153.V373306.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): 12-15 People who use the service experience adequate quality outcomes in this area because the life style in the home mostly meets the expectations of the people who use the service. People are not, however entirely happy with the food provided and requests for a lock on a bedroom door have been unmet. This judgement has been made using available evidence including a visit to this service EVIDENCE: The main objective of the Expert by Experience was to look at how the staff maintain and promote residents dignity, independence and respect: in terms of the environment, the appearance of people who use the service and laundry. Therefore she focused her time in the home in the living and dining areas of the home. She also spoke to people who use the service in their bedrooms. She observed staff knocking on doors, treating the residents with respect, using footplates and one carer asking a resident to fold his arms whilst using a wheelchair, so they would not get knocked in the corridor. All residents had a drink and sometimes a jug of water to hand. One gentleman was on his 3rd respite visit and said, ‘I have no complaints; otherwise I wouldn’t keep Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 15 coming back. I am quite happy and have no problems with the staff.’ There are not locks on bedroom doors and one person who use the service stated that he had asked many times for a lock to his room but this had not been provided. This was discussed with the registered manager. This will be a requirement of this inspection. The expert reported this on activities The home has an ex-long-serving carer in the home who in the last 2 years has been responsible for activities in the lounge area from 10 30-14 30, 5 days a week. She said, ‘I get to know what they like.’ She organizes flower-arranging which she said ‘the residents find easy’, cards, hoopla, chair exercises, bingo and arts and craft which several of the residents were doing during the inspection. They were painting Christmas plates. The ‘activities-lady’ had bought for two of the residents small toy pets, which I saw them cuddling. One resident who had never left his room in the past now enjoyed coming into the lounge during the day and was seen sitting listening to music. There were notices in the hall about: monthly Holy Communion Services which I was told are popular, a choir coming on 18th Dec, and a Quiz for relations and staff. A mobile shop came around weekly with toiletries etc. Visiting singers or musicians also come to the home. One lady said, ‘I like the couple who do the sing-a-longs’. The expect by experience also established that there is a four week rolling menu with choice offered each day. The choice in puddings was limited and one person who does not like puddings used to get offered nice cheeses but now only gets cheddar. Another said ‘We don’t get a lot of fruit, fresh fruit salad would be nice.’ Most people were happy with their lunch and had enjoyed it. In the kitchen stores there was not a lot of fresh food in evidence, apart from mushrooms, some small pumpkins, which were not going to be used, a cabbage and a few pieces of fruit. Residents are given a choice of meals in the morning and if neither choice is wanted, the assistant chef will make a sandwich or alternative. One person who is vegetarian said, ‘ I have awful trouble with the food. They try their best but I’ve had to resort to eating fish as the other things are a bit boring Meals were served on a tray with a paper napkin, at the tables in the small dining-area. One person complained that when the drinks came round at 3pm, sometimes the trolleys didn’t go to all the rooms in the Daffodil Wing. This was brought to the Manager’s attention later. The AQAA stated that the home actively encourages the participation of relatives and they are helping to organise the Christmas fete. Homebeech DS0000024153.V373306.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): 16,18 People who use the service experience adequate quality outcomes in this area because they are protected from abuse but do not feel complaints are listened to. This judgement has been made using available evidence including a visit to this service EVIDENCE: There is a clear complaints procedure which is on display and which is included in the Statement of Purpose and Service User Guide. The procedure clearly identifies to whom a complaint should be addressed to and the timescales taken to deal with complaint. It needs to display the Commissions updated contact details, which the registered manager agreed to do. People who use the service were clear as to whom they can raise concerns with. One relative had complained that her mothers new dressing gown had been lost in the laundry. Not all people who use the service feel complaints will be listed to. Some comments we received were sometimes things are sorted like what time the carers see you’, ‘We have a moan but there’s no sort of improvement’, has complained to no avail that her laundry goes missing and another had lost most of her roll-neck pullovers despite being labelled. The home has agreed to replace one dressing that has gone missing. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 17 There are safeguarding policies and procedures in place and staff have had safeguarding training yesterday. Staff spoken to demonstrated knowledge of the procedures to follow. The providers have fully cooperated with a safeguarding investigation raised regarding pressure area care. The registered manager seeks appropriate advice from the community nursing team on this issue. Homebeech DS0000024153.V373306.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): 19,26 People who use the service experience good quality in this outcome area because they live in a well-maintained homely and relaxed environment with pleasant grounds and garden areas. EVIDENCE: The home was neat and well decorated throughout, although some of the carpeting in the corridor is worn and some of the paintwork is scuffed and worn. The main part of the home has a large sitting room and dining room used by both the people from the main home and those from the Daffodil Suite. There is a maintenance programme. There are plans to convert one bathroom to a shower room. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 19 There are safe well-maintained grounds, which are accessible to people who use the service. We noticed there was an amount of clutter in some areas including wheelchairs, spare furniture, footplates and mattresses. The registered manager stated that this is an issue she is addressing. The premises were clean and hygienic throughout and free from offensive odours. Not all people who use the service feel complaints will be listed to, they feel they have to wait to long to have call bells answered and clothing goes missing in the laundry. There are suitable laundry facilities sited away from areas of food preparation and storage. There are suitable washing machines with the required variable range of temperatures and there is a sluicing facility. Homebeech DS0000024153.V373306.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): 7-30 People who use the service experience adequate quality in this outcome area because people stated that they have to wait to have needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff rotas showed staffing levels, which looked sufficient to meet the needs of residents. However several people who use the service, feel that the home is understaffed and that they have to wait at busy tines to have their call bells answered. Four surveys received from people who use the service did not express any concerns but one expressed concern regarding the management of gastric feeding and another commented on not enough communication from home. The expert by experience reported that not all people who use the service know the names of staff and that not all staff wore name. There is housekeeping, laundry kitchen, and maintenance support There are robust recruitment procedures in place and staff files inspected contained all the documentation required to ensure the protection of people who use the service. There was evidence of application forms with employment history. Criminal Records Bureau Clearance and POVA check, two references, identity documentation and photograph were all in place. The personal identification number of one registered nurse was not up to date. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 21 Staff spoken to all stated that the home is a pleasant and supportive place to work. Three surveys received from staff made positive comments on the home. There is a staff-training programme in place, which covers all mandatory training. Fifteen carers are completing the National Vocational Qualification (NVQ) Level 2. Three have attained the NVQ Level 3 and a further three are completing this. The home operates a key worker system which staff demonstrated an understanding of. Staff were also aware of Whistle blowing procedures. Training on gastric feeding was organised when the registered manager became aware of poor practice in this area. Homebeech DS0000024153.V373306.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): 31,33,35,36,38 People who use the service experience good quality in this outcome area because key national minimum standards are generally met but there are areas for improvement. The newly registered manager is working towards raising standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 23 The registered manager has many years experience in care and has recently met the Commissions criteria to be registered. She has completed the Registered Managers Award. She stated at her fit person interview that she found much disorganisation in the home and that she has been working to address this. Quality assurance systems are being implemented. The home sent us the AQAA when we requested it and it contained the information we needed. There are also residents and relatives meetings; some residents feel that there is little change following these meetings. They feel that their comments on laundry and delays in answering call bells are not addressed. There are annual surveys; the last one was done in August 2008. Staff meetings are not held regularly but as required. Allowances for people who use the service are held securely and are recorded and receipted. Staff supervision is not up to date; the registered manager stated that it is her intention to get this up to date as soon as possible. The registered manager ensures the health and safety of staff by providing mandatory training. Substances hazardous to health were stored correctly. There are contracts in place for the maintenance of gas, electrical and fire safety equipment. Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 24 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 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 2 X 3 2 X 3 Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? 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 OP14 2 OP36 18(2) Standard Regulation 4(A) Requirement The registered provider to provide locks on bedroom doors to ensure the privacy of people who use the service. The registered person to ensure that staff are appropriately supervised. Timescale for action 28/02/09 31/01/09 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 Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Homebeech DS0000024153.V373306.R01.S.doc Version 5.2 Page 27 - 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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