Inspection on 01/10/05 for The Beeches

This inspection was carried out on 1st October 2005.

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

The Beeches 17/11/09

The Beeches 15/09/09

The Beeches 10/07/09

The Beeches 02/06/09

The Beeches 26/11/08

The Beeches 29/05/07

The Beeches 06/06/06

The Beeches 24/05/05

The Beeches 04/11/04

The Beeches 18/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Beeches West Harling Road East Harling Norwich Norfolk NR16 2NP Lead Inspector Mrs Judith Huggins Unannounced Inspection 1st October 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Beeches Address West Harling Road East Harling Norwich Norfolk NR16 2NP 01953 717584 01953 717584 beeches03@aol.com 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) The Beeches (East Harling) Ltd Mrs Sheila Ann Kingsmill-Brown Care Home 36 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (36) of places The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate one named person, male, under the age of 65 years and with dementia, until such time as the person reaches 65 years of age or is no longer living at the home. 24th May 2005 Date of last inspection Brief Description of the Service: The Beeches is a large converted house in its own grounds, with an enclosed and private garden to the rear, providing accommodation and personal care to 36 people who are elderly and with mental frailties. There are four shared rooms, the remainder being single rooms. All rooms have en-suite toilets, washbasins and showers or baths. The majority of rooms are on the ground floor. Fees cover personal care, furnished accommodation, light, heat, all meals and drinks, and laundry. Health care services are obtained locally, with residents registering with a local medical practice. A dentist visits and arrangements are made for eyesight and hearing tests as need be. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced, and carried out from 9am on a Saturday morning, to see how the home was functioning at a weekend. As such, there may be some requirements from the last inspection that were not fully checked and may not be repeated until a future inspection. Six staff and three residents were spoken to. It was difficult for some of the residents to express their views clearly, due to the levels of confusion shown. Care records for four people, and a sample of other records including those for medication were examined. A tour of communal areas of the home was undertaken. What the service does well: What has improved since the last inspection? A new carpet has been provided to the front hall and stairs, and outside the home, the wall to the corner has been repaired. Some work has been undertaken to improve the frequency of review of assessments underpinning the care plan process, and there was an improvement in the range of information gathered about prospective residents before planned admissions are made. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 Individual plans do not clearly set out the current care needs of residents, so that staff can meet residents’ care needs properly. Residents are not protected by the way that medication is dealt with in the home and are at risk of not receiving proper medical treatment. Residents are treated with dignity and respect on most occasions. EVIDENCE: There were inconsistencies in the assessments and care plan goals, and care records seen. For example, two current assessments on one file variably describe the person’s appetite as “poor” and weight below average. A second and current assessment of nutrition describes the same person’s appetite as average. Where people’s weight is noted as below average, and appetite as poor, there is no clear instruction for staff about how this is to be addressed. One person’s personal care needs have not been updated clearly despite an annotation by the manager in September that the person is now bed bound and needs total care. This is not reflected in care plan goals. The moving and handling care plan for the person has not been reviewed since August, and the The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 10 moving and handling assessment set up in February 2004 was last reviewed in June 2005. There is no goal for the person to maintain skin integrity, personal hygiene, or what is adequate fluid and dietary intake, and the one set of documents refer to the person not being left unattended in the bath or when on the bath hoist, despite the manager stating they are bed-bound. Where reviews have taken place these record “no change” where daily notes and other records show that there has been a deterioration (as above). Care plan goals do not clearly set out what staff are expected to do to assist in achieving them, and daily notes do not show care delivered to meet goals. One person asked was unsure where the care plans were located, and relied on daily notes alone. Neither Life histories nor communication plans have been completed for all residents. These are essential for those who are becoming increasingly confused. There are omissions from records of administration of medication where it is not possible to determine whether the medication was given as prescribed, refused or withheld for some reason. This is particularly noted where medication is supplied in boxes or bottles and not in the monitored dosage cassettes. Medication prescribed for routine administration, that is not specified as “when needed” on the doctors prescription, is frequently coded as “not required”. Medication of limited shelf life, for example eye drops, is not always dated on opening. Antibiotics obtained for infection are not always administered promptly on receipt. For example one obtained and recorded as received on 27th September was not administered until 6pm on 28th September. Records of one medication show receipt of 28 tablets, 21 remaining and with 6 doses signed, one illegible on the first day, one coded “O” for other, and with additional missing signatures but with staff asserting it was given on occasions when it had not been recorded. The balance does not therefore tally. The use of the letter “O” for “Other” on MAR charts is not explained with the reason indicating the medication was not given. One person prescribed a weekly treatment for osteoporosis/bone loss had this first due on 23rd September. On that day the code “O” was entered with the annotation that the person had difficulty swallowing. The tablet remained in the pack indicating it had not been offered, to see whether the person could swallow, and there was no clear record of follow up discussion with the GP to The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 11 see whether an alternative easy to swallow version was available, whether they should persist with the existing prescription or take other action. In the bottom of the medicine trolley, a one pound jam jar was half full of mixed tablets for disposal, despite the pharmacy delivery of medication in weekly lots. In one monitored dosage pack tablets remained for a lunchtime administration earlier in the week, when the MAR chart indicated they had been given. Two boxes of the same medication were contained in the trolley for one person, both started, and with an incorrect total on the MAR chart recording the amount held. (The balance on the record was shown as 23. There were 13 in one box and 21 in the other, with regular morning doses signed as given meaning that the total of 23 could not have been accurate.) All staff spoken to were aware of the importance of ensuring privacy and treating residents with dignity. All considered that this was generally upheld although one person spoken to felt that there are one or two staff who are not so good at doing so. It was considered that the manager would not be aware of this as her presence would ensure good practice operated. During the inspection staff were noted as gentle in their hoisting, guidance and support when assisting residents. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Residents are helped to exercise choice. EVIDENCE: It was difficult to fully determine the extent of choice as residents seen were very confused. However, it was evident from observation that residents could choose where to eat their meals, with the lounge, small sitting area outside the lounge, and dining room all being in use. Notes show that while routine is encouraged, there is some flexibility for when residents wish to rise or retire. Residents rooms show that they are able to bring in some personal possessions from home. Exploration of advocacy or other legal representation could not be verified in the absence of the manager. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None. Standard 18 was inspected at the last inspection. Standard 16 could not be fully inspected due to lack of access of information from the manager regarding complaints investigations undertaken. EVIDENCE: The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Routine maintenance needs to improve if residents are to live in a wholly “well maintained environment.” While generally clean, areas of the home had an unpleasant odour. EVIDENCE: The environment was not inspected in full, but some requirements made at the last inspection had not been met. The courtyard door from the reminiscence room has not been replaced. The room will not be warm, usable and draught free during the forthcoming winter if this is not addressed. This has been the subject of repeated requirements over several inspections and renders the registered persons liable for enforcement action. Since the last inspection bolts have been fitted to the outside of some of the WC/bathing facilities. This is despite requirement in the past that this type of fastener be removed from the exterior of residents’ accommodation as they were open to abuse. Residents would not be able to open these doors from The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 15 inside. If it is necessary to secure rooms when floors are wet, on a temporary basis, then the normal engaged/vacent privacy bolts could be used. Despite previous requirements (outstanding for more than one inspection) no privacy bolt has been fitted to the assisted bathroom. This renders the registered persons liable for enforcement action. No action has been taken to increase the lighting in the dim back corridor. The hot water supply to all showers has not been reinstated as required at the last and some previous inspections. The requirement made was not met and has therefore been repeated. There were areas of the home where there were significant odours associated with difficulties in managing continence, although the appearance of areas seen was clean. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Residents needs were not fully met by the numbers and skill mix of staff, although emergency cover was in place. It was not possible to fully inspect other standards given the absence of the manager and access to confidential staffing records. EVIDENCE: The duty roster for the day showed that there were to have been sufficient staff on duty. However, the cook’s shifts had not been covered and the person who was to be leading the shift was having to prepare the main meal. A second person had assumed responsibility for the organisation of the shift, and the person who had completed the waking night shift stayed on until after lunch. This latter does present concerns for the overall stress and occupational health of the person covering this number of hours, although a senior member of staff on duty reported that this was not a usual occurrence and staff providing additional cover were not normally asked to do so by following a waking night shift with an early shift. There was a mixture of experienced and new staff on duty. One of the new members of staff was interviewed and had a clear understanding of what was expected in terms of the home’s routine and the delivery of personal care. (What was of concern was the lack of awareness of staff working at the home about the content of care plans within which they were expected to work. This The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 17 was compounded by the labelling of the file for daily notes which referred to care plans.) As at the last inspection, consistent comment was made to the inspector about the confidence of staff in one member of senior staff not currently on shift, who was felt to “flap” when under pressure and not to be clear in delegating properly and consistently, taking into account the individual workload of each staff member. Staff did not feel confident that an emergency would be dealt with properly when this person was in charge. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 The home is managed and run on a day-to-day basis, by a person fit to be in charge, although there are concerns regarding maintenance of good relationships with staff by the owner. It was not possible to examine other key standards in the absence of the registered persons. EVIDENCE: The manager has registered with the Commission, ensured that she has participated in training (one certificate seen displayed and other training discussed at previous inspections). Although not present, it is known from previous inspections that she is working towards the registered manager’s award, and that she is a qualified nurse from her registration application. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 19 Staff members commented that the person operating the home and providing staff accommodation, had provided contracts for employment but not tenancy agreements in respect of the accommodation supplied. The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 20 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 21 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 12(1) 15(1) Requirement The registered persons must ensure that care plans specify exactly the things staff need to do to assist residents to meet the specified aims. The registered persons must ensure that assessments are consistent with one another and reflect current needs and abilities. The registered persons must ensure that care plans and assessments are reviewed at least once each month and more often where needs change. The registered persons must ensure that care actually delivered and recorded is in accordance with the plans. The registered persons must ensure that all care staff are involved in and aware of the care planning process. The registered persons must ensure that full, accurate and contemporaneous records are made of all medication administered, refused or withheld. DS0000027451.V249954.R01.S.doc Timescale for action 31/10/05 2 OP7 10(1) 12(1) 14 31/10/05 3 OP7 12(1) 13(4) 14(2) 12(1) 13/10/05 4 OP7 30/11/05 5 OP7 12(1) 15(1) 18(1) 13(2) 7(1) Sched 3 30/11/05 6 OP9 31/10/05 The Beeches Version 5.0 Page 22 7 OP9 12(1) 13(1) 13(2) 8 OP9 12(1) 13(1) 13(2) 9 OP9 12(1) 13(1) 13(2) 10 OP9 12(1) 13(1) 13(2) 12(1) 13(1) 13(2) 13(2) 11 OP9 12 OP9 13 OP9 13(2) 14 OP19 23(2) 15 OP19 23(2)(j) The registered persons must ensure that medication prescribed for daily administration as recorded on MAR charts, (and not “PRN”) is administered/offered as prescribed. The registered persons must ensure that medication with limited shelf life, such as eye drops, is dated on opening to ensure it remains safe and effective in use. The registered persons must ensure that medication prescribed is administered at the first available opportunity on receipt, and in accordance with the prescription. The registered persons must ensure that medication not in monitored dosage cassettes is administered as prescribed. The registered persons must ensure that, if residents have difficulty swallowing a medication, this is followed up with the GP. The registered persons must make arrangements for the prompt and safe disposal of wasted medication. The registered persons must ensure that amounts received, administered and disposed of are fully and accurately recorded to ensure there is no mishandling of medicines. The registered persons must replace the external door to the reminiscence room/quiet lounge. Outstanding for more than one inspection with last timescale of 31.08.05 unmet. The registered persons must ensure supplies of hot water at or close to 43 degrees Centigrade, to en-suite showers. DS0000027451.V249954.R01.S.doc 31/10/05 31/10/05 31/10/05 31/10/05 31/10/05 31/10/05 31/10/05 13/11/05 13/11/05 The Beeches Version 5.0 Page 23 16 OP19 13(4) 23(2)(p) 17 OP19 13(6) 18 OP21 12(4)(a) 19 OP31 12(5) Oustanding for more than one inspection with last timescale of 30.09.05 unmet. The registered persons must review and increase lighting levels in corridors. Oustanding since last inspection with timescale of 31.07.05 not met. The registered persons must remove bolts from the exterior of WC/bathing facility doors and any other door to facilities used by residents. The registered persons must fit a privacy bolt to the communal bathroom, that can be opened from the outside in an emergency. Outstanding for more than one inspection with last timescale of 30.06.05 unmet. The registered provider must seek advice to see whether there are legal obligations as yet unmet, to staff for whom she provides accommodation. 31/10/05 31/10/05 31/10/05 31/10/05 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 OP7 Good Practice Recommendations The registered persons should progress the assessment information for communication to better reflect the needs of those with dementia. Outstanding from last inspection. The registered persons should ensure that life histories are completed as part of the assessment and care planning process, as these are intergral to good dementia care. Outstanding from last inspection. 2 OP7 The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Beeches DS0000027451.V249954.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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