Inspection on 18/05/06 for The Beeches

This inspection was carried out on 18th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 29/09/05

The Beeches 19/04/05

The Beeches 09/11/04

The Beeches 06/05/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

Insight - Eastchurch

Southfields

Magenta

Seabourne House

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

CARE HOMES FOR OLDER PEOPLE Beeches (The) The Beeches Forty Foot Road Leatherhead Surrey KT22 8RN Lead Inspector Sandra Holland Unannounced Inspection 18th May 2006 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beeches (The) DS0000013565.V295476.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. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beeches (The) Address The Beeches Forty Foot Road Leatherhead Surrey KT22 8RN 01372 227540 01372 374564 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) sharon.blackwell@anchor.org Anchor Trust Mrs Linda Ryan Care Home 52 Category(ies) of Dementia - over 65 years of age (24), Learning registration, with number disability over 65 years of age (12), Old age, not of places falling within any other category (16), Physical disability over 65 years of age (6) Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE Of the 16 (sixteen) service users in the category OP up to 6 (six) may also be in the category PD(E) That the Manager completes level 4 NVQ in Management by June 2005 That the Manager attends a vulnerable adults training organised by Social Services specifically for senior staff within four months of registration. 29th September 2005 Date of last inspection Brief Description of the Service: The Beeches is a purpose built care home providing care for up to 52 older people. The home can accommodate up to 24 people (over 65 years) who have dementia, up to 6 people with a physical disability (over 65 years), and up to 12 people (over 65 years) who have a learning disability. It is owned and managed by Anchor Homes and is situated close to Leatherhead town centre, which has a range of leisure and shopping facilities. The home consists of five separate units, four of which have a separate kitchen area and all units have separate dining and lounge facilities. All bedrooms are for single occupancy, with en-suite facilities. A courtyard area with wheelchair access, is situated in the centre of the home. There is ample parking to the front of the building. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first to be carried out in the Commission for Social Care Inspection (CSCI) year, April 2006 to June 2007. As it was an unannounced inspection, no-one at the home knew it was to take place. Mrs Sandra Holland, Lead Inspector for the service carried out the inspection over eight hours. Mrs Beryl Rapley, Deputy Manager was present representing the service. A number of records and documents were examined including service users’ individual plans, medication administration record (MAR) charts, staff files, the complaints record and some (but not all) health and safety records. A tour of the premises was carried out, and service users and staff on each of the units and three visitors were spoken with. A pre-inspection questionnaire was supplied to the home and this was completed and returned. Some of the information supplied has been used and will be referred to in this report. The inspector would like to thank the staff and service users for their time, assistance, and hospitality during the inspection. What the service does well: The home is decorated in a bright and colourful style and presents a well maintained and homely and environment for the service users. The staff were seen to be caring for the service users in a friendly and respectful way. Service users were encouraged to maintain control over their daily life as much as possible. A variety of well balanced meals are offered, which were attractively presented. A survey organised by an independent organisation was very complimentary about life at the home and has praised the staff for their kindness. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 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 Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 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): 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments have been carried out for some but not all service users. The home does not provide intermediate care. EVIDENCE: From the records seen it was clear that some service users have been assessed before admission to the home but for one service user, there was no record of this. In some cases, the assessment had been carried out by a care manager and a copy of the assessment had been supplied to the home. A new style of assessment form was seen to have been used to assess some service users. The deputy manager advised that the new style forms are being tried out in the home to assess their suitability, before being supplied to all homes in the group. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 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, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The individual plans need to accurately reflect service users’ needs and assessments of risks to service users need to be more effectively carried out. Service users’ healthcare needs are well met and medication appears to be well managed. EVIDENCE: The deputy manager stated that the home is currently using a new type of individual plan alongside the original type. This is to trial the new style for effectiveness, prior to the new style being used in all Anchor homes. From the individual plans seen, it was noted that not all information was up to date, some areas of the plans were incomplete and some of the information was not co-ordinated within the plans. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 10 For one service user, the individual plan did not contain a “personal details” record sheet. This is used to record the service user’s next of kin, religion and any allergies amongst other details. Most of the pages of the plan for this service user had not been signed or dated and although the religion of the service user is stated elsewhere in the plan, the page relating to spiritual, cultural and religious needs had not been completed. For another service user who is being cared for in bed, the personal care section of the plan refers to having a bath and a wound assessment sheet has not been completed, although from information given by staff, this would be appropriate. A requirement made at the last inspection that personal care charts are regularly completed to ensure that an accurate record is kept of the personal care provided, has not been met. For one service user who likes a daily bath, this has not been recorded everyday on the personal care chart, although this was recorded in the daily notes. The personal care chart has provision for the bath water temperature to be recorded, but this had not been recorded. Assessments of risks to service users need to be more effectively carried out. Although a chart within the individual plans is marked “risk assessments” this only lists any risks that have been identified. These do not assess the individual risks listed or record any control measures or actions to be taken or avoided. These must be carried out fully, by staff trained to do so, to protect service users. Medication administration records (MAR) charts and medication storage were seen and medication appears to be managed satisfactorily. A senior member of staff explained the system of monitoring any gaps that occur on the MAR charts and that these would be addressed with individual staff to prevent recurrence. Staff were observed to treat service users in a friendly, relaxed but appropriate manner. Personal care was provided discreetly and in a way that promoted service user’s privacy. Staff advised that service users’ preferences regarding the sex of staff providing personal care was respected. Three requirements have been made regarding Standard 7. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 11 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): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service user are offered a variety of recreational and social activities and are supported to maintain contact with family and friends. The meals provided are of a high standard. EVIDENCE: Service users spoke of enjoying a number of different activities, including singa-long sessions, bingo and music and movement. One service user went out to the local shops with the activities co-ordinator to make purchases for the trolley shop that is operated within the home. The activities co-ordinator has re-introduced this, and it enables service users to buy toiletries, sweets and items of stationery. Specific items can also be bought on request. A newsletter has been introduced by the activities co-ordinator and a copy of this was seen displayed in the entrance hall. This advertises forthcoming events and reports back on the success of events that have taken place. Service users told of keeping in touch with their families and friends and some service users have telephones in their rooms. A number of visitors were seen Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 12 in the home and were spoken with. They stated that they were made welcome in the home and spoke of the helpfulness and cheerful approach of staff. Staff were observed to encourage service users to be independent and to make their own choices. One service user likes to go out for walks alone and this is accommodated. Staff ask that the service user advises them of his departure, so that they can be aware of the time that he is out and can be alert to any delay. The lunchtime and evening meals were seen to be nourishing and wellbalanced, with a choice of two main course items and a selection of vegetables offered. A dessert was also offered and fresh fruit and yoghurts were available as alternatives. The meals are delivered to each unit in a heated trolley and are served by the staff of the unit. This enables staff to offer residents the specific items and portion size they prefer. The meal was taken in a relaxed way and assistance was offered discreetly to those residents who needed it. The chef manager has recently changed the way the choice of meals are offered. In the past, service users would be asked to make a choice for the next day’s meal, but when the meal was served, some service users preferred to have the alternative option or disputed what they had ordered. Now the choice of meals is offered to service users at the time the meal is served, so an immediate choice can be made. Staff stated, and it was observed, that this system is working well and is popular with service users. From the pre-inspection information supplied, the menu is varied, nourishing and well-balanced. The chef manager advised that he creates special menus for notable days, and examples of these were seen for St. Georges Day, Burns Night and Easter. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are handled effectively and staff are aware of their responsibilities in the protection of service users. EVIDENCE: The complaints record was seen and contained a small number of complaints since the last inspection. The entries had been signed and dated by the manager or deputy with a brief reference as to the actions taken. A very recent complaint made by a service user’s relative, had been responded to immediately by the deputy manager. Staff spoken to said they would inform the manager, deputy manager or their personal supervisor if they had any concerns regarding the abuse or suspicion of abuse, of residents. They stated that there is an open atmosphere in the home and that senior staff are approachable. Some staff members stated that they had attended training on the protection of vulnerable adults and records of this were seen. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 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. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well laid out, suited to purpose and is effectively maintained and attractively decorated. The premises are clean and pleasant and appear hygienic. EVIDENCE: The deputy manager stated that the home has been purpose built as a care home and is divided into four smaller units, each for twelve residents. Residents are provided with individual bedrooms on their units, which also have a communal lounge, dining room and kitchenette. Each bedroom has an its own toilet and basin, and bathroom facilities are easily accessible on each unit. A smaller four-bedroom unit is attached to one of the larger units. This was originally designed as a day unit, but was brought into residential use as this was found to be the greater need. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 15 Each unit has its own lounge, separate dining room, kitchenette and bathrooms and toilet facilities. Additional seating is available in the communal entrance area to each unit and in the main entrance hall. A large courtyard garden with seats is available in the centre of the building. It was pleasing to see the home so attractively decorated in a range of cheerful colours with coordinated furnishings. The home is spacious and light and comfortably furnished to meet the needs of service users. It was evident that the home was clean and free from odours. Hand-washing facilities with liquid soap and paper towels are provided in all appropriate places to maintain hygiene and staff were observed to use appropriate procedures and equipment to prevent the spread of infection. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 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, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A team of staff are employed to meet the needs of service users. The recruitment of staff is appropriately managed. Although most staff are trained according to their role, the activities co-ordinator needs to receive training. EVIDENCE: From the pre-inspection information supplied and the staff rota seen on the day of inspection, it was clear that a full team of staff are employed to meet service users’ needs. Although the team consists predominantly of care staff, a number of other staff are also employed. These include an administrator, an activities co-ordinator, a receptionist, housekeeping staff, kitchen staff and a handyperson. The pre-inspection information states that fifty per cent of care staff are trained to National Vocational Qualification (NVQ) Level 2 or above which meets the recommended standard. The recruitment records of recently employed staff were seen and contained the required records and documents. It was noted that one member of staff had declared a health condition on the pre employment health questionnaire, but no action had been taken in relation to this. It is recommended that any declarations on the pre-employment health questionnaire are referred for a Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 17 medical reference or to the Occupational Health department, to ensure the applicant is fit for the role they are applying for and the condition will not present a hazard to the residents or to the staff member. Staff in the home advised that they have undertaken a number of training courses, some required by law, such as fire safety, food hygiene and first aid, and others to develop their knowledge and skills such as NVQ’s, dementia care and infection control. The training undertaken by staff is related to the role they carry out. Housekeeping staff for example, stated they had received training in the Control of Substances Hazardous to Health (COSHH), as they are regular users of these products. It was noted however that the recently recruited activities co-ordinator, whilst enthusiastic and energetic, has not had training specific to this role. It was noted that induction training records for new staff were not available for inspection. These must be retained in the home and made accessible to staff there. This will prevent any loss and ensure that these records are available for inspection, as required. A requirement and a recommendation regarding Standard 29 and a requirement regarding Standard 30 have been made. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 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, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is effectively managed and a quality assurance survey has been carried out. Service users’ finances are safeguarded and the health and safety of service users is promoted. EVIDENCE: From speaking to service users and staff and from the records and documentation seen, it was evident that the home is effectively managed. The manager is supported in this by two deputy managers and a team of senior care staff. The administrator and receptionist also work closely with the manager to ensure the smooth running of the home. A Quality Assurance survey was carried out by a national company who are independent of Anchor Homes, in March 2006. A summary of the responses Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 19 was supplied at the inspection. It was pleasing to see that many positive comments had been received and staff were praised for the level of care and kindness they displayed. Of the forty-eight surveys sent to residents, twentyeight responses were received. Forty-one surveys were sent out to resident’s next of kin and twenty-five were returned. The home was measured against thirty-six attributes, such as cleanliness, bedrooms, laundry, food, personal need, staff attention and complaints. The overall outcome was very good, in that thirty-one of these areas met or exceeded the average for all the homes that were surveyed. The survey stated that no significant weaknesses were identified in the home. Monies are held for safekeeping for a number of service users and the records held were compared with the amounts held. These were seen to accurately match. The health and safety of all those in the home is well managed and of those records sampled, all were appropriately maintained. Checks, including fire alarm testing, fire system servicing and food temperature testing, have been carried out to the required frequency and were seen to be within required ranges. Only one shortfall was noted in relation to health and safety, which was the propping open of the main office door. This door has a self-closing device fitted in order that the door will close when the fire alarm sounds, but this will not occur when the door is propped open. An alternative means of securing the door open that will close when the fire alarm is activated, must be found, if that is required. A requirement has been made regarding Standard 38. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 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 OP3 Regulation 14 Requirement Service users must not be admitted to the care home unless an assessment of their needs has been carried out and a copy of the assessment has been obtained and retained by the care home. Personal care charts must be regularly completed to provide an accurate record of the personal care carried out. TIMESCALE UNMET FROM 30/11/05. Service user’s individual plans must be fully completed to contain all the required information and must be kept up to date. Assessments must be carried out of all known or identified risks to the health, safety or well-being of service users. A record of the induction training of staff must be maintained and retained in the home. Staff at the home must receive training appropriate to the work they are to perform. DS0000013565.V295476.R01.S.doc Timescale for action 18/05/06 2 OP7 12 15/06/06 3 OP7 15 15/06/06 4 OP7 13 18/05/06 5 6 OP29 OP30 17 Schedule 4 18 17/08/06 17/08/06 Beeches (The) Version 5.2 Page 22 7 OP38 23 (4) (c) Specifically, the activities coordinator must receive training for this role. Fire doors fitted with automatic closures must not be propped open. An alternative means of retaining them in the open position must be found if this is required. This must ensure that the door(s) will close when the fire alarm is activated. 18/05/06 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 OP29 Good Practice Recommendations It is recommended that applicants for employment at the home are referred for a medical reference or to Occupational Health in the event that a health condition is declared on the pre-employment questionnaire. Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Beeches (The) DS0000013565.V295476.R01.S.doc Version 5.2 Page 24 - 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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