Inspection on 29/07/08 for The Beeches

This inspection was carried out on 29th July 2008.

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

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 10/07/07

The Beeches 08/06/06

The Beeches 06/01/06

The Beeches 06/07/05

The Beeches 21/02/05

The Beeches 19/07/04

The Beeches 20/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Beeches 163 High Street Hanham South Glos BS15 3QZ Lead Inspector Odette Coveney Unannounced Inspection 09:30 29th July 2008 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 DS0000003332.V360434.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. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address 163 High Street Hanham South Glos BS15 3QZ 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) 0117 9604822 0117 9857190 Miss. Julie Alexandra Windows Ms Janet Margaret Windows. Mr Matthew Roy Windows Care Home 23 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (23) of places The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th July 2008 Brief Description of the Service: The Beeches is an extended, detached Victorian building situated in Hanham High Street. There is parking to the front and a small parking area to the side of the house for three or four cars. There is a small garden to the rear with a patio area. The larger of the gardens has been built upon and the former garden has been reinstated. The home is close to local shops and amenities and is also on a main bus route between Bristol and Bath. The home is arranged on two floors. The home has two double bedrooms, both with en-suite facilities and nineteen single bedrooms, seven of which are ensuite. There are two lounges and two dining rooms one of which has a small conservatory leading from it. The home is managed and owned by three generations of one family. Fees at this home range from £404 - £499 per week and are dependent on individuals assessed need. The Beeches DS0000003332.V360434.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. The focus of this visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for those who live at the home. This visit was carried out over a 7.5-hour period. The owner’s Ms Julie and Mrs Janet windows were on duty and gave their time to assist with the inspection process. The Annual Quality Assurance Assessment (AQAA) had been completed and was sent to us before the inspection. This contained relevant information and assisted us with the pre planning of the visit to the home. Questionnaires were sent to those who use the service and their relatives as well as visiting health care professionals. Three questionnaires were given to us upon arrival at the home, these were from people who live at The Beeches, and their comments are included in the report. A tour of the premises was made and information about this is included within this report. The home was quiet at the start of the inspection as many people were relaxing after their breakfast. People were seen later in the morning in their rooms and others in the communal rooms. Daily life and activities at the home were observed plus including lunch. People who live at The Beeches, their visitors and staff were spoken with during the day. Records were requested and sampled. These included the maintenance records, recruitment and staff training records, care plans and medication records. Feedback was given to both Ms Julie Windows and Janet Windows at the inspection visit and records that were requested by post were received in a timely manner after the inspection. We would like to thank the people living at The Beeches, their visitors, staff and the management and staff for their contribution to the inspection process. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has worked diligently in order to meet the requirements and recommendations that were set during our last visit to the service. Those living at the home are provided with clear information as the home has updated their statement of purpose to include details of how individuals will be fully supported at the home. In order to demonstrate that incidents had been dealt with effectively it was required at our last visit that the home must inform the Commission of incidents, which affect the wellbeing of individuals who live at the home. This requirement had been met, the home has contacted us when required and have kept us informed. People living at The Beeches can be sure that staff have accurate information about their needs and support wishes. Since our last visit the home have ensured that individuals care plans have been reviewed at least on a monthly basis. It is noted that the home have updated their information sooner than this is peoples needs had changed. Also since our last visit individuals information about their ‘past histories’ had been completed for all and improvements had been made within daily records completed by staff, these now show who wrote the entries within these reports, as this was not always clear. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 7 In order that those who live at The Beeches are given an opportunity to give their views about the running of the home and to forward any ideas and suggestions they may have it was recommended during our last visit that residents meetings are held more often at the home, and that these should be recorded. During this visit we saw that minutes of meetings had been recorded and those living at the home told us that the meetings ad taken place. During our last visit to The Beeches we said that in order that those living at the home can be confident that staff are working in accordance with correct guidance it was recommended that the home update and review their policies and procedures to ensure information provided is accurate. We reviewed a sample of these during our visit and found that these had been updated and reviewed in line with current good practice. During our last visit we noted that the glass on the internal front door was loose and it was required that this was made safe. The Registered Provider Mrs Janet Windows told us that a repair to this window had taken place, however this window was still not as safe as it should be and attention must be given to this again to ensure that the glass is not liable to fall out. 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 summary of this inspection report can be made available in other formats on request. The Beeches DS0000003332.V360434.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 The Beeches DS0000003332.V360434.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, 2, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had their needs and aspirations assessed so that they could be met by the home. Each person had an individual contract and statement of terms and conditions with the home. EVIDENCE: The home has a procedure for admissions, which ensures that people have their needs assessed and get to know The Beeches before moving in. The home works closely with other agencies and outside professionals to help a new person into the home to settle in as well as possible. During our last visit to the home we reported that we had reviewed the homes statement of purpose, that this outlines the admission procedure into the home, how to raise a complaint and provided information about the services The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 10 and facilities offered at the home, there were some areas within this document which require some amendment. At that visit we required that in order that current and prospective residents are provided with clear information the home must update their statement of purpose and that a copy of this must be forwarded to the Commission. This document with the required amendments was forwarded to us following our visit. We saw at this visit that the home had again reviewed this document and had updated it to reflect the full range of needs, which can be supported at the home. All people who live in a care home, whether they are self-funding or not should have a contract of the terms and conditions in place which outlines their rights and the responsibilities expected of them and of the people who provide the service. At this visit we reviewed the terms and conditions of four people who live at The Beeches, these documents contained all of the required information and had been signed by both the person who lives at the home and a representative of the home. A relative visiting the home at the time of our visit told us that they had received a contract including the terms and conditions of the placement for their parent. Intermediate care is not provided at this home. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those who live at the home benefit from the information that has been recorded about how their needs are to be met. This helps ensure that the staff team provides consistent support, in the way that those living at the home prefer. Individuals have access to healthcare services, however the home must ensure that individuals are fully supported with their emotional wellbeing. Medication practices within the home are good, however some improvements are needed in the recording of stock held medication to make sure that it is always looked after safely and is clearly accounted for. EVIDENCE: During this visit we reviewed a number of care documents, these included care plans, risk assessments, daily records, individuals past history and Individual’s care plans. We noted during our last visit that a number of individuals care plans had not been reviewed or updated for sometime and a requirement was made that care plans must be reviewed on a monthly basis. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 12 We reviewed in full the care and associated records for four people and sampled the records of two others and saw that care plans had been reviewed a minimum of every month, and had been updated sooner when an individuals needs had changed, in line with expected practice. Care plans were well written and contained information in order that individuals are supported appropriately. There is an individual living at the home who has a diagnosis of dementia, this person is supported well at the home and the home assists them to maintain a level of independence. We paid particular attention to this person and reviewed their care and health records in some detail. We saw that this person is assisted with all aspects of their daily life within the home such as personal care, meals, laundry and assistance with medication. We read the assessment completed by the local authority prior to this person being admitted into the home and saw that prior to being admitted into the home and saw that this person had made a number of allegations against others. It was also recorded that allegations made, upon investigation, had been unfounded. In this persons daily records we saw an incident in which an allegation is made about a member of staff. We spoke with the Registered Provider Julie Windows about this and also a staff member who was on duty on the date of the alleged incident. We also spoke with the resident concerned. The resident had no recollection of the incident. The manger and staff member both, when asked separately by us, told us that the resident dislikes the staff member whom the allegation was about and the staff member further went on to say that she was on duty when the alleged incident took place and the staff member did not attend to the resident at all during the shift. The home was reminded of their responsibility in respect of safeguarding vulnerable adults and two requirements were made. The first requirement was that the home must contact this person’s general practitioner and request that a further assessment/support is given to assist this individual with aspects of their mental health and their levels of anxiety and distress. Furthermore it is required that the home complete a risk assessment in respect of potential allegations ensuring that the assessments make reference to the homes safe guarding policies and procedures and whistle blowing policies in order to ensure the safety and wellbeing of both the individual and staff. During our last visit we saw that weight charts for people for whom there were concerns over their health, had not had weights recorded. We recommended that these be better maintained. We reviewed these at this visit and saw that these records had been clearly and consistently recorded. When we at the home in July 2008 we reviewed information within individuals care plans and saw that past history information within these records had not always been completed. In order that full information is available to direct and guide staff practice, in particular for those people who have short term memory difficulties, we recommended that past information, where available, The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 13 should be obtained and recorded. Of those records we reviewed we saw that this information had been fully documented. Staff told us that gathering this information had enabled them to gain a greater insight and understanding of individuals, their choices and values. We reviewed are the daily records written about individuals who live in the home. These record the support that individuals have had, what activities they have been involved with, healthcare support and individuals general wellbeing as well as relationships. During our last visit it was not always clear which staff member had written these reports and we recommended that daily records must show who had written the entries. Upon review at this visit generally this had been achieved by the home with clear, sufficiently detailed records being maintained. There are good arrangements for access to health services including dental, optician and chiropody. The community district nursing service also provides a service to the home to support those individuals who require regular support with wound dressings. Records were kept of the appointments that people had with their GPs and other healthcare professionals. Records had been completed after each appointment, which provided a good report of the outcome and any action that needed to be taken as a result. Those who live at the home told us that they are well cared for, that staff are kind, respectful and polite. People also told us that they see their doctor when they need to and have access to healthcare support. People told us they are supported to attend hospital appointments. The daily records of people who live at the home confirmed that people access a range of healthcare support. In talking with individuals who live in the home they all spoke positively of the approach of staff “always speak to me as I would like” “they treat you as individuals”, “staff here are kind and respectful”. We also noted that when talking about those who live at the home both staff and management were respectful of individual’s privacy. The home has a clear confidentiality policy, which is discussed during staff induction and this is also included within the homes statement of purpose. At the time of this visit none of the people living in the home look after their own medicines, staff look after and give all the medicines. The pharmacy supplies medicines to the home using a monitored dosage system. We saw that medication is held securely in a locked trolley. Within training records saw that staff have completed medication competency training. We reviewed records of medication and saw that there are clear records of medication arriving at the home, administration of medication for regular prescribed The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 14 medication and records of medication that are returned to the pharmacy because they are no longer required. When we reviewed the records of stock held medication such as pain relief medication we saw that the home had recorded when this medication had entered the home, however, they had not recorded the amounts held in stock, nor was the name recorded of the person who undertook the stock audits of these medication. It is required that better records are maintained for stock held medication in order to ensure the safe handling and auditing of these medications. The Beeches DS0000003332.V360434.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, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities and entertainment are provided for those who wish to be involved. Individuals maintain contact with family and friends and the local community as they wish. EVIDENCE: People who live at the home are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They have been involved in the planning of their lifestyle and quality of life. Regular meetings are held with the people who live at the home and people told us that these meetings were an opportunity to give their opinion about the home. We saw minutes of these meetings and saw that a range of topics are covered such as staff support, meals and menu planning, activities and entertainment preferences. People who live at the home can access and enjoy the opportunities available in their local community, such as using public transport, library services, the The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 16 local pub, and local leisure facilities. The service promotes and fosters good relationships with neighbours. The visitors book showed that a number of people come to visit those who live at the home and people we spoke with confirmed that their visitors are made welcome by staff at the home and that there are no restrictions on visiting hours. We spoke with a visitor at the home who said they had looked at a number of care homes before choosing The Beeches, they said ‘mum is very happy here, she has settled well and I would recommend the home’ The home’s practice and routines are flexible and enable those who live at the home to exercise choice and have control over their lives. We saw in key worker review meetings that people are asked about the care service and the support they receive at the home, they are asked for their opinion about life at the home and how this can be improved for them. The lunch was seen and looked appealing and individuals all spoke positively of the food provided in the home: “it’s always good” “always a choice”. On the days of this visit the meal was well presented and staff were available to assist individuals. It should also be noted that in April this year the home was visited by environmental health officers from South Gloucestershire Council and were awarded five stars for their food hygiene controls in the kitchen. The interactions between staff and people living at the home were observed and heard during the routines during the day, all were polite and respectful. One person commented that ‘the carers here are lovely’, ‘nothing is too much trouble’. Visiting relatives were seen; one person expressed their gratitude to the care by staff at the home for their relative’s health improvement since admission into the home. Since our last visit to the service as well as photograph’s of social events and activities on the notice board the home have introduced a photo album for those who live at the home and their visitors showing some of the events which occur at the home. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Processes are in place for people to complain and people are given opportunities to raise any issues they may have. Those who live at the home are protected by the homes policies and procedures and incidents that affect the wellbeing of those we live at the home are reported to us, however the home must ensure that vulnerable people are protected. EVIDENCE: The home has not received any complaints since our previous visit to the service; the CSCI has not received any complaints. One of the Registered Providers, Julie Windows told us there have been no complaints since our last visit to the home. There had been no safeguarding adults referrals during the last year. The home had written policies and procedures which covered safeguarding adults, the prevention of abuse and whistle blowing. There was a copy of the South Gloucestershire Safe Guarding Procedure, which recorded the action that needed to be taken if there was a concern involving possible abuse. Within the health and personal care section of this report we recorded that due to an individuals emotional healthcare needs we have required that the home The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 18 complete a risk assessment in respect of potential allegations. The home must ensure that the assessments make reference to the homes safe guarding policies and procedures and whistle blowing policies in order to ensure the safety and wellbeing of both the individual and staff. A staff member who was met with said that she had read the vulnerable adults policy, which gave guidance about the local procedures for safeguarding adults. They also said that they had received training in the protection of vulnerable adults during the last year. The home has a complaints procedure and when we spoke to a person in the home. They understood that they could make a complaint if they were unhappy. A member of care staff on duty explained that during review meetings staff sit down with people living in the home and go through the complaints procedure with them. This is a good practice as it helps to enable people living in the home to understand the procedure. Three questionnaires received by us from people who live at the home informed us that they knew who to speak with if they had a complaint or concern about the service provided at the home. During our last visit to the home we reported that upon examination of records it was found that there had been a few situations that have affected the wellbeing of people who live at the home. These were incidents that we should have been informed about. In order to demonstrate that incidents had been dealt with effectively it was required that the home must inform us of incidents, which affected the wellbeing of individuals who live at the home. Since our last visit the home had reported incidents as required and demonstrated compliance in this area. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 19 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, 20, 24, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained, clean and comfortable, however, attention must be given to the inner entrance door and there were odours in bedrooms, which must be eliminated. EVIDENCE: The Beeches is an extended, detached Victorian building situated in Hanham High Street. There is parking to the front and a small parking area to the side of the house for three or four cars. There is a small garden to the rear with a patio area. The home is close to local shops and amenities and is also on a main bus route between Bristol and Bath. The home is set over three floors and there is a small passenger lift for those with limited mobility. There is a large well decorated lounge/dining room and a spacious well furnished lounge at the front of the house. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 20 During our last visit to the home it was noted that the internal front door had a pane of glass, which was loose, it was required that this is given attention in order that it is safe. When we checked this at this visit the lower panes of glass were still loose. Mrs Janet Windows, one of the registered providers told us that the glass had been repaired. This repair was not sufficient enough to ensure the safety of those at the home and proper attention must be given to ensure the glass is secure. During our visit we saw people relaxing in both lounges, both of these areas are comfortable, the rear lounge had benefited from a new fire being fitted, creating a focal point in this area. This lounge over looks the well tended rear garden, the garden has seating and a pergola and well established planting for people to enjoy and make use of this area. There are two rooms at the home in which two people share. At this visit two people occupy only one of the rooms. Bedrooms are only shared in limited situations and when this happens it is only by agreement with the people concerned. Screens are provided for privacy and the rooms have the personal belongings of both people. The service is open and honest with people when discussing the use of shared rooms and the prospect of having their own room. Since our last visit new, improved safe storage facilities for individuals valuables had been installed in each bedroom. We viewed a number of bedrooms during this visit and were shown rooms, which had benefited from new furnishings such as bedroom furniture, matching bedding and vanity units. These improvements will be extended to other rooms requiring attention and we look forward to viewing these at our next visit. We saw that bedrooms were clean and tidy, however there were at least two rooms that had an unpleasant odour. This was discussed with the owners of the home who told us of the cleaning and infection control measures within the house. It would appear that this is an area of concern for the owners. In order to ensure that people are living in a home which is odour free attention must be given to eliminate the odour in those rooms identified during our visit. The home is generally clean and tidy. Toilets are appropriately located within the home, are easily accessible and in sufficient numbers. We also saw that since our last visit to the home that as part of a bathroom refurbishment a ‘Parker’ bath has been installed, Mrs Janet Windows explained that this was in order to support people with increased mobility needs, that the new bath was well used and those who live at the home enjoyed this new facility. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 21 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, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s recruitment and selection procedure does not put people living in the home at unnecessary risks. Training for staff is provided, however this must be appropriate and sufficient. EVIDENCE: On the day of our visit two of the providers were on duty, there were also a senior care assistant, a support care assistant and the cook on duty. We spoke with staff about their recruitment process, staff confirmed to us that the home was clear about what was involved at all stages and was robust in following its procedure. We reviewed the recruitment documents for four staff members and viewed all of the required documentation, each person had a protection of vulnerable adults check, two references, and confirmation of individual’s identity. We did find that one person undertaking their induction training did not have a criminal records bureau check (CRB) in place and questioned the provider Julie Windows about this. We were told that this had been applied for and that this person was not providing personal care support, was not handling individuals money or medication. Promptly after our visit we received confirmation from the Provider that the CRB had been obtained. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 22 There are clear contingency plans for cover for vacancies and sickness and there is no use of any agency or temporary staff. Julie Windows recognises the importance of training, and tries to delivers a programme that meets statutory requirements and the National Minimum Standards. We discussed with Julie Windows the currant practice of training videos and their validity especially within the area of first aid as this training requires practical techniques and requested confirmation from the training provider that the training given is in line with current good practice and legislation. The manager is aware that if the video training is not sufficient then there are some gaps in the training programme and plans to deal with this. There is eleven staff that has obtained a National Vocational Qualification in Care; staff told us about other training they have undertaken which included safe handling of medicines, dementia awareness and infection control. Staff spoken with were fairly motivated and happy at the home. Staff told us ‘I enjoy working here, we have a good team’. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 23 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, 37, 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 run and managed by a person who is fit to be in charge and those who live at the home benefit from the management approach of the home. The health, safety and welfare of people living at the home are promoted and protected. EVIDENCE: The Beeches is a family run home and three generations of the same family work at the home. Janet and Julie Windows are Registered Providers and Mathew Windows is the Registered Manager. Mathew Windows has worked at the home for over fifteen years and has obtained National Vocational Qualifications at levels 2,3, and 4 in Care Management. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 24 Mathew Windows manages the home and retains a hands on role at the home and knows the people in residence and their relatives well. In the homes completed AQAA document when they were asked to demonstrate how do they know they give value for money they replied: “The home provides professional personal care tailored to individuals needs within our family run care home, with support from trained carers who enjoy the work they do and provide more care over and above their jobs description (staff have taken residents out for a day when they are not working, with the residents and their families permission and visited with on their days off to talk and interact with the residents). We try our best to ensure the residents suggestions and ideas are integrated into daily life or taken into account with decorations and garden arrangements. Provide a safe environment for staff and residents and do our best to ensure that visitors are welcomed and enjoy coming to the home”. We asked about equality and diversity and how the home can ensure they uphold these within the home, within their completed AQAA the home told us that: “All staff receive training in this area in order that they are aware of the acts, laws and rights of the residents they care for, and that through training staff are refreshed on these issues and uphold the rights of the residents in their care. If staff need more information they can read the policies and procedures in the home, which are always available. Getting feedback from staff during our staff meetings is important to see if we can improve upon this”. The home does not hold any money on behalf of individuals who live at the home, individuals are provided with safes in their rooms in order to store any valuables they may have. The practices of the home help to make sure that the health, safety and welfare of individuals who live and work in the home are as far as possible protected. Risk assessments were in place for identified areas of hazard, including manual handling; these contained appropriate information, were updated and reviewed when needed. We reviewed the maintenance logbook completed by the home and saw that since our last visit the boiler and the lift and fire safety equipment had been serviced. During our last visit to the service we reported that there were a number of policies and procedures in place at the home and these are all relevant to the care setting, the staffing at the home and were in line with the support needs of those who live at the home. We noted that a number of these policies and procedures had not been reviewed for some time and contained minor errors The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 25 within the information provided, at this visit these had been ammended and reviewed as needed. A review of the fire logbook found that appropriate checks are undertaken to ensure the systems to detect fire are maintained and equipment is provided to deal with a fire. Daily, weekly and monthly checks and staff training are completed as required. No concerns over fire safety were noted during this visit. We also read the report of a fire officer who visited the home in February 2008 who recorded satisfactory standards of fire safety at the home. A record of staff supervision sessions was available to see and showed that people receive supervision regularly. Staff confirmed this. We also saw that regular staff and residents meetings are held more often and these are recorded. Minutes of meetings read by us showed that there is an open management approach at the home; the management wants to hear ideas and suggestions for improvement from those who live and work at the home. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 26 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 Standard No 1 2 3 4 5 6 OF HOME Score ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13 (2) Requirement The home must record the amounts of stock held medication and also record who audits and checks these amounts. The home must contact an identified individuals general practitioner to request an assessment of this person mental health needs in order that they can be fully supported at the home. Timescale for action 29/09/08 2. OP8 13 (1) b 05/08/08 3. OP26 16 (2) k 4. OP19 23 (2) b In order to ensure that people 29/09/08 are living in a home which is odour free attention must be given to eliminate the odour in those rooms identified during our visit Glass in the internal entrance 29/09/08 door must be made safe, to reduce the likihood of injury to those who live and work at the home. This requirement was made at our last visit to the home and had not been fully met. The home must complete a risk DS0000003332.V360434.R01.S.doc 5. OP18 13 (6) 29/09/08 Page 28 The Beeches Version 5.2 assessment in respect of potential allegations ensuring that the assessments make reference to the homes safe guarding policies and procedures and whistle blowing policies in order to ensure the safety and wellbeing of both the individual and staff. 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 OP30 Good Practice Recommendations The home should obtain confirmation from the video training provider to verify it is in line with current good practice and legislation. The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Beeches DS0000003332.V360434.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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