Inspection on 03/08/05 for The Beeches

This inspection was carried out on 3rd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 13/09/07

The Beeches 25/04/07

The Beeches 04/01/07

The Beeches 10/02/06

The Beeches 29/03/05

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Abbey The

Snydale Care Home

Whiteley House

Hawkhills

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Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

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

CARE HOMES FOR OLDER PEOPLE THE BEECHES 59 Ferrybridge Road Castleford Wakefield WF10 4JW Lead Inspector Pat Pedley Unannounced 3 August 2005 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 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 J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Beeches Address 59 Ferrybridge Road Castleford Wakefield WF10 4JW 01977 517685 01977 517685 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Care Care Ltd New manager in post - application pending. Care Home 23 Category(ies) of Older People 23 registration, with number Physical Disability 23 of places Mental Disorder 23 THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Conditions of this registration are listed on the registration certificate displayed at the service. Date of last inspection 29 March 2005 Brief Description of the Service: The Beeches is a care home providing accommodation and personal care for up to 23 Older persons who may have additional physical disabilities or enduring mental health problems. The enterprise is privately owned through a limited company. The accommodation is on two floors that has a passenger lift between the floors. Not all the rooms are single and few have en-suite facilities. It is sited on a main road close to the centre of Castleford. The accommodation has a garden to the front and a car park to the side and rear of the building. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Whilst carrying out this inspection, the inspector met with residents, visitors, spoke with staff and the new manager, examined records and looked around the home. It was pleasing to hear positive comments about the care provided by staff and, in the inspector’s opinion, the staff team have responded well to a number of changes whilst continuing to meet residents’ needs. What the service does well: What has improved since the last inspection? Since the last inspection a number of requirements and recommendations have been met, particularly in developing and amending policies and procedures. The new registered providers have also started to make changes to the home including fitting new wooden floors and lighting to communal areas and redecorated the dining area and a couple of bedrooms. There are plans to make further changes in coming months. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 6 The home has another new manager who has brought new ideas and is currently working alongside staff to get to know the staff team and residents living in the home. 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 J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 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 standard(s) 1 & 2 The home’s Statement of Purpose requires amendment to include details of any restrictions to service users and details of the new manager. The Statements of Terms and Conditions of Occupancy should be available for inspection and be kept on the service user’s file. EVIDENCE: At the last inspection, a recommendation was made that the home’s Statement of Purpose be amended to include details of restrictions used in the home such as use of guards on the homes main staircase. It was found that the document is yet to be amended and the Statement of Purpose and Service User Guide also need to be amended to include details of the new manager. Those care files examined did not include a statement of terms and conditions of occupancy although the home’s manager thought that these were kept elsewhere by the home’s administrator who was not present at the time of inspection. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 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 standard(s) 7, 8, 9, 10 Further work is required to ensure that all care plans are individualised by using a holistic approach clearly setting out individual needs, including detail of choices and preferences, likes and dislikes and the action needing to be taken by staff to meet those needs identified. All care plans must be signed as agreed by the resident or their designated representative. Care plans need to show a realistic expectation of the action to be taken by staff and include information which demonstrates that goals have been achieved. Further development of risk management and assessment processes is also needed to be incorporated into individual care plans. Action must be taken to ensure that no medication runs out of stock. Appropriate weighing scales must be purchased so that all residents can be weighed regularly. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 10 EVIDENCE: At the last inspection a recommendation had been made that care plans should be individualised. Through examining a sample of care plans, it was seen that some work had been carried out although the contents were unclear on several points. It was difficult to identify what action the care plan required staff to undertake as the actual care needs were unclear. There were recordings of action to be taken such as “try and find out likes/dislikes” but no evidence of this being carried out and recorded and others “keep a record of urine colour” but no evidence that action had been taken to meet identified goals. There was little evidence of residents’, or their designated representatives’, involvement in the care planning process as those seen were unsigned by those parties. Care plans seen did not contain a photograph of the resident but it was pleasing that updates had been made. Discussion took place with the manager about new care planning methodologies, which could be introduced to meet the needs of the home. On one care plan it was seen that a resident was prone to wandering but there was no risk assessment, nor was there a risk assessment for a resident who had been assessed as high risk through the Waterlow Assessment. Another care plan stated, “needs to put weight on” but did not provide detail of how this was to be achieved. Another care plan stated, “can’t be weighed because of scales”. This was discussed with the manager who said there were difficulties, as several residents cannot use “stand on” scales and they need a more appropriate facility for weighing. Evidence was seen in the staff diary, and from examining some medication administration sheets, that several medications had run out of stock and this was discussed with the manager so that action could be taken to obtain stock straight away. Residents and visitors spoken with said that the staff were kind and helpful and made sure that their privacy was respected. From observations made on the day of inspection, staff were seen to be responding to individual needs with sensitivity. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 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 standard(s) 12, 13 & 15 Consideration should be given to providing a regular programme of activities suitable to the needs of those living in the home. Greater evidence of choice of meals at lunchtime should be seen. Staff were seen to be very responsive to the needs of residents at mealtimes. Visitors are made welcome at any reasonable time. EVIDENCE: On the day of inspection there was little activity taking place, staff said they spent time talking with individual residents and indeed this was observed. There was no evidence around the home, or from talking with residents and visitors, that a regular activity program is organised with the home and this was discussed with the manager. Several residents were seen to have visitors during the day. They said they visited often and were made welcome and were satisfied with their relatives’ care and with the attention given by staff. Time was spent with residents whilst they were having lunch. The meal of the day consisted of chicken casserole or meat salad and pear crumble. Menus were discussed with the cook and she was asked how choice was offered. She THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 12 said that the menu was followed but they could offer choice. However, from this discussion, this appeared to be more of a last minute arrangement rather than planned. From looking at the record of meals taken, most service users had eaten the main meal but this was a limited indicator of a choice of main meal being given or taken at lunchtime. There was greater evidence of choice for teatime as the afternoon cook was seen asking service users what they would like for tea. However, the lunchtime meal looked nutritious and of a good portion size. Staff were seen to be patiently assisting residents who needed a soft diet and assistance with eating. It was nice to observe that a resident who was visually impaired had it explained what was on her dinner plate. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 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 standard(s) 16 & 18 Risk assessments must be completed on an individual basis for the continuing use of restraints on the home’s main staircase. These must be added to individual case files. A review of the locks fitted to residents’ bedrooms must be carried out and missing or broken locks replaced so that residents can choose whether to lock their door or not whilst in their room. If there is any uncertainty of the type of lock to be used then the advice of the Commission or the Fire Officer must be sought. Staff would benefit from attending the local authority training on the Mistreatment of Vulnerable Adults and Adult Protection. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 14 EVIDENCE: There were no recorded complaints on the complaints file shown to the inspector. The complaints policy has been amended since the last inspection with a copy of the amended document having been forwarded to the Commission. At the last inspection, it was noted that the home’s staircase had restraining devices at the top and bottom. These have been in place for a number of years although there have been changes to the residents living at the home during this time. It was required in the last inspection report that the use of these be reviewed and either removed or justified through the risk assessment process as the purpose of these was not seen on any service user’s file or in the home’s Statement of Purpose as restrictions on choice for service users. There was no evidence of this piece of work having been completed in residents’ care files examined during this inspection. Also at the last inspection, concerns were raised about the locks to residents bedrooms. At this inspection, most were found to be missing or broken on the inside so could not be locked by residents from the inside. Staff were asked what they would do in the case of an allegation of abuse taking place. Although they gave a reasonable response it was suggested to the manager that staff and the new manager would benefit from attending the local authority training on the Mistreatment of Vulnerable Adults and Adult Protection. The providers had written to the Commission to say that they were amending the vulnerable adult policy but a copy of a new draft has not been seen as yet. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 15 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 standard(s) 19, 20, 21, 23, 24 & 26 Generally residents said that they liked living in a nice home and found it to be homely and comfortable. Thought needs to be given to how the damage to doors and door frames could be addressed to enhance the look of the home. All bedroom doors need to be checked to ensure they close properly into the rebate and missing and broken locks replaced. The stair carpet may need to be replaced within the foreseeable future. EVIDENCE: Generally the home was found to have lots of homely touches and the owners of the home were seen to have started to carry out some refurbishment including fitting expensive new wooden flooring and lighting to the lounges and dining room. Residents said that they do not like the dark floor in the lounges but the manager said that there are plans to redecorate the walls in light and fresh colours soon, which will brighten the room. The dining room has already been repainted and looks very nice. Many doors and doorframes were seen to have damage caused by wheelchairs. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 16 As previously mentioned, a number of bedrooms were examined. They were found to be nicely personalised although a little crowded occasionally which could be difficult for staff to move about. One visitor was asked if the resident she was visiting had a bedroom key and this was shown to the inspector. Staff said that two bedrooms have been recently decorated by the providers and there are plans to buy new soft furnishings for those rooms. Some bedroom doors did not close properly and therefore a risk may be posed a risk to residents in the case of fire. The stair carpet was seen to be starting to wear thin in several places and may need to be replaced soon. The home’s bathrooms were seen to meet the needs of current service users but have few adaptations to meet the needs of more disabled residents. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29 Staffing levels were satisfactory at the time of inspection. Recruitment practices need to be reviewed including amending the application form for new staff and obtaining a recent photograph for staff files. A full overview of staff training will be undertaken at the next inspection to ensure it is up to date although staff did say that they had lots of training opportunities. EVIDENCE: At the time of inspection staffing levels were found to be good. A number of staff files were examined. It was noted that there was insufficient space on the application form for new staff to record their previous employment history. It was explained to the manager that this information is needed so that she can explore any gaps in the employment history during recruitment. From examining three staff files it was noted that each needed a copy of a recent photograph as photocopies from passports were very blurred. A full overview of staff training was not carried out at this inspection as it was difficult to access some records on the home as the manager is very new and just getting used to finding her way about the home’s record keeping systems. Staff who spoke with the inspector said that they had a good number of training opportunities. From discussion, it was uncertain whether 50 of the staff were trained to NVQ Level 2. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 & 38 This inspection has taken place following the very recent arrival of the new manager therefore is not a reflection on her capabilities for running and managing the home on a daily basis. Indeed the staff have done well to carry on with their day-day routines as well as meeting residents’ needs through a time of several changes for which they are commended. The new manager will need to apply for registration and enrol for the Registered Managers Award. Staff supervision should take place at least six times a year. Copies of the home’s maintenance certificates should be forwarded to the Commission. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 19 EVIDENCE: Since the last inspection, a new manager has been appointed who is very new to the home. She has recently completed a return to nursing course since she has not been practicing as a nurse for some years. She said that she has lots of previous experience in residential care with older people. She does not have a management qualification as yet. Staff said that they were pleased to have a new manager and said that she was working alongside the team to get the work done. From discussion it appears that staff supervision is a little behind because of the change in manager and other nursing staff but the new manager hopes to address this in coming months. The new manager could not find the maintenance certificates. There was a record of regular fire drills taking place and evidence of regular fire training. There was not a chart to identify any training gaps although this had been previously kept. A fire risk assessment had been completed. Fire records showed that alarms are tested weekly. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 2 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 x 1 3 x 3 STAFFING Standard No Score 27 3 28 2 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 x x x x 2 x 2 THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) Requirement Care plans which identify the personal needs of service users must be signed as agreed by the service user or their designated representative. Medication must not run out of stock at any time. Satisfactory arrangements must be in place for ordering new stock. Individual risk assessments, confirmed through care reviewing processes must occur, and be reviewed, in relation to: the use if restraining devices on stairs and locking devices on service users doors which restrict service users choice. Any restrictions must be detailed in the statement of purpose for the home. Locks for bedroom doors must be repaired or replaced. Staff files must include a copy of a recent photograph. THe application form must be amended so that a full employment history is given by each applicant to a post. The Statement of Purpose and Service user Guide will need to be amended to include the Timescale for action 30 November 2005 Immediate 2. OP9 13(2) 3. OP18 & OP23 4 & 13 30 November 2005 4. OP29 19 Schedule 2 31 October 2005 5. OP1 4 31 October 2005 THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 22 details of the new manager and details of restrictions around the home such as the use of restraint on the stairs. 6. 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. 2. Refer to Standard OP2 OP7 Good Practice Recommendations All service users should be issued with an up-to-date copy of their statement of terms and conditions of occupancy. The service provider should ensure that all care plans are individualised fully to include details of personal choices and preferences. The service users and their representative should be actively involved in the care planning and reviewing process and realistic goals applied. Risk assessments proceeses also need to be developed further. A photograph of residents should be included in the care plan file. The service provider should redraft the procedure for the protection of vulnerable adults with reference to ‘No secrets’ and the local joint agency procedure. The service provider should ensure that all staff receive training in the management of aggression. Staff wouild also benefit from training on the Mistreatment of Vulnerable Adults and Adult Protection. 50 of staff should achieve the NVQ level 2 qualification by 2005. The service provider should ensure that the manager lodges an application form for registration. The manager’s hours should be made supernumerary to the care rota. The service provider should ensure that all staff receive supervision at least six times per year. Appropriate weighing scales should be purchased so that all residents can be weighed regularly. It would be of benefit to service users to offer a regular activity programme. Thought needs to be given to addressing the damage to doors and doorframes and replacing the stair carpet. The manager should apply for registration by 31 October 2005 and enrol for the Registered Managers Award before J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 23 3. OP18 4. 5. 6. 7. 8. 9. 10. OP28 OP31 OP36 OP8 OP12 OP19 OP31 THE BEECHES 11. OP38 the end of 2005. Copies of the homes maintenance certificates should be forwarded to the Commsiion as soon as possible. THE BEECHES J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 Page 24 Commission for Social Care Inspection Park View House Woodvale Office Brighouse HD6 4AB 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 J51J01_s60847_Beeches_v242657_030805.doc Version 1.40 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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