Inspection on 31/05/06 for The Beeches

This inspection was carried out on 31st May 2006.

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 03/08/09

The Beeches 28/05/08

The Beeches 29/05/07

The Beeches 05/12/05

The Beeches 12/07/05

The Beeches 25/10/04

The Beeches 22/07/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE The Beeches Green Lane Newtown Stockton-on-Tees TS19 0DW Lead Inspector DEREK STOW Key Unannounced Inspection 31st May 2006 12:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Beeches DS0000000053.V297128.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 DS0000000053.V297128.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address Green Lane Newtown Stockton-on-Tees TS19 0DW 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) 01642 618818 01642 618818 T L Care Ltd Mrs Valerie Smith Care Home 64 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named individual who is under the age category of 65 years. 5th December 2005 Date of last inspection Brief Description of the Service: The Beeches is a two storey 64 bedded purpose built care home providing personal care for older people and for individuals suffering from dementia within two specific units. Personal Care for older people is provided on the ground floor whilst care for people suffering from dementia is provided on the first floor. There is a patio and garden area available for use. The home has been operating since January 2002. It is situated within an urban setting with close access to the town centre and public transport. The vast majority of the bedrooms are single rooms with ensuite facilities. There are two double rooms available within the home also with ensuite facilities. Cost of service at The Beeches. On the date of this inspection the standard fee for care at The Beeches was £360 per week. The fee for care on the unit for people who suffer from dementia was £376. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took thirteen hours spread over three days with the inspector examining a number of records; speaking to five residents, three relatives the manager, the administrator, three members of the Care staff and the cook. A tour of the building was carried out and requirements identified at the last inspection were re-visited. This inspection looked at only those standards, which the Commission for Social Care Inspection regard as Key standards. The details of any issues identified as requiring action are to be found at the back of this report. What the service does well: What has improved since the last inspection? What they could do better: The Manager must address those issues requiring action which are detailed at the back of this report including improvements to the Care plans, quality assurance and health and safety issues and training issues. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 6 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 DS0000000053.V297128.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 The Beeches DS0000000053.V297128.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): 1 and 3. Quality in this outcome group of standards is good. Service Users have sufficient information about the service at “The Beeches” to help them make a choice of where to live. Service users have their needs assessed before moving in to “The Beeches”. EVIDENCE: The statement of purpose, brochure and leaflets for “The beeches” have recently been updated and is clearly available and on display in the entrance area along with resident and relative comment forms, complaints information, and inspection reports as well as the “Counsel and Care brief care Home Guide”. One relative spoken with was particularly impressed with the information available as well as the pre-admission and admission process when staff had even downloaded information about a particular illness for her from the Internet. The Manager said that the new information is being put in to the “Welcome Pack” of information in each resident’s room. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 9 The sixteen resident / relative surveys received by the Commission for Social Care Inspection all expressed satisfaction with the information made available to them and most could remember been given a written contract following admission. The seven residents/Relatives spoken with all confirmed that preadmission visits were made and the three files examined showed extensive evidence of pre-admission assessment by the manager. Improving the detail gathered regarding the personal profile of residents, particularly around previous lifestyle including hobbies, leisure social and religious needs could strengthen the pre-admission information. This information can then be transferred to the care plan as well as inform the Activity organiser. All information made available to residents could be improved with greater contrast/definition and larger font size. Intermediate care is not provided at The Beeches. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 10 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 group of standards is adequate. Residents at “The Beeches” enjoy the privacy of their own rooms whenever they wish and feel treated with dignity and respect. Residents’ health and personal care needs are met as stated in the care plans however; care plans should be strengthened with greater clarity of care plan statements including social, leisure and religious needs. Appropriate policies and procedures are in place for dealing with medication. EVIDENCE: Three care plan files were examined and contained a great deal of information linked to over twenty index headings. The manager and some of the staff spoken with agreed that the personal files were too complex and the flow of information could be improved together with greater clarity of care plan statements. The personal profile was lacking substance in one file and discussion took place with the manager regarding the need to gather more information about a residents previous lifestyle, hobbies leisure, social and religious needs followed by clear care plan statements to ensure these aspects of life needs are met and recorded. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 11 The manager and staff spoken with said that care plans are reviewed monthly and that this involves residents, however improvements to the record should be considered especially where “ no Changes” have occurred. One of the care Plan files did not have a named key worker recorded. The Manager currently audits care plan files on a monthly basis and is working to involve staff more in the development of the files and care plans including consideration of the above issues. The giving of medication to residents was observed to be given on an individual basis and the particular staff observed gave a very clear “ good practice “ account of how to give medication safely and appropriately including giving it at the time and method advised by the Pharmacist. The manager has recently taken appropriate action in changing to a new Pharmacy suppler following unsatisfactory service from the previous supplier. The Medication Administration Record was examined and found to be satisfactory. All of the sixteen resident / relative surveys returned to the Commission for Social Care inspection expressed overall satisfaction with the health and personal care at “The Beeches”. One of the residents spoken with said “nothing can be perfect all of the time but I only have to wait a couple of minutes for help on a night”. Another resident said that “care staff are brilliant” while a relative spoken with said that the person they cared for could get a bath every night and that they had been given a key to the residents room to help ensure privacy and safety of possessions. At one point during the inspection, privacy and freedom of choice was demonstrated by the observation that in the ground floor residential unit of the 28 residents, 20 were enjoying time in their own rooms, there were 3 people in each of the 2 lounges, 1 person and a carer were at the betting shop and 1 person was out with a relative. All the residents seen were observed to be clean and smartly presented. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome group of standards is good. Residents on the whole find life at The Beeches satisfactory. There are activities organised 5 days a week and there is open visiting for friends and relatives. A wholesome and balanced diet is provided which is constantly being reviewed by the manager in terms of quality. EVIDENCE: The Beeche’s Activities Organiser was observed and spoken with and the inspector was told that activities take place on both the ground floor residential unit and the first floor unit for people who suffer from dementia each day Monday to Friday and a quiz involving resident was seen to be taking place. The activities planned both inside and outside the home should be supported by a programme, which is posted around the units so that residents, relatives and staff are informed. A number of residents who suffer from dementia were seen to be enjoying a few minutes of sunshine outside on the ground floor patio. One resident spoken with when asked by the inspector had there done any activities that day said “ I usually do but today I had a sleep instead”. Another resident said that they thought there should be more exercises in the home. The manager said that religious needs are met and that the Church of England minister visits monthly and that staff ask if residents need help in getting out to church. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 13 During the inspection lunch taken with 2 residents both of whom said that the food at The Beeches was very good and that residents were asked each day what they would like from the menu or further alternatives were always offered. The Manager said that the menus have been improved and are now on a 4 week rotation although these should be kept under review as some staff spoken with felt that there should be more use of fresh rather than frozen foods and more encouragement for residents to eat fresh fruit. During the inspection residents were observed to be freely using their own rooms as they wished and relatives were coming in and out of the home throughout the day. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 14 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 group of standards is good. Residents and relatives are confident that their views and concerns are listened to and acted upon by staff and managers and that resident are protected at the Beeches; however not all staff have yet been trained in the protection of vulnerable adults. EVIDENCE: An appropriate complaints procedure is in operation at The Beeches and this is displayed in the entrance area together with inspection reports and comment forms which the manager says she positively encourages people to fill in so that she can address any areas of concern. Residents and relatives spoken with all said that they were confident in approaching staff or the manager with any issues of concern. Two formal complaints were recorded at the home since the last inspection and it was felt that the manager dealt with the issues appropriately. Two relatives who completed a survey form, although high in their praise for the overall service and particularly the staff did feel that the service could be improved with better communication between staff at shift handover as well as improving the laundry service. The Manager said that The Adult Protection Policy for The Beeches is currently being updated. Staff spoken with during the inspection all knew what to do if they suspected abuse, however the manager must ensure that all staff including ancillary staff receive appropriate adult protection training. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 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 the following standard(s): 19 and 26 Quality in this outcome group of standards is good. The Beeches is generally clean, safe, comfortable and well maintained although confidentiality around the ground floor “nurses Station” should be strengthened. EVIDENCE: A tour of The Beeches took place with the manager. All the bedrooms examined were clean, well furnished and decorated and personalised with residents’ own possessions. All the residents spoken with were very happy with their own bedrooms with en-suite facilities and no unpleasant odours were apparent. The upstairs corridor carpets have been replaced since the last inspection. The manager said that appropriate infection control polices were in place and in addition a bacterial hand rub dispenser was in place between the two main units. There is clearly a lack of privacy and confidentiality around the “nurses station” on the ground floor, which should be addressed. The Beeches DS0000000053.V297128.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 group of standards is good. Residents’ are supported by sufficient numbers of trained staff and they are protected by safe recruitment polices and practice. EVIDENCE: Three staff files were examined during the inspection and all held evidence of identity, Criminal Record Bureau checks as well as 2 references. The Manager stated that no staff start employment without full clearance from the Criminal Record Bureau. The manager said that a full training matrix has been developed and this informs the home when statutory training for individual members of staff needs to be up-dated. A training and supervision record was seen to be in place on staff files and the manager is working hard to increase the frequency of supervision to the recommended 6 times per year for each staff. One member of staff spoken with had not yet received formal supervision and priority should be given to ensure that all staff working on the unit with people suffering with dementia receives specific training in “dementia care”. One member of staff who had worked on the unit for over a 18 months was still awaiting specialised training. All of the residents and relatives spoken with said that they had confidence in the staff and manager of the home and felt that they were safe and protected. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 17 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 group of standards is adequate. A competent manager who promotes their health, safety and welfare as well as protecting residents finances runs The Beeches in the best interests of the residents. However, Quality assurance systems and some safety checks and records needs to be strengthened. EVIDENCE: The new manager is clearly building and strengthening the systems which help to ensure that high quality service is delivered to residents on an ongoing daily basis. Comment forms for residents and relatives are clearly in use in order to capture issues of quality so that they can be addressed. These customer focussed quality systems need to be built upon with regular staff and resident meetings and formal residents / relative surveys at least twice a year. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 18 A number of documents and records were examined at the inspection including the accident book, fire safety checks, fire drills, legionella checks, hot water temperatures and various other records. The money held on behalf of three residents was checked and found to be correct. The manager had developed a detailed analysis of accident information following the last inspection and this included action taken to reduce certain risks with “Wander Mats” which help to reduce injury and accidents with people who suffer from dementia. A gas safety certificate was not available and the hot water temperatures should be checked, recorded and any remedial action on a weekly basis. All of the 5 Hot water outlets checked for temperature at the inspection were below safe limits with 3 of them being below 40 degrees and 1 was 32.5 degrees. This is probably considered to be too cool to be comfortable for a bath or shower. The manager must ensure that servicing and maintenance of the hot water mixer valves complies with the manufacturers recommendations. The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 19 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 3 X 3 X X X 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14 Further development must continue to be completed in regard to residents assessments of need and must include lifestyle and preferences including focus on social, leisure and religious needs. Outstanding from the last inspection. 2. OP18 13 All staff including ancillary staff must receive Training/instruction in Adult abuse and the newly developed adult protection procedure. The registered manager must complete NVQ 4 in Care The registered manager must complete the registered managers course . The Quality Assurance systems must be strengthened including regular resident meetings and resident /relative surveys should be carried out at least twice a year. DS0000000053.V297128.R01.S.doc Requirement Timescale for action 30/09/06 30/09/06 3. 4. 5. OP31 OP31 OP33 9 9 24 31/12/06 31/07/07 30/09/09 The Beeches Version 5.2 Page 21 6. OP38 13 The health and safety and maintenance systems and records must be improved. An up to date gas safety certificate must be available. The hot water mixer valves must be serviced and maintained in accordance with the manufacturers recommendations and the hot water temperatures must be recorded weekly and adjusted to the required temperatures. 31/05/06 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. 2. 3. Refer to Standard OP1 OP7 OP12 Good Practice Recommendations The information made available to residents would be more accessible in larger font and with greater contrast and definition. A named Key worker should be appointed for each resident and recorded on file. A formal programme of activities within the home together with a list of outside opportunities should be developed and posted around the home. This helps to focus both staff and residents; gives people something to orientate them as well as look forward to. The manager should continue to review menus as well as focus on the balance and use of fresh/frozen foods and the availability of fresh fruit. Care staff receive supervision at least six times a year. Further consideration should be given to increasing the level of confidentiality around the nurses station on the ground floor. Care staff should receive training in the care of people with dementia with priority given to those working on the specialist care unit. 4. 5. 6. 7. OP15 OP36 OP37 OP30 The Beeches DS0000000053.V297128.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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 DS0000000053.V297128.R01.S.doc Version 5.2 Page 23 - 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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