Inspection on 04/08/05 for The Beeches

This inspection was carried out on 4th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Beeches 16/10/06

The Beeches 17/01/06

The Beeches 30/12/04

The Beeches 22/07/04

The Beeches 13/11/03

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE The Beeches St Georges Road Hayle Cornwall TR27 4AH Lead Inspector Richard Coates Announced 04 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 D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Beeches Address St Georges Road Hayle TR27 4AH 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) 01736 752725 01736 754324 Mr Peter Ian Pool Mrs Lesley Jennifer Pool Mrs Marian Rich Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (5), Terminally ill (5) of places The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: No conditions of registration have been set. Date of last inspection 30 December 2004 Brief Description of the Service: The registered provider for The Beeches are Mr P I Pool and Mrs L J Pool. The providers are registered to provide accommodation and care with nursing for up to 28 older persons and to include a number of younger adults. The home is in a pleasant residential area of Hayle. There are 22 single rooms and three shared rooms. All the bedrooms in this home have ensuite washbasins and toilets. There is a small step at the main front door, and a portable ramp is available for wheelchair users. The ground floor is level and there is a passenger lift to the first floor. Communal space comprises a large dining room, a lounge and a conservatory. There are attractive and spacious gardens providing areas that can be accessed by residents. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This planned announced inspection took place on Thursday 4 and Friday 5 August 2005. The aim of the inspection was to review compliance with the one requirement and two recommendations set at the last inspection and to focus on key standards in the areas of choice of home, health and personal care, staffing, and management and administration. The duration of the inspection was ten hours. The provider had submitted a pre-inspection questionnaire. The inspector examined records and documents, toured the premises and spent time with management, residents and staff. The inspector is grateful to the provider, registered manager, staff and residents for their assistance during the inspection. It should be noted that, until the beginning of this year, the Beeches had experienced two years of relative stability in residents and staff. However, five new bedrooms were commissioned seven months ago, and this coincided with an increased frailty of residents admitted. This has placed additional demands upon the staff and management. The registered provider and the registered manager stated that these issues have now been resolved. What the service does well: Senior staff visit prospective residents in their current situation and carry out an assessment to determine if the home is able to meet their needs. Further detailed assessments are completed to enable effective care planning to meet the healthcare, social and individual needs of residents. Nursing staff and care staff work effectively together to ensure that the residents’ healthcare needs are monitored and addressed. Residents reported that their health is assessed and action taken when necessary. Care plans are regularly evaluated. The systems for the safe handling of medicines, often involving significant individual prescriptions of medication, protect residents. Residents have confidence in nursing and care staff, value their competence and caring qualities, and feel safe when care is delivered. The home has a thorough recruitment policy and prospective employees are interviewed prior to employment. All relevant checks such as criminal record checks are done before new staff start. There is a structured training programme for staff and the registered manager provides effective support to staff in their training and personal development. The home is on target to meet the 50 level of NVQ qualification by the end of this year. Staff reported that they receive effective support and supervision. The home is effectively managed. The registered persons makes every effort to meet the requirements and recommendations set by the Commission for Social Care Inspection. There is a policy and The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 6 procedure in place to reduce the risk of infection. Hand-washing facilities for staff are good, and gloves and aprons are provided and used. There are systems to promote safe working practices. Regular maintenance and equipment service checks are undertaken and up to date. Accidents are reported appropriately. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.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 D52-D04 S8967 The Beeches V231399 040805 Stage 4.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) 3 and 6 The needs of residents are assessed before they move in so that they can be assured that the home can provide adequate care. EVIDENCE: The records for three residents were case tracked. These records included a needs assessment carried out before the resident was admitted, and sufficient to establish whether the home can meet their needs. Following admission, the staff complete more detailed assessments including moving and handling, activities of daily living, tissue viability and functional abilities. The assessment leads to detailed care planning for the resident’s nursing and personal care needs, preferred social and recreational activities, and a risk assessment for falls and for other individual areas of risk. The Beeches does not currently provide intermediate care in the form of short periods of intensive rehabilitation and treatment as set out in standard 6. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.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, and 10 Detailed written care plans direct and inform staff about how to meet the residents’ health, personal and social care needs. The healthcare needs of residents are thoroughly monitored and addressed so that their needs are met. EVIDENCE: All three of the records inspected set out detailed directions and information for staff in care plans for meeting the residents’ healthcare, personal care and social needs. Care plans include risk assessments covering, for example, the risk of falls and environmental risks, and individual risks relevant to each resident. Regular and consistent evaluations of care plans had been recorded. Records also evidenced review visits by commissioning authorities. Nursing staff record regular notes in relation to nursing care; care staff record daily notes in relation to personal care. Residents were aware in general terms about their care plans, but had not signed the record to confirm their involvement. Given the frailty of some residents, this is understandable. Where residents are not able to sign the care plan, a relative or representative could be asked to do this. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 10 Care plans detail care procedures and treatments – for example in relation to tissue viability. The care plans and notes record monitoring of healthcare needs and detail contacts with, and input from, GPs, health professionals and tests and investigations. Residents reported that their healthcare needs were well monitored and action taken when required. The policy and procedure on medication covers most required areas but needs to be amended to include new procedures for the disposal of unused medicines from care homes that provide nursing. There is also a statement about the disposal of small amounts of unwanted medicines that is no longer accurate and should be deleted. Medicines are stored in locked storage in a designated room. There is a suitable cabinet for controlled drugs and a small refrigerator for medicines. A monitored dosage system is use. However, a significant number of currently prescribed medicines are not suitable for pre-packaging in this system. The records detail the checking of medicines upon receipt. The stocks of a controlled drug were checked against the records and found to be accurate. Signing for administration was consistent. Changes to a resident’s prescription were appropriately referenced to GP directions. A record is kept of medicines disposed of to complete an audit trail. The qualified nursing staff administer medicines. The pharmacist had last visited in March 2005. Residents were very positive about the qualities of the staff and the care provided. They stated that staff were competent and sensitive, and respected their privacy and dignity when assisting with care. Residents also reported that staff were friendly and kind, and they felt safe when they were being cared for. The provider stated that residents can use the home’s telephone. A number of residents have had their own telephone installed. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.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) These standards will be inspected in the unannounced inspection later in the year. EVIDENCE: The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 12 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 The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. EVIDENCE: The complaints procedure complies with the standard and regulation. The provider had recorded one formal complaint during the year. The registered manager discussed how this had been resolved. The provider maintains a complaint record. This should set out each complaint in an individual record to comply with access to information requirements. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 13 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) These standards will be inspected in the unannounced inspection later in the year. EVIDENCE: The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 14 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 and 30 The staffing and training arrangements ensure that the needs of residents are met. Recruitment procedures are robust and offer protection to the service users. EVIDENCE: There is a recorded roster which detail the staff’s planned work and records amendments to what was actually worked. During weekdays there are two qualified nurses on duty during the morning and daytime, with one qualified nurse during the evening and night. The provider has carried out a recent staffing review and is currently recruiting for a second qualified nurse during the daytime at weekend. There are five care workers on duty during the mornings and evenings, four during the afternoon and two at night. There are two cooks and two domestic staff. The registered manager reported that staffing is increased when there are additional demands. Currently seven out of seventeen care staff have NVQ at level 2 or 3. Three staff are working towards their NVQ at level 2 and two staff are working towards level 3. This is on target to meet the recommended 50 level of qualification by the end of 2005. The Beeches had previously consistently exceeded the 50 level of qualification, but a number of staff with NVQ at level 2 and 3 have left. Staff files inspected contained the documents required by legislation and required checks had been completed. There is a standard application form. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 15 The health declaration on the application form needs to be reviewed to ensure that it is adequate. Staff are issued with terms and conditions of employment and a relevant job description. The Beeches has a structured staff training programme which supports the aims of the home. The registered manager has a proactive approach to training for all staff. Staff have a separate training and development record. All new staff have a mentor and a planned induction which meets industry standards set out in a standard format. The records of recent inductions inspected had not, however, been completed and signed off fully. These records did include a number of records of observed practice as part of the induction. There is an in-house moving and handling trainer. Team leaders have recently completed training in supervisory management; two staff have completed training in palliative care; qualified staff have done a course on dressings. The provider needs to review the arrangements for consistent refresher training in food hygiene and infection control. Staff reported that they receive effective support and guidance from the registered manager and qualified staff. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 16 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, 33, 35 and 37 The home is well managed; the home’s record keeping and policies and procedures safeguard the residents’ interests. The health and safety of residents and staff are promoted and protected. EVIDENCE: The registered manager has previous experience as a first level nurse in the health service. She has completed her NVQ at level 4 in management and care and the registered managers award. She is currently undertaking a coaching and mentoring course. She is reviewing and updating the job description for the post. The provider has carried out one quality survey through a questionnaire for service users and their representatives but the response was limited and did not support the production of a summary. The provider reported that the The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 17 further development of the quality monitoring systems had been restricted by the recent pressures on management discussed in the summary of this report. The provider held a meeting for residents and their representatives, but this was not well attended. There is a financial plan for the home which sets targets and monitors actual outcomes against these targets. The provider maintains a record of letters and cards of appreciation from the relatives and representatives of residents. These clearly record the senders’ appreciation of the standard of care provided and the atmosphere in the home. The registered person reported that he does not act as agent for any resident for benefits and does not hold any bank account books or savings books. The pre-inspection questionnaire detailed the arrangements for managing the finances of residents. The registered person provides safe-keeping for spending money for residents which is paid in by the representatives managing their finances. All transactions for this money are detailed on a suitable record. The content of the records for staff inspected complied with the regulations and Schedule 2. The content of the records for residents complied with Schedule 3. There is a record of visitors. There is a written menu and record of food served. This report has reported on a number of the other required records. The Beeches Health and Safety Policy details organisational and individual responsibilities for health and safety. Staff draw up detailed risk assessments for all residents. There is an appropriate accident record. The pre-inspection questionnaire detailed required maintenance records and safety checks. A sample of these were found to be accurate against the original records. There is a policy and procedure for infection control. Staff reported a good supply of protective gloves and aprons and the use of alcohol based hand sanitisers. There are facilities for hand washing in all residents’ rooms. The laundry has industrial standard machines and meets required standards. Records detail regular required checks on fire systems. The fire risk assessment has been completed. This sets a number of recommendations which the provider intends to implement over the next two years. Fire training for staff was planned over the weeks following the inspection. The provider has also arranged for a five yearly survey of the electrical hard wiring of the premises. An electrical socket on the first floor corridor was noted to be loose in its housing. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 18 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x 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 Standard No 16 17 18 Score 3 x x 3 x 2 x 3 x 3 3 The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 19 no 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 30 Regulation 18 Requirement The registered person must ensure that staff receive structured induction training to current industry standards. Timescale for action 31.10.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. The Beeches D52-D04 S8967 The Beeches V231399 040805 Stage 4.doc Version 1.40 Page 20 Refer to Standard 7 33 29 9 16 38 Good Practice Recommendations Where the service user is not able to sign their care plan, a family member or representative should be invited to do this. The registered person should continue to review the systems for quality control and quality assurance. The registered person should develop a person specification for use in staff recruitment. The registered person should amend the medication procedure to take account of revised systems for the disposal of medicines. The record of complaints should comply with guidelines on access to information. The loose electrical socket on the first floor should be secured. Commission for Social Care Inspection John Keay House Tregonissey Road St Austell PL25 4AD 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. 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