CARE HOMES FOR OLDER PEOPLE
The Beeches Green Lane Newtown Stockton-on-Tees TS19 0DW Lead Inspector
Jackie Herring Unannounced Inspection 5th December 2005 09:30 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.V267627.R01.S.doc Version 5.0 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.V267627.R01.S.doc Version 5.0 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 Julie Hickey 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.V267627.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th July 2005 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. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second annual inspection and was unannounced. The inspection took place over two inspection days, nine inspection hours in total. A tour of the home took place, staff and residents were involved in discussions with the inspector, and a number of records were examined such as resident’s files, staff files and the quality assurance records. A number of relative surveys were also received. The inspection was very open and although there was a number of requirements and recommendation identified, there was much constructive discussion with the new manager, which was positively received. It was acknowledged that a number of the requirements are outstanding from the previous inspection, however developments have taken place and progress continues to be made. What the service does well: What has improved since the last inspection?
The pre admission assessment has been developed since the last inspection. Some progress has been made in regard to assessment of resident’s needs and development of care plans. One of the dining rooms in the upstairs unit has been improved and is more conducive for its purpose. Some progress has been made to the quality assurance systems and the confidentiality issue around the “Nurses Station” on the first floor unit has been addressed. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 6 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 DS0000000053.V267627.R01.S.doc Version 5.0 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.V267627.R01.S.doc Version 5.0 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): 1,3 The statement of purpose continues to need further development, in a format that offers prospective residents information about the home. Pre admission assessments are undertaken, ensuring individual residents needs can be met at The Beeches. EVIDENCE: It was confirmed through discussion with the manager that the Statement of Purpose and Service User Guide is being updated and is currently at head office. New brochures had been published which contained information about all of the registered homes operated by TL Care. Pre admission assessments were contained within a random sample of files examined and contained appropriate information. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The assessment and care plans did not contain sufficient detail to ensure that health, personal and social care needs are fully met. Procedures for the management of medication, particularly in regard to recording is not robust enough. EVIDENCE: Four sets of resident’s records were examined and whilst improvement had been made, there was still the need to develop these further. This primarily relates to the actual detail of the assessment, which did not contain the full information about social, personal and health care needs and where needs had been identified, there was insufficient information to give correct guidance to staff. An example of this was “due to stroke can struggle at meal times”; there was no further information to specify in what way, i.e. due to dexterity or due to swallowing problems etc. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 10 The actual assessment of need rather than individual plans of care continue to be evaluated monthly and it was also identified that there was the need to have more specific care plans in place detailing how individual needs were being met and giving clear instruction to care workers about how to meet their needs. Care plans for more complex problems such as problems relating to behaviour needed to be more detailed to include the recording of triggers, the actual intervention and whether the plan is effective or not. Detailed discussion took place with the manager and one of the unit managers and more evidence and advice was given. It was confirmed that this is an areas for which further training is planned. The medication systems were examined and the manager had also recently conducted an audit, which had identified some areas for improvement and for which action had already been taken. The actual ordering, receipt and storage of medication was satisfactory however there were concerns in regard to some residents medication regularly not being given as a result of them being asleep; medication being omitted without any explanation, some missing signatures and the need to ensure that items such as eye drops are dated when opened. The manager confirmed that staff meetings were taking place with key individuals and that further training would take place. Resident who were involved in discussion about life at The Beeches said, “my needs are definitely met, the staff assist and support me when I need it and I see the GP when I need to”, “ I am treated with dignity and respect, the staff are helpful and friendly”. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Whilst the meal provision is in the main satisfactory, variety should be increased to enable residents to have more choice. EVIDENCE: During discussion with residents there were mixed comments about the menu and meal provision. The menu was a two-week rolling menu as opposed to four weeks and some of the residents said there were insufficient variety and a sense of the menu being the same. One resident said they believed they had even less choice due to being diabetic. Another residents said that they were visited each day to decide on menu choice however this particular resident said that they preferred to have chicken and potatoes most days, which was regularly the second choice on the menu. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 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 the following standard(s): None of these standards were examined on this occasion. EVIDENCE: The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 23, 26 The environment at The Beeches is generally safe, clean and well maintained, although a number of carpets need to be replaced. Further development is needed to the upstairs unit to provide a more homely environment in one of the dining rooms. Resident’s bedrooms are very personalised and are suitable to meet individual needs. EVIDENCE: Whilst walking around the home on the day of the inspection, it was observed to be clean and well maintained however some offensive odours were noted on the ground floor unit. Residents who were interviewed said that the home continues to be kept very clean and that it was a very pleasing environment. The two-lounge/dining rooms on the upstairs unit have been altered since the last inspection with one becoming a dedicated dining room. The other room continues to be in need of further development to create a more homely environment, as it appeared somewhat crowded. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 14 A number of carpets continue to be in need of cleaning or renewal particularly the corridors on both floors and one of the dining room carpets on the first floor, which were now looking worn. The manager did say that they were regularly cleaned, however this had little positive effect on improving their appearance. One of the dining room carpets was also in need of attention as there was a hole in it and it could lead to a potential tripping hazard. Residents were very happy with their individual rooms and there was much evidence of personalisation. One resident said that they had chosen their wallpaper, which they thought, was very tasteful and the room was decorated lovely. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 15 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, 29, 30 Resident’s needs are being met by sufficient numbers of staff with a range of skill mix. The recruitment of staff is not as robust as needed and such does not fully protect residents. EVIDENCE: A sample of staff files were examined during the inspection and in the main contained the required information such as application form, photo and references. There was however concerns raised about one of the files, which has no supporting information such as references and CRB/POVA for which immediate action was required. In some of the other files, there was the need to discuss the appropriateness of some of the references and the manager confirmed that additional more appropriate references would be obtained. There was also discussion about commencing care workers prior to receipt of CRB and only with a POVA First, as there was no supporting evidence demonstrating the supervision systems in place. It was confirmed by the manager that this practise has now ceased throughout the organisations. The duty rota demonstrated that there was the required minimum number of staff on duty although agency staff are being used by the home due to sickness and maternity leave cover. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 16 Training was briefly discussed as it had been fully examined at the last inspection, it was confirmed with the manager, that a number of staff continue to be in need of more client specific training such as dementia care which will be arranged and form part of the regular training programme. Training records continue to be developed. Residents who were involved in discussion about life at The Beeches said of the staff, “I have lots of friends here, they are not carers, I get hugs and kisses”, “the staff are kind and helpful”. Other residents spoke well of individual staff members, one said, “she is lovely, we get on like a house on fire”. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 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, 37, 38 There has been a change to the home manager and the current proposed manager is underway with the registered manager process with CSCI. Confidentiality of resident’s information is not as robust as it could be and does not fully safeguard personal information. Quality assurance systems have not been fully implemented and do not demonstrated that the home is run is the best interest of the residents. Systems for managing resident’s personal allowances are in good order. Accident analysis is not sufficiently detailed to ensure risks are minimised to individual residents. EVIDENCE: The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 18 There has been a recent change to the manager of the home and the home is currently being managed by a proposed manager who is in the process of completing the fit person process with CSCI to become the registered manager. Staff said, “the new manager is lovely, she is visible and approachable, you can talk to her”. Residents during interview expressed some concerns about the change in managers, as this is now the third manager since the home was registered and some residents found this a little unsettling. They did however say that they had been made aware of the management changes. During discussion with the manager, it was confirmed that quality assurance systems continue to be in need of development and introduction, this includes obtaining the views of residents and relatives about the service being provided. Whilst some attempt had been made to develop this further with questionnaires being developed and completed, they contained very little information and were more of a tick box. A random sample of resident’s personal allowance records were examined during the inspection and found to contain the appropriate level of information. The matching sample of actual money was also examined and was found to be in order. Progress has been made since the last inspection in regard to the confidentiality of resident’s information on the upstairs unit, with the “nurses station” now being a small office, which the staff said, has had a positive impact. The “nurses station” in the downstairs unit however remains open and accessible. Staff who were interviewed confirmed that they had received moving and handling training, fire safety, COSHH, First Aid and Infection Control training. During an examination of the accident records it was identified that the actual accident analysis really just detailed the times of accidents and numbers rather than information in regard to the actual resident and how the steps taken to minimise risk. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 2 X X 3 X X 2 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 Page 20 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. 2. Standard OP1 OP7 Regulation 4 14 Requirement The statement of purpose must be updated and must be available within the home. Further development must continue to be completed in regard to residents assessments of need and must include lifestyle and preferences. Further development must continue take place to ensure that residents have detailed individual plans, risk assessments and health records. The medication systems and recording of medication must be reviewed and further staff training given. Corridor carpets and dining rooms carpets must be replaced Recruitment and selection procedures must be robust and in keeping with Schedule 2 and as per POVA guidance. A competent, experience and qualified person must be appointed as the manager. Quality assurance systems must continue to be developed and introduced and include
DS0000000053.V267627.R01.S.doc Timescale for action 01/04/06 01/04/06 3. OP8 14 01/04/06 4. OP9 13 05/12/05 5. 6. OP19 OP29 23 19 01/05/06 05/12/05 7. 8. OP31 OP33 9 24 01/03/06 01/06/06 The Beeches Version 5.0 Page 21 information about residents and relative views of the service. 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. Refer to Standard OP15 OP20 OP30 OP37 OP38 Good Practice Recommendations The meal provision should be reviewed further and residents should be consulted and their views taken account of and there is an increase in variety. The lounge/dining room on the first floor unit must be developed further to ensure they are homely and conducive for purpose. The training programme should be developed further to identify all of the training and that all staff are up to date the required training. Further consideration should be given to increasing the level of confidentiality around the nurses station on the ground floor. Accident analysis should be developed further to include specific information about individual residents and steps taken to minimise risks. The Beeches DS0000000053.V267627.R01.S.doc Version 5.0 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
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