Inspection on 06/06/07 for The Beeches

This inspection was carried out on 6th June 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Beeches 10/06/09

The Beeches 23/06/08

The Beeches 07/09/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow 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 6 Brunswick Terrace Wednesbury West Midlands WS10 9DA Lead Inspector Deirdre Nash Key Unannounced Inspection 6th June 2007 11:30 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 DS0000066611.V343329.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 DS0000066611.V343329.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address 6 Brunswick Terrace Wednesbury West Midlands WS10 9DA 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) 0121 556 0435 Asha John Mr Dennis Valentine John Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19/03/07 Brief Description of the Service: The Beeches has been in operation as a care home since 1985 but in May 2006 came under new ownership. It is located in a cul de sac very close to Wednesbury town centre so it is in reach of numerous facilities including shops and main bus routes. The house is a large traditional property that has been extended in the past to its present size and layout. All bedrooms are sited on the first floor of the house and can be accessed by a shaft lift. There are a number of toilets on the ground and first floors with bathrooms (including assisted facilities) on the first floor. The ground floor also houses the lounge, dining room, kitchen, laundry and office. Ramped access is now available to the rear of the property, this a valuable addition to the facilities on offer and greatly assists access in and out of the home for frailer residents. The home is managed on a day-to-day basis by a joint provider/manager who is supported by care staff (some seniors) cooks and domestics. The home offers predominately long stay accommodation but has offered some short-term care in the past. The charges for accommodation are £328 per week with the only additional charges for hairdresser, chiropody (if not health service), papers and toiletries (although basics of the latter are provided). The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We looked at all of the information that we have received about the home since it was last inspected. The Inspector arrived without notice at the end of a morning, looked around the home, talked to four residents, the manager/owner and four staff members, looked at records and left some comment cards for residents to fill in and post back to us. Two cards were returned to us and the views expressed in them are also included in this report. In this way the care of two residents was closely followed to see if they are getting looked after as they should be. All of the residents in the home looked well taken care of. What the service does well: What has improved since the last inspection? What they could do better: The new systems for care planning, risk management and activities planning are in early stages. Their success will depend on staff understanding the importance of properly planned and accountable care of people and the contribution that written records make to it. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 6 Residents should be more involved in these plans and helped to keep control over whatever even small bits of their care that they can. For example staff could remind or prompt some individuals to take their regular medication rather than taking over its management completely. Some residents told us that they would like to be offered some fresh fruit and seasonal vegetables. Some staff have yet to be trained in important health and safety topics such as food hygiene and moving and handling of people with mobility problems. We have made a number of requirements for improvement around health and safety. The building still requires a lot of further work by way of redecoration, refurbishment and replacement of furniture. We have asked the owners to send us an improvement plan. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Beeches DS0000066611.V343329.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 DS0000066611.V343329.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre admission needs assessments are basic. The home has more to do to skill up staff to look after residents with complex needs so that people moving into the home can be confident that it can properly look after them. EVIDENCE: We did not see a Statement of Purpose or a Service User Guide at the Home. These are important documents for residents, their relatives and for prospective residents and should be kept easily available. We looked at two care files including that of person recently admitted to the home. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 9 There is a brief written pre admission assessment undertaken by the manager in the file of the recent admission. This format is limited and should for example also include hearing and visual ability. There is a hospital discharge form including a list of medication and a copy of a letter to the prospective resident confirming that as a result of the assessment the home believes that it can meet her needs. There is no contract or statement of terms and conditions on file. We saw a contract in the other file, a resident who has been at the home for some years and it included the fees payable. There are a range of written risk assessments in both files that include mobility, falls and personal care. These are newly produced documents. The longer established residents needs are complex and include dementia care. We looked at the training file for her key worker and saw certificates for the NVQ Award in Health and Social Care at Level 2 acquired at the end of last year and this is positive progress for the home. We spoke to the worker and she confirmed that she is attending dementia awareness training in July 2007. We looked at the file of a recent recruit to the team and saw certificates from a pre employment scheme for training in communication, abuse awareness, disability awareness, equality and diversity and personal care training. This worker will also need to undertake dementia care training in order to be able to meet the needs of all residents. This home no longer offers intermediate care. The Beeches DS0000066611.V343329.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Detail in written care plans for individuals has improved although still does not sufficiently show that residents are involved in agreeing them. Residents are not getting opportunities to remain in as much control of their lives as they could be. EVIDENCE: There are written service user plans in the files of both residents that we ‘tracked’ for this inspection. The longer established resident with complex needs has a comprehensive plan and risk assessments including for skin viability and falls. There is a care plan for ‘communication’ and this describes what her ‘behaviours’ are likely to be indicating that she needs or wants and her key worker was able to talk about this when we asked her. This is an example of very good practice. There is also a personal profile and family involvement details and an action plan with aims of the service with the key The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 11 workers signature and space for a relative’s signature. The plan is dated December 2006 and shows monthly review since then. This is very positive improvement for the home. The newer residents file has less detail but something has been included in every section of the plan and there are risk assessments, and it was reviewed a month after her admission. There are also key workers notes in this residents file. We saw no real evidence however of the resident’s involvement in these plans, assessments and reviews although our contact with her suggested that she could contribute and make decisions. This is an area that requires further improvement. We saw daily notes for both residents and they are written respectfully and clearly and communicate some good information. They should make reference to how the individual is in relation to the aim of her care plan. This helps to check the quality of the plans and monitor if they are actually working. The medication records that we looked at make clear where PRN (as required on occasion) has been given and there is a PRN authority procedure that staff are familiar with. However there is no written individual PRN protocol for residents and this could result in the drugs becoming used routinely without a specialist’s review of the situation. They are appearing signed on the record of one resident that we followed as ‘not needed’ rather than only ‘when needed’ and this suggests a lack of understanding of their use. There is a certificate for safe handling of medication training and a record of two practice observations sessions in the key workers file. There is no clear risk assessment for self medication in either residents file although there is a comment in the care plan of new resident that she wants staff to administer her medication in case she forgets to herself. The home could have a more creative and enabling approach, for example a system of prompting or reminding by staff. One of our comment cards filled out by a resident asks for ‘fresh vegetables please’ a number of times. We noticed that a number of residents were taking laxatives. One told us that she did not take this before she entered the home. The home should review the amount of roughage in the food on offer to residents. There are routine and specialist health care appointments on record in the file of the long established resident including physical health assessment and a recent mental heath assessment. There are weight chart in both files and a The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 12 clear note by a manager checking these records that one resident has lost a lot of weight recently. Staff do record whether or not she has taken a meal in daily notes but there is no record of how much she eats or drinks in a day and there must be otherwise this monitoring is not effective and the resident may suffer malnutrition and dehydration. Residents that we spoke to confirm that staff respect their dignity and privacyand always knock on bedroom door ‘even when they bring you tea in the morning.’ The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have a comfortable but limited life style. Steps taken to improve this are still in early stages. EVIDENCE: There are records kept of interests in resident’s files although those that we saw are limited. Daily notes kept for the week beginning 01/06/07 for five days recorded 3 activity sessions including some ‘beauty’ treatment for one resident who has complex mental health needs. We did not see this resident occupied with anything during the time that we were at the home however. Other residents were reading magazines and newspapers and one did some needlework. Library books are delivered and put in the lounge along with two daily newspapers each day and this is positive. Annual flowers are planted where residents can see them from the house. This is positive practice. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 14 The home is on an un adopted road that is in poor repair. Staff that we spoke to said that although there are shops at the bottom of the road it is difficult to use with wheel chairs. There is regular pedestrian traffic past the large front windows of the house and children can be seen going up and down the hill to school twice a day and many residents notice this. The house is on high ground and there is a view over the region and we heard one of the residents with confusion remarking on this. One resident confirmed what staff told us about taking people into the garden on fine days and added ‘but it is often too cold’. The grass was high when we arrived but was cut later in the day. There is a bench in the garden. We saw an activities book that the home had just introduced a few days before the visit. The structure for ensuring activities and stimulation should be supported by drawing up a timetable/weekly programme for each resident with alternatives if they decline, to guide staff. The manager or deputy can then audit this against the activities book and daily records to check its effectiveness. This information can be used along with others at the review of individuals care to develop effective ways of maintaining mental health and cognitive function. A visiting NVQ Assessor had returned to the home after an unsatisfactory assessment of a care assistant at competence in supporting residents to take a meal the previous day. She had also commented that the quality of the food was poor that day and had discussed this with the manager. We had lunch and the food was good and hot and well cooked, staff were attentive and sensitive to individuals needs and the care worker was then passed as ‘competent’ by the Assessor. Things had clearly improved over night. The two residents that we sat with said that they get sufficient to eat. We spoke to the new cook on duty that day and agreed with her that the home should buy in some fresh as well as frozen vegetables. Referred to above some residents also asked for this. There was no fresh fruit available even as a drink or in a yogurt. Resident should be offered some fresh seasonal vegetables and fruit. We left some leaflets promoting daily fresh fruit and vegetable consumption produced by Sandwell local authority for care homes and other establishments. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider does not always listen and act when residents and other stakeholders raise concerns or give feedback on the service. Residents are not sufficiently protected by full use of the homes procedures. EVIDENCE: The home has a complaint procedure. We received a complaint about the home in May and referred it to the Provider to investigate, which they did and reported back to us. The home now has a whistle blowing policy. One resident told us that she has no hesitation to take up any concerns or complaints with the provider/manager but said ‘sometimes he listens and sometimes he doesn’t’. The information sent to us by the home in an Annual Quality Assurance Assessment (AQAA) says that residents are now encouraged to request what they want to eat but we were told by more than one resident that they have asked for certain foods including fresh vegetables but not been given them. When we raised this with the manager/owner he insisted that this food is just wasted when he buys it in and he cant afford the waste. We comment later on the conduct of the business. Residents that we were able to speak to say that they are happy and generally satisfied with the home. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 16 Both staff files that we looked at have certificates for training in Abuse Awareness and this was confirmed in our interview with a key worker who is very clear about her duty to report any suspicion or allegation of abuse. The AQAA reports that there are now two staff signatures put against each transaction of resident’s money looked after by the home. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home still needs considerable decorative improvement and the electrical and gas installations are undergoing further remedial work. Residents experience a different quality of environment and different levels of safety depending on the part of the home that they are in. EVIDENCE: The house is a large period building and the public rooms retain some original features such as the fireplaces and this gives a central focus to them. The windows are large and there are views down the valley and residents said they appreciate this. Referred to above school children and shoppers pass by throughout the day and residents especially those with some confusion can gauge the passing of the day this way. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 18 There are some shared rooms in use although the home is carrying a number of vacancies. We asked the residents who share one room if they mind/like sharing and they each said that they didn’t mind as it is for the benefit of the other who does not like to be alone. They did refer to themselves as friends. We saw residents with independent mobility going up and down to their bedrooms throughout the day. The interior of the house is in the process of being upgraded in parts and there is unfinished paint, wallpaper and flooring work in many places including one of the first floor bathrooms that looks very sparse with a bath that has no panels and also incomplete floor covering. There are no en suite facilities in the home. The high, unfinished veranda at the back of the house has no railings and although the manager/owner and staff say that residents don’t use the back door we want to see that this substantial danger is properly assessed and managed. The first floor corridor does not get much natural light and although on the first day we were there the lights were put on, the second day they were not. The home has residents with mobility difficulties and confusion to whom this could present a danger. Most of the light fittings in the public areas are clusters of candle type bulbs. We saw on the first day that none of the bulbs in the fitting on the main staircase were working and that 10 out of the 20 bulbs in the fittings in the lounge were not working. The manager/owner told us that he has difficulty keeping up with the replacements as they keep failing and he suspects that the wiring circuit needs improvement and is looking in to it. We saw one resident straining to see the close mending work that she was doing in the lounge because only half of the lights her corner were working. She said she was finding it difficult and her eyes were streaming. The home should provide good lighting including standard lamps for residents to read and work under. There were gas engineers in the house two days running. The boilers were replaced in November last year but the manager told us that engineers were finding problems with the quality of that work. He told us a number of times that the house was not in the condition that he expected when he took it over. The roof was replaced last year and the drains were gas flushed on the recommendation of the environmental health officer to deal with a persistent odour. Bedroom carpets are also being replaced and all this is very positive in a short time. We comment on the work remaining to be done in the last section of this report on conduct of the business. The house is was very clean including the bathrooms and there was no bad odour except in one bedroom. Light pull strings in toilets and bathrooms need to be replaced because they are dirty and an infection hazard. The toilet seat The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 19 on the first floor is broken and this could cause a skin wound to people with already frail skin. There are two toilets near the public rooms so residents don’t have to go upstairs to a toilet. Bedrooms have personal belongings and photographs in them but much of the furniture in the home is shabby. For example most of the varnish is chipped and worn off the cupboards in the dining room and the arms of the chairs in the lounge. This devalues residents. There should be a programme of replacement and refurbishment and repair, we raised this at the last inspection and refer to business planning under the section on conduct of the business later in the report. There is no place to store wheelchairs and other equipment. Although a sloping path has been built to give access to the garden along the side of the house there is no safe boundary to the front so that residents can go out into it unaccompanied by staff if they wish. This is especially important for residents with confusion who keep on the move to reduce distress and agitation. As it is there is a low level gate across the front door to deter them from going outside alone and this is not best dementia care practice. This should be taken into account when the rear of the property is developed/improved. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels have improved and staff are catching up with training necessary to meet residents needs. Residents are safely looked after. EVIDENCE: There are two care staff and the deputy or the manager on duty during the mornings and afternoons and evenings. We saw this level when we arrived unannounced. Two staff are on duty at night, one sleeping. There are currently only eight residents in the home and the manager admits that the current staffing levels are at the insistence of social services contracting managers as a minimum. Staff told us that residents do benefit as they can give them more attention in the afternoons than they could when only one care assistant was on duty. This is positive as it contributes to maintaining individuals mental health and ability. Both staff files we looked at contained most of the information and proofs required for the protection of residents. One file had three references but only one of them properly satisfies legal requirements. A recent recruit to the team has an induction programme but it is not the Skills for Care Induction and it should be. There was evidence of one to one supervision on both files including practice observation, a training record in each file and a training matrix for the team. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 21 This is positive. Individual files show an average of two short training courses/sessions plus an NVQ Award during 2006. The new starter came with a wide range of training short courses relating to care including ‘Communication’, ‘Personal Care’ and Equality and Diversity from a local college. We saw a notice on the staff notice board telling staff that they could have no further paid leave until the home is allowed by social services to take more admissions. Staff that we spoke to are not happy about this. The owner/manager told us that he feels forced into unaffordable staffing levels. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management and administration of the home is reactive to regulation rather than planned and systems to ensure quality are at early stages of development. Residents live in a home that is struggling through change. EVIDENCE: The home is managed by one of the two owners and they are registered with us. There is an experienced deputy manager and the new systems of care planning, risk assessment and the administrative framework for carrying out safe care that meets peoples assessed needs has been put in place by her. These systems are still in their infancy. The manager referred to it as The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 23 ‘paperwork’ to keep regulators happy. He is occupied with bringing the building and general environment up to standard including doing much of the work himself. There are senior care assistants in charge of each shift. The manager expresses frustration about the reliability of records made by staff and whether they can satisfy social services sufficiently to lift the admissions block. We noticed that a daily record made about a resident with very high needs while we were there did not fit with what actually happened. It is the registered managers responsibility to make sure that the home is running well and safely. Referred to above the manager/owner has refused to pay for any further staff leave until he has more residents in the home generating income. He says he was not aware of the extent of repair, replacement and refurbishment required in the home when he bought the business. We are concerned about the continuing development of the home now and require an improvement plan including a refurbishment plan with clear timescales. Inspection of a sample of safety records showed a mixed picture. Water quality risk assessment and records of daily hot water temperature checks for baths are carried out, fridge and freezer temperatures are recorded and up to date but weekly fire alarm tests seem to have stopped after 09/05 07. There was no evidence of any inspection of the bath hoist and the date on the sticker on the equipment is not clear. No proper documentation was available to show that the passenger lift has been inspected and /or serviced so far this year. These must be done for the safety of residents, staff and visitors to the home. Referred to above there is doubt about the validity of the GORGI certificate for the gas boilers installed in December 2006. Both staff files that we looked at showed a patchy picture for training in safe working practices. Both workers have first aid certificates but the newer member of staff for example has a manual-handling certificate and the senior care assistant does not. Only one has food hygiene training yet all care staff in the home handle food. All staff must be given up to date training on health and safety topics relating to work in a care home to ensure safe working practices with and around residents. We have raised this before. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 24 The manager tells us that he has surveyed service users on their views of the quality of the service at the home. A summary of the findings and actions planned to improve the service as a result of resident’s contributions should be sent to us so that we can be confident that the provider is committed to improving the service. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 25 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 1 2 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 2 2 3 x 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 3 3 3 2 The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 12 Requirement Timescale for action 10/07/07 2. OP9 13 3. OP19 23 4. OP25 23 Residents with cognitive impairment must be protected from malnutrition and dehydration. Record daily amounts of food and drink taken by individuals who have been recognised as losing a significant amount of weight, monitor and act on the findings. 20/07/07 Residents must be protected from the potential danger of excessive and inappropriate amounts of sedative medication. Agree with GP’s and other interested parties an individual PRN protocol for any individual that has medication for episodes of agitation and aggressive behaviours, put it in writing and review it regularly. Residents must be protected 08/06/07 from the danger of uncompleted building works. Make the garden terrace safe on risk assessment. Immediate requirement. Residents must be protected 07/06/07 from the dangers posed by insufficient illumination around the home. Make the stairs and DS0000066611.V343329.R01.S.doc Version 5.2 The Beeches Page 27 5. OP21 13 6. OP26 13 7. OP29 19 8. OP30 13 9. OP38 23 10. OP38 23 corridors safe on risk assessment. Immediate requirement. Residents must be protected from injury by broken fittings. Make the toilet in the first floor bathroom safe to use. Immediate requirement Residents must be protected from spread of infection. Clean toilet and bathroom light switch cords. Residents must be protected from staff who are not suitable to look after them. Potential employees must be expected to provide references from previous care employers and references directly addressed to the provider of the home in person. Residents must be protected by safe working practices within the home. Train staff in manual handling and food hygiene practices. Residents must be protected from faulty fire detection equipment. Test the fire alarm regularly Residents must be protected from faulty lifting equipment. Arrange for regular inspection and servicing of the lift and bath hoist. 08/06/07 30/06/07 20/07/07 01/08/07 30/06/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Make the homes statement of purpose and service users guide easily available. Residents and potential residents DS0000066611.V343329.R01.S.doc Version 5.2 Page 28 The Beeches and relatives should able to see up to date information about the service. 2. OP2 Issue written terms and conditions of care and accommodation to all residents at the point of admission to the home. Residents should have clear information on the terms and conditions of their stay. Include hearing and sight in the pre admission assessment format. Residents must be confident that the home has sufficient information to meet their needs safely. Show in care plans and through daily notes how individuals are involved in agreeing their own care and keeping as much independence as possible. Individuals should be able to keep as much control as possible over their lives including their medication. Consider medication care plans that include staff reminding or prompting residents to take their medication before deciding that staff should administer it totally and completely. Residents should be able to rely on the home providing a balanced diet with sufficient roughage to avoid or reduce the need for regular laxative medication. Take advice from dieticians and follow it. Resident should be able to benefit from activities and occupation that keep them mentally and physically alert. Agree a weekly timetable of activities for each individual as part of their plan of care in order to guide staff. Residents should be able to enjoy a fresh and wholesome diet. Offer some seasonal fresh fruit and vegetables daily. Residents should be confident that the repairs and redecorations to the home will be completed and know the timescale for continued disruption. Draw up a written re decorative programme that identifies works on an on going basis and the timescales in which these will be addressed and make it available to residents and relatives with updates. Residents, especially those who need to keep on the move should be able to enjoy free, spontaneous and safe access to the garden. Make the garden secure. Residents should be confident that their clothes and bed linen are kept in a clean environment. Refurbish the drying/bed linen storage room so that it is appropriate for its purpose. Residents should benefit from staff training that is nationally accredited. Provide ‘Skills for Care Induction DS0000066611.V343329.R01.S.doc Version 5.2 Page 29 3. 4. 5. OP3 OP7 OP9 6. OP9 7. OP12 8. 9. OP15 OP19 10. 11. OP22 OP19 12. OP30 The Beeches 13. OP33 Training’ for new staff. Residents should be confident that the service improves and progresses. Implement an appropriate quality assurance/monitoring system and send us annual summaries of the findings and improvements planned from them. The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Beeches DS0000066611.V343329.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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