CARE HOMES FOR OLDER PEOPLE
The Beeches Care Home The Beeches 25 Park Road Coppull Chorley Lancashire PR7 5AH Lead Inspector
Vivienne Morris Unannounced Inspection 29th August 2007 09:45 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 Care Home DS0000025548.V343831.R02.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 Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Beeches Care Home Address The Beeches 25 Park Road Coppull Chorley Lancashire PR7 5AH 01257 792687 01257 470067 manager.beeches@m-a.co.uk 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) Mr Mohammed Hussain Mrs Anwar Hussain, Mr Naveed Hussain Miss Krystyna Kolodziejewski Care Home 34 Category(ies) of Dementia (27), Old age, not falling within any registration, with number other category (7), Physical disability (2) of places The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service is registered for a maximum of 34 service users to include: *up to 7 service users in the category of OP (Old Age not falling within any other category). *up to 27 service users in the category of DE (Dementia). *up to 2 service users over the age of 45 in the category of PD (Physical Disability) 30th August 2006 Date of last inspection Brief Description of the Service: The Beeches nursing home is situated in Coppull, approximately two miles from Chorley town centre. It is located off the main road in three acres of land with gardens to the front and rear. The home can be accessed by a regular bus service. Mr Mohammed Hussain, Mrs Anwar Hussain, and Mr Naveed Hussain own the home, which is registered to provide accommodation for up to 34 older people with personal, nursing or dementia care needs. The Beeches has both single and shared private accommodation available on two floors; the upper floor being accessed by a passenger lift or stair case. All bedrooms have wash hand basins and there are 16 rooms with an en-suite. A variety of communal areas are available throughout, where people living at the home are able to entertain their visitors, eat their meals, join in activities or just simply relax. The Beeches promotes a flexible, friendly environment, so that people are able to entertain their visitors or take their meals within the privacy of their own accommodation, should they so wish. Information about the service and facilities available is included within the home’s Statement of Purpose and Service Users’ Guide, which is supplied to any potential residents and their families. The fees, as at 29th August 2007, ranged from £495 to £550 per week. Additional costs were being incurred for hairdressing, chiropody, newspapers and periodicals. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced site visit, which formed part of a key inspection, was conducted over one day in August 2007. During the course of the visit to this service, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from eight people involved with the service and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, which gives information to the Commission about how the home is meeting outcomes for people using the service and how the quality of service provided is monitored. Some of this information forms part of this inspection report. The inspector ‘tracked’ the care of three people during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at the home. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. What the service does well:
People were provided with sufficient information about the services and facilities available to enable them to make an informed choice about moving into the home. The information gathered before admission was detailed, providing staff with a clear picture of individual needs, so that the home was able to determine how the staff team could meet the assessed needs of people. The information recorded on the plans of care was well written, providing staff with clear guidance about how the needs of people were to be met and regular reviews had been conducted, showing that any change in care needs had been reflected within the plan. Residents or their relatives had been given the opportunity to be involved in the care planning process, so that they could make some decisions about the care received. One resident said, “The care here is excellent”. Staff were seen treating people with respect, making sure that their privacy and dignity was consistently being maintained. One relative commented, “They (the staff) do seem to genuinely care for their residents and do treat them with dignity and respect” and another stated, “The Beeches provides a caring environment for my relative, which has given my family peace of mind”. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 6 A variety of external professionals had been involved in the care of people living at The Beeches to ensure that their health care needs were being appropriately met. One relative stated, “The staff and nurses within the home are always eager to listen and learn from other people’s experiences and advice given from medical staff” A range of risk assessments were in place at the home and medications were well managed, ensuring that systems were in place to protect the health and safety of those living at the home. The service offered a range of activities, both indoors and within the local community, so that people were entertained. Those less able to participate received 1:1 input from the activities co-ordinator and staff, ensuring that some form of stimulation was provided. However, no one was pressurised to join in activities if they did not wish to do so, showing that people had a choice and were able to have some control over their lives. One person said, “It is a lovely atmosphere and we have some fun with the staff”. It was evident that the diverse needs of people living at the home were appropriately met by the provision of suitable equipment and the input of specialised care from external professionals. Relatives spoken to were happy about how visitors were received into the home and they informed me that the staff were all very friendly, kind and caring, and that people living at the home were able to have some control over their lives by managing their own finances, should they so wish. One relative, when asked what the home does well, commented, “The care home staff are wonderful. On visits I am greeted with a smile from staff, who are willing to discuss any problems. My relative has settled in well and he enjoys all the good food they make”. People living at the home were, in general provided with nutritious, wellbalanced meals so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The policies and procedures in relation to safeguarding adults were in accordance with the Department of Health guidance ‘no secrets’, so that people knew the procedure to take should a safeguarding alert be necessary. Staff at the home were aware of their responsibility to ‘whistle blow’ should they have any concerns about the welfare of anyone in their care. The home was tastefully furnished and pleasantly decorated to a high standard and the premises, both internally and externally were well maintained providing those living at The Beeches Care Home with a safe, clean, comfortable and homely environment. Effective infection control measures The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 7 were in place to ensure that the health and safety of people was adequately protected. Staffing levels were calculated in accordance with the assessed needs of people to ensure that adequate care was being delivered. Robust recruitment procedures and financial arrangements were in place at the home, which demonstrated that those living at The Beeches Care Home were adequately protected. It was evident from examining staff records that issues surrounding equality and diversity were taken into consideration when appointing people to work at the home. The registered manager held relevant qualifications, had a lot of experience and was appropriately trained to manage the care home. Residents, relatives and staff thought highly of her and they all felt supported by the management of the home. The health, safety and welfare of residents was protected by the policies, procedures and practices of the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. What has improved since the last inspection?
It was pleasing to see that all eight requirements outstanding from the previous inspection had been appropriately addressed and that fifteen of the seventeen recommendations had also been attended to. The current manager of the home had been in post for a period of twelve months, during which time she has worked hard, leading her staff team to improve the standards of service provided, which is commendable. Those living at the Beeches had been provided with a contract of residency, including fees payable, so that people were aware of the charges made by the home. The care records, in general were better organised and plans of care were fully completed on this occasion, providing staff with a clearer picture of the care, which people needed whilst living at the home. Any risks identified had been fully assessed, with strategies implemented, to ensure that people living at the home were adequately protected. Improvements had been made in telling people how they may make a complaint. The complaints procedure was freely available within the home and it was also included within the statement of purpose so that people were given enough information about how did they could make a complaint should they so wish. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 8 A lot of environmental improvements had been since the last inspection, including refurbishment, decoration, new equipment, replacement of soft furnishings and wall pictures, which enhanced the surroundings in which people lived. Improvements had been made in how the number of staff on duty were being calculated to ensure that the assessed needs of people living at the home were fully met. The manager of the home has been registered with the Commission for Social Care Inspection and has completed the Registered Manager’s award. She was demonstrating leadership skills to improve the standards of service through a person centred approach. A lot of training had been provided for all staff, including recognised qualifications in care and dementia care courses, so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet people’s assessed needs. One relative said, All the staff I have spoken to at the Beeches have attended training. The majority of staff are mature and have the life skills which I feel are appropriate to meet the needs of elderly vulnerable residents” Meetings for residents and their relatives, as well as staff were being held on a more regular basis so that important information was passed on and so that people were given the opportunity to openly discuss any issues, which they felt necessary. Formal supervision for staff had improved dramatically and now people working at the home were meeting with the manager every two months in order to discuss their progress and to identify any training needs, so that staff were regularly monitored and adequately trained to look after the people in their care. What they could do better:
The plans of care could be extended so that they focused on person centred care more, by including the social care needs of people and how those living at the home could be supported to maintain their leisure interests and hobbies whilst residing at The Beeches. The importance of privacy and dignity could have also been incorporated, particularly in relation to the provision of personal care. The findings of any risk assessments conducted could have been incorporated into the care planning process, so that staff were fully aware of what strategies had been implemented in order to eliminate or minimise any potential risks. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 9 The nutritional status of all residents could have been routinely assessed; to ensure that everyone was receiving adequate nutrition, particularly those suffering from a dementia related illness. The arrangements for the storage of equipment could have been better, so that all communal areas were easily accessible by residents and so that staff were easily able to access emergency equipment. Photographs of residents could have been attached to the Medication Administration Records in order to reduce the possibility of any drug errors. Although I was told that the pulse rate of people taking digoxin was checked before administration, it would have been nice to see the readings recorded on the Medication Administration Records. Not enough information was provided to people about the use of the local advocacy services to act on their behalf, should they so require. When asked how the care home could improve, one visitor said, “I and my relative would like to see some improvement in the meals provided, such as teas – maybe a little more thought and effort would not go amiss. Also more selection of potatoes instead of mashed potatoes on a daily basis”. The availability of advocacy services could have been better advertised, so that people living at the home and their relatives knew that they could appoint an independent person to act on their behalf, should they so wish. It would be better if people living at the home were able to choose an option from the menu at lunchtime, in advance of the meal being served. The information provided on the surveys conducted for residents and their relatives could be gathered and made public for all interested parties to read, so that people can see how the home is progressing. This process could now be extended so that the views of external professionals are sought on how the service is achieving its goals for the people living there. 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 Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 10 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 Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 11 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 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wishing to live at the home had been given sufficient information about the service before making a decision to move in. The preadmission process was thorough enough to ensure that individual needs could be adequately met. EVIDENCE: The manager informed me that people were given as much information about the home as possible to enable them to make a choice about accepting a place and that if they wanted to they were able to spend a few hours in the home before making a decision to move in on a trial basis. Comment cards received from people using the service indicated that they had received enough information about the home before going to live there, so that they knew what would be available for them. One of these people wrote, “We were given a full tour, even in the laundry and kitchen”.
The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 12 The Statement of Purpose and Service Users’ guide were freely available at the home and both documents had been reviewed to include up to date information about the facilities and services provided and the changes in the management structure of the home. A comment card from one resident showed that they had received a contract, and this person wrote, “I am quite happy and satisfied with everything I have found at the Beeches”. At the time of the site visit there were twenty-four people living at the Beeches, three of whose care was ‘tracked’, not to the exclusion of other residents. The manager told me that a trained member of staff conducted an assessment of residents’ needs before admission and that some improvements had been made in the last twelve months to promote the choice of home. The care records seen showed that detailed information about the needs of people had been obtained prior to admission to ensure that the staff team were confident that they could meet individual needs of everyone moving into the home. The detailed assessments had been retained on residents’ files so that those working at the home were aware of individual assessed needs. Policies and procedures were in place at the home, so that staff were provided with guidance about the admission process and the admission criteria was clearly stated in the service users’ guide so that people wishing to move into the home were aware of the admission process. The manager told me that all relatives were invited to participate in the Care Planning process, but most declined the offer because they trusted the judgement of the qualified staff and were happy with the resulting plan of care. However, she did say that the home would like to encourage more involvement with the planning of care, as they felt that it would give relatives a clearer understanding of the resident’s condition and progress. The assessed needs of those admitted to the home were consistently recorded within the care plan therefore staff were provided with detailed information as to how residents’ needs were to be met. One relative said that he had seen the plan of care for his relative and a staff member had discussed it with him. Staff spoken to knew about the needs of people and how to access the care plans, policies and procedures, which showed that they were able to obtain relevant information if they needed it. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 13 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living at the home were being consistently met and their privacy and dignity was always respected. EVIDENCE: The care of three people living at the home was ‘tracked’ during the course of the site visit. All three plans of care had been, in general developed from the information gathered prior to admission so that staff were aware of the assessed needs of people living at the home. The plans of care were well written documents and the care records, as a whole were well organised, providing a lot of useful information for staff guidance. However, although the social and leisure interests of individuals was recorded within each file, this information had not been transferred onto the plans of care to show how people were to be supported to maintain their hobbies and interests whilst living at the home.
The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 14 Residents or their relatives had been given the opportunity to be involved in the care planning process so that they were able to make some decisions about the care provided. The plans of care had been consistently reviewed every month to show that the needs of people living at the home were regularly assessed and accurately reflected. The registered manager told me that residents could retain their own General Practitioner, if possible or they could choose one who covered the home and that chiropody, optician and specialist services could be accessed when required. This information was confirmed by seeing the care records, which showed that a variety of external professionals were involved in the care of people living at the home to ensure that their health care needs were being appropriately met. Specialised equipment was provided to make the lives of people living at the home as comfortable as possible. The comment card received from an external professional indicated that individual’s health care needs were always met and that, in general the care service supported individuals to live the life they chose. One resident told me how the staff managed to heal the pressure wounds with which she was admitted, adding, “They (the staff) really worked very hard to get them better”. All comment cards received from residents, relatives and General Practitioners showed that they were satisfied with the overall care provided to the people living at the home. One resident wrote on the comment card, “The carers are all mature people showing compassion and thoughtfulness” and a relative simply stated, An excellent care home. Comment cards received, in general indicated that relatives were always kept up to date with important issues and that care and support was given to people living at the home. One relative commented, “I am happy to know that my relative is being well cared for” and another stated, “They (the staff) look after people in a relaxed, but very kind and caring manner”. One relative wrote the following comment, “The home should continue to monitor the behaviour and whereabouts of other residents, in particular those on respite care, who are more likely to be disorientated and behave aggressively towards other residents”. The registered manager told me that some improvements had been made in the last twelve months, in relation to the comprehensive review of Care Plans, which included all aspects of identified risks, health and personal care. The care records showed that a wide range of risk assessments had been conducted in order to reduce potential harm to people living at the home.
The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 15 However, the elements of risk had not been incorporated into the care planning process to show what strategies had been implemented in order to eliminate or reduce the potential risk for people living at the home. There was not always a nutritional risk assessment conducted for individuals in order to ensure that people were receiving an adequate dietary intake and to ensure that their nutritional status was being monitored. It is recommended that these assessments be implemented, particularly for those with dementia care needs. The management of medications was in general satisfactory. However, a photograph of each resident was not always attached to the Medication Administration Records for identification purposes and the pulse rate had not been recorded for one person receiving digoxin to show that the medication was only administered when required, in accordance with the heart beat. The inspector observed staff speaking to residents in a respectful manner and knocking on bedroom doors before entering to ensure that privacy and dignity was consistently maintained. One relative said, “People living here are treated very well. The staff are so kind and caring”. A written policy was in place and available to staff, which demonstrated that those living at the home were supported to maintain their privacy and dignity at all times. Induction records showed that staff had been instructed to treat service users with respect. However, the plans of care seen did not demonstrate that the wishes of people were respected in relation to maintaining privacy and dignity when giving personal care. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 16 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social, cultural and recreational activities met residents’ expectations and those living in the home received a healthy, varied diet according to their preferences. EVIDENCE: The home employed a person to be responsible for the organisation and provision of leisure activities and although planned activities were not always successful, due to the category of people living at the Beeches, I saw a lot of 1:1 interaction and people participating in small group activities. The registered manager told me that there was a varied programme of activities available with flexible daily routines to accommodate the fluctuating needs of people with a dementia related illness. People were seen being offered choices in relation to their daily routines and how they wished to spend the day. The atmosphere was friendly and jovial, providing a happy environment for those living at the home. I saw one lady
The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 17 enjoying dancing to music with a member of staff, others were enjoying manicures and hand massage, whilst chatting about their interests with staff and some people were quietly reading newspapers or discussing old photographs with members of staff. A small group of people were embroiled in a game of dominoes, one of whom said, “I love living here, it is better that being alone”. One person was enjoying watching the general activity, stating, “The staff are very good, all of them, particularly two of them, they are always singing, dancing and laughing. It keeps us going. The night staff are very good too” One resident confirmed that trips out were arranged on a regular basis and any special events or birthdays were celebrated, “in style”. People spoken to said that a range of activities were provided on a daily basis, which they enjoyed and that Religious Ministers visited the home regularly, so that their spiritual needs were being met. There were a variety of notices displayed telling people of forthcoming events, should they wish to participate. One resident told me, ““If I don’t join in I quite like to sit and observe activities”, and another commented, “The Beeches provide activities on a regular basis and organise events, such as Easter, Mothers day, barbeques and special events, which include family and friends”. There was an easily accessible sensory garden, which provided a pleasant and safe area for people to sit during the nicer weather. One person living at the home said, “I love to go and sit in the garden. It is very pleasant”. Comment cards received from residents indicated that staff were usually available when residents needed them and one added, Sometimes the staff seem to take tea breaks at the same time as each other leaving us unsupervised. I think this has been brought to the attention of the management of the home after a few incidents. At the time of this site visit I saw staff present in the communal areas of the home, so that people living there could be supervised in order to prevent any unnecessary incidents. The care records showed that people’s choices had been taken into consideration and their leisure interests were recorded, so that staff were able to provide activities in accordance with people’s preferences. Both residents who submitted comment cards said that staff listen and act upon what people living at the home say. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 18 The manager told me that open visiting was in operation at the Beeches. Relatives were seen to be visiting people in private and visitors spoken to felt that they were welcome to the home at any time and that a friendly environment was provided for both residents and visitors. The comment cards received supported this information. One relative said, “The Beeches welcome visitors and always make them feel at home, providing feedback about my relative’s care”. A visiting policy was in place at the home and information relating to visiting was also included in the statement of purpose and service user guide to ensure that all interested parties were aware of the visiting arrangements of the home. Wherever possible people living at the home controlled their own finances with regard to payment of fees and personal money, so that they had some control over their lives. The manager told me that people had access to advocates, so that they could appoint an independent person to act on their behalf, if they so wished. However, there was little evidence available to show that the home told people about the availability of advocacy services. The manager told me that at the time of the site visit all those living at the home had relatives who, where required acted on their behalf. I noted that personal possessions adorned individual rooms, where appropriate to create a homely environment and audits of service users’ belongings had been conducted on admission to protect the safety of individual’s personal possessions. The manager told me that the meal experience was treated with great importance at the Beeches and that special diets were provided, in accordance with people’s dietary needs and preferences. I spent a long period of time sitting in the dining room with residents, whilst they were served lunch, so that I could observe the management of a typical meal-time. The dining room was found to be relaxed and friendly, with well-presented tables and an unhurried atmosphere, providing comfortable and pleasant surroundings in which people living at the home could eat. One visitor was seen assisting their relative to eat, showing that families were encouraged to participate in the care of their loved ones. I saw staff supporting people with their lunch, as was needed, although specialised tools were provided, where necessary, in order to promote independent eating. During the meal I observed staff chatting with people in a dignified manner, complimenting residents about a variety of things, and those requiring a long time to eat their meal were allowed to eat at their own pace, without being hurried. The food served appeared appetizing in order to aid The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 19 nutrition. One relative, who visited regularly at meal time said the meals always appear nutritious”. The chef was involved with the serving of meals and evidently knew people’s preferences. One resident told the chef that lunch was very good. Some choices were offered during lunchtime, giving people some control over their lives. However, a choice of main course was not routinely offered before the mealtime, so that people were able to choose options from the menu. However, I was informed that residents could have alternatives to the lunchtime menu should they so wish. One resident said, “Just odd times we are given food that is more convenient to staff, with no nourishing content. Most of the time the food is very good”, another stated, “The food is very good. I eat everything”. One relative commented, “The Beeches try their best to give my relative a healthy diet and stay within her dietary requirements”. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 20 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were well managed and people living at the home were adequately safeguarded. EVIDENCE: The registered manager told me that the home had an open policy regarding complaints and that she is available to listen and discuss any concerns, which people may have. A detailed complaints procedure was in place, which was displayed prominently within the home and which was included within the statement of purpose, showing that people were given enough information about making a complaint should they wish to do so. One comment card received from a relative indicated that they would not know how to make a complaint. However, other comment cards received showed that people would know how to make a complaint, should the need arise and all the people spoken to at the time of the site visit said that they would know what to do if they were not happy about something. One relative stated, “In the first instance I would address the home direct – in the past this has been enough to address any problem”. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 21 In general, people spoken to felt that the home had responded appropriately if they had raised any concerns. One relative commented, “I have no complaints” and another stated, “Whenever necessary The Beeches have responded to my concerns and have acted appropriately”. A system was in place at the home so that any complaints received could be recorded and any recurring patterns identified and regularly monitored. However, the complaints file contained loose leaf, unnumbered sheets, which could result in pages being lost or removed. Records showed that one complaint had been received since the last inspection, which was currently being investigated by the home. One person said, “I had need to bring one concern to the attention of the current manager, which was dealt with immediately and effectively”. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. Policies and procedures were in place at the home in relation to safeguarding adults, which were in accordance with Department of Health guidance, so that people were fully aware of the action to take should an allegation of abuse be reported to the home. The registered manager said that staff had received training in relation to safeguarding adults, which was confirmed by staff members spoken to records seen supported this information. Staff were aware of what they should do if they had any concerns about the welfare of anyone in their care to ensure that appropriate action would be taken. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 22 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was safe, well maintained, pleasantly decorated and furnished, providing a clean and homely environment for people to live in. EVIDENCE: The registered manager told me that the home promoted and maintained a welcoming, informal, family-like friendly atmosphere balanced with professionalism. She also said that a lot of environmental improvements had been made since the last inspection, including the development of sensory gardens, furnishings for individual rooms and communal areas had been updated, the outside entrance area had been refurbished and many soft furnishings and wall pictures had been replaced. A lot of new equipment had also been purchased in order to raise the standards for people living at the home. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 23 I toured the premises during the course of the site visit and found that a lot of work had gone into improving the standards of the environment since the last inspection. The home was tastefully decorated and well maintained, providing a very homely and pleasant environment for people to live in. The gardens were well presented and suitable for the needs of the people living at The Beeches. The laundry department was fit for purpose and was suitable for the needs of the residents’ and the home. Detailed policies were in place at the home to ensure that the control of infection was being adequately met so that the health and safety of people living there was appropriately safeguarded. The registered manager told me that standards of hygiene had been improved in both the housekeeping and laundry departments by staff working to a structured routine via handbook procedures, which was seen to be good practice. Odour control was effective so that the home was pleasant smelling. One person stated that the home is always fresh and clean and another said, “The staff do their best to keep up the standards of cleanliness and freshness”. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 24 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff working at the home were trained, skilled and in sufficient numbers to fulfil the aims of the home and to meet changing needs of residents. The recruitment procedures adequately safeguarded those living at the home. EVIDENCE: At the time of the site visit there were 34 people living at The Beeches Care Home. The registered manager was able to demonstrate that the number of staff on duty was being calculated in accordance with the assessed needs of people living at the home. The staff duty rota showed that a good skill mix of staff made up the staff team so that residents’ needs were being fully met. Residents spoken to felt that their needs were being met and that the staff were patient and did not rush them when assisting them with activities of daily living. Staff and relatives spoken to felt that there were enough people on duty to meet the needs of those living at the home. Staff were seen spending time with people living at the home, who were chatting together comfortably, providing quality 1:1 interaction. There was a total of eighteen care staff employed by the home, eleven of whom had achieved a National Vocational Qualification at level 2 or above,
The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 25 giving a total of 61.5 of care staff with a recognised qualification in care, showing that people working at the home were appropriately trained. Three staff files were examined at the time of the site visit. It was found that recruitment procedures were being adequately followed in day-to-day practice and sufficient checks had been undertaken on staff to ensure that those living at the home were adequately protected. The registered manager said that a comprehensive Induction Programme was in place for all new employees and that Health Care Assistants were able to progress to obtaining a recognised qualification in care, so that staff were encouraged to keep up their personal development, whilst working at the home. Staff spoken to and records seen confirmed this information and staff said that they felt a lot of training was provided and everyone’s training needs were identified through supervision, which was held every 2 months. Records showed that a lot of training for staff had been introduced and formal supervision was being conducted on a regular basis, to ensure that staff were adequately trained and competent to do the job expected of them. The registered manager told me that once the decision had been made to accommodate people with dementia care needs, the services of a specialist dementia nurse trainer were engaged. For staff to complete a specific training programme in relation to dementia care is now an integral part of the induction process, which is considered to be very good practice and which should be sustained. Seven other members of staff had obtained a level 2 qualification in a recognised dementia care course, which had enabled additional training to be introduced to all staff. The home manager had also attended a course on Therapeutic Activities & Dementia, which enabled her to help staff to improve their overall understanding of dementia care. Comment cards from relatives indicated that staff, in general had the right skills and experience to deliver appropriate care and one resident commented, “The staff are dedicated and are always there for me”. One relative said, “Permanent staff are usually very good, but temporary/bank staff can be lax and not always caring enough”. The registered manager said that the amount of agency staff had been gradually reduced over the last year and a ‘bank’ of staff employed by The Beeches had been built up, in order to cover any staffing deficits. One member of staff said, “It is like a little community here. Everyone gets on well. Team spirit is excellent. We all support each other. We are all like a family, both residents and staff. It is so friendly”.
The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 26 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, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was being well managed by a competent person, having effective systems in place for monitoring the quality of service provided and the health, safety and welfare of people living at the home were adequately protected. EVIDENCE: At the time of the last inspection the registered manager was very new to her position. However, since that time it is evident that she has worked hard to improve the standards of service for the people living at The Beeches Care Home. On this site visit she was found to be a competent and highly motivated Home Manager, which should enable the service to be taken forward in a structured and positive manner. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 27 There was a strong belief of being open and transparent in all areas of running the home so that people were kept informed of matters involving themselves. The manager had completed a variety of additional training courses and was resident focused, by leading and supporting the staff team who had been appropriately recruited, so that those living at the home were adequately protected. Staff spoken to felt that the manager of the home was extremely supportive. One said, “The manager is very approachable. Any concerns are dealt with immediately”. The registered manager said that a new quality assurance system had been introduced in order to improve the ongoing monitoring of the standard of service provided and that the home was in the process of achieving a recognised external quality award. Surveys had recently been conducted so that the views of residents and their relatives were obtained about how the service was performing. The information gathered had not been put together and produced to show interested parties the strengths and weaknesses of the service. A variety of meetings had been held and these were recorded as minutes, so that people were kept informed of any relevant matters and evidence was available to show that any issues raised had been appropriately addressed. The registered manager had put in place a variety of regular, detailed audits, which enabled her to identify and address any shortfalls in relation to health and safety, in order to keep the people living at the home in a safe environment. A wide range of risk assessments had been conducted, which were sufficiently detailed, showing that some systems had been put in place in order to reduce the possibility of injury to people living at the home. Systems were in place at the home to ensure that residents’ finances were adequately protected. The relatives of residents were responsible for the management of their money. However, small amounts of money were retained by the home on behalf of residents, so that they had money available, should they need it. Clear records were kept of any money or valuables retained at the home on behalf of residents so that the possibility of any mishandling was reduced. Records showed that people working at the home were formally supervised at regular intervals, when they met with the manager of the home to discuss their progress and to identify any specific training needs, so that everyone was monitored and adequately trained to look after the people in their care. The registered person told me that all systems and equipment within the home had been appropriately checked, so that the health and safety of people living
The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 28 there was protected. This was confirmed by examination of a random selection of service certificates. Accidents occurring in the home had been accurately recorded so that the manager was able to audit and monitor the frequency of accidents. The environment was free from any hazards, which could pose risks to those living at the home. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations The plans of care should show how residents are to be supported to maintain their social interests and hobbies whilst living at the home. The plans of care should incorporate the findings of any risk assessments conducted and should identify any strategies put in place to eliminate or reduce the elements of risk. It is advised that nutritional risk assessments are conducted for all residents, particularly those with dementia care needs, to ensure that individuals are receiving an adequate dietary intake and so that the nutritional status of people is consistently monitored. Photographs of all residents should be attached to the Medication Administration Records for identification purposes. The pulse rate should be taken and recorded prior to the administration of digoxin, to show that the medication is
DS0000025548.V343831.R02.S.doc Version 5.2 Page 31 3. OP8 4. 5. OP9 OP9 The Beeches Care Home 6. 7. OP10 OP14 8. OP15 9. OP16 10. 11. OP33 OP33 only administered in accordance with the heartbeat. The plans of care should include the need for privacy and dignity, particularly in relation to the provision of personal care. It is recommended that a system be implemented to provide people with information about the availability of advocacy services, should they wish to appoint someone to act on their behalf. It is recommended that a choice of meals be included on the menu at lunch time, so that people living at the home, are given the opportunity to select an option from the menu. It is recommended that a system for recording complaints be implemented so that pages cannot be lost or removed and if this did happen the missing page number could be easily identified. The results of the surveys returned by residents and their relatives should be published, so that interested parties can see how the service is performing. The monitoring of the quality of service provided should now be extended to obtaining feedback from stakeholders in the community, who are involved in the care of residents, to obtain their views on how the home is achieving it’s goals for the people living there. The Beeches Care Home DS0000025548.V343831.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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