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Inspection on 30/08/06 for The Beeches Care Home

Also see our care home review for The Beeches Care Home for more information

This inspection was carried out on 30th August 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Before people are admitted to The Beeches they have an assessment of what help they will need. Important information needed to support them in every day living such as nursing needs is recorded and available to plan the care required. Resident`s healthcare needs were monitored. People requiring nursing care had the benefit of qualified nurses working in the home. Professional care and advice to benefit residents was sought from healthcare personnel such as General Practitioners when required. Residents considered activities were enjoyable and varied. An activities coordinator organised these and considerable effort was made to make sure all residents had an opportunity to do what they wanted. Residents said they enjoyed baking sessions and others being `pampered` with a manicure by staff. Entertainment was provided and special occasions such as Christmas and birthdays were celebrated. Visiting arrangements were good. Written comments from visitors, and those visiting during inspection, said they were made welcome in the home and could visit when they wanted. Meals and mealtimes were considered enjoyable and met with resident`s satisfaction. Staff helped residents who had difficulty managing to eat their meals themselves. To protect residents, all staff in the home were trained in Protection Of Vulnerable Adults (POVA) and had written instructions how to follow correct procedures.Residents thought their bedrooms were comfortable and they had everything they needed in place. Some residents had their own pieces of furniture accommodated. The standard of accommodation and general cleanliness was good. Written comments from residents all agreed the home was usually kept clean and fresh. Good recruitment procedures were followed to protect residents. The training given to staff, meant residents were cared for by staff who knew how to help them safely. Good financial management of temporary savings held for residents was followed. Teamwork was evident amongst the staff. This helped them to work towards providing a quality service to the residents. Staff were described by residents as mainly `good girls`, and `helpful`.

What has improved since the last inspection?

Since the last inspection, residents have a written plan of care that shows what help resident needs in respect of their health and welfare. The refrigerator temperature for storing medication is checked regularly. Policies and procedures relating to the protection of vulnerable adults had been reviewed and staff had been trained in Protection Of Vulnerable Adults Procedures. Worn furniture and fittings had been replaced and other work such as a risk assessment regarding the control of the risk of legionella had been completed. The fire department had visited and a satisfactory report given. New bedding, curtains and carpets had been provided and some rooms decorated. The provision of staff training had improved and the home has achieved a high percentage of staff trained in National Vocational Qualification in care level 2. A training and development programme had been developed that showed how the home achieved this. There is an improved accounting of residents money held at the home with records of payments made for example hairdressing receipted properly.

CARE HOMES FOR OLDER PEOPLE The Beeches Luxury Nursing Home The Beeches 25 Park Road Coppull Chorley Lancashire PR7 5AH Lead Inspector Mrs Marie Dickinson Unannounced Inspection 11:00 30th August 2006 & 7th September 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 Luxury Nursing Home DS0000025548.V308877.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 Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Luxury Nursing Home Address The Beeches 25 Park Road Coppull Chorley Lancashire PR7 5AH 01257 792687 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) beechescarehome@tiscali.co.uk Mr Mohammed Hussain Mrs Anwar Hussain, Mr Naveed Hussain 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 Luxury Nursing Home DS0000025548.V308877.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 OP (Old Age not falling within any other category) Up to 27 service users in the category DE (Dementia) Up to 2 service users over the age of 45 in the category of PD (Physical Disability) Date of last inspection 17th January 2006 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. The home is registered to provide personal care and accommodation for 34 older people with a range of physical and personal needs. This includes those requiring nursing care, residential and dementia care. The accommodation has both single and shared rooms. There are two floors; the upper floor can be accessed by a passenger lift. All rooms have wash hand basins and there are 16 rooms with en-suite facilities. Two of the three bathrooms have hoists for assisted bathing. There are three lounges; one is for residents who wish to smoke. In addition, there is a dining room and an activity room. Information about the service is available from the home for potential residents in a Statement of purpose and Service User Guide. Weekly charges for personal care and accommodation range between £400 and £525. Residents are responsible for additional extras such as hairdressing, private chiropody and transport costs for trips out. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit was unannounced and took place on the 30th August and 7th September 2006. The inspection involved getting information from staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the registered provider,relatives, and included a tour of the premises. Five responses were returned to the Commission from relatives/visitors and five from residents, who gave their personal view of the services provided. Areas that needed to improve from the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Older People. What the service does well: Before people are admitted to The Beeches they have an assessment of what help they will need. Important information needed to support them in every day living such as nursing needs is recorded and available to plan the care required. Resident’s healthcare needs were monitored. People requiring nursing care had the benefit of qualified nurses working in the home. Professional care and advice to benefit residents was sought from healthcare personnel such as General Practitioners when required. Residents considered activities were enjoyable and varied. An activities coordinator organised these and considerable effort was made to make sure all residents had an opportunity to do what they wanted. Residents said they enjoyed baking sessions and others being ‘pampered’ with a manicure by staff. Entertainment was provided and special occasions such as Christmas and birthdays were celebrated. Visiting arrangements were good. Written comments from visitors, and those visiting during inspection, said they were made welcome in the home and could visit when they wanted. Meals and mealtimes were considered enjoyable and met with resident’s satisfaction. Staff helped residents who had difficulty managing to eat their meals themselves. To protect residents, all staff in the home were trained in Protection Of Vulnerable Adults (POVA) and had written instructions how to follow correct procedures. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 6 Residents thought their bedrooms were comfortable and they had everything they needed in place. Some residents had their own pieces of furniture accommodated. The standard of accommodation and general cleanliness was good. Written comments from residents all agreed the home was usually kept clean and fresh. Good recruitment procedures were followed to protect residents. The training given to staff, meant residents were cared for by staff who knew how to help them safely. Good financial management of temporary savings held for residents was followed. Teamwork was evident amongst the staff. This helped them to work towards providing a quality service to the residents. Staff were described by residents as mainly ‘good girls’, and ‘helpful’. What has improved since the last inspection? What they could do better: To avoid any misunderstanding; people should be given a contract of residency to include full fees payable prior to moving into the home. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 7 To make sure staff know what to do to help residents as they need and wish, the plan of care should have more detail written. Daily records should show how care is given. In addition to this any risk identified should have a plan of action for staff to take in keeping people safe. To make sure residents dignity is never compromised, staff must be available to assist residents with personal care at all times, be courteous and responsive to diverse needs. A daily living plan would help this be achieved. Handwritten additions to the MAR (Medication Administration Record) should be checked by two people and signed confirming the accuracy of the record. Eye drops when first opened should be dated to help ensure they are not used for extended periods. A choice of menu would improve the catering arrangements for residents and the use of a menu board in the nursing unit would inform residents of meals to be served. The complaints procedure should be promoted better to make sure residents and relatives know what to do should they have any concerns. To complete the refurbishment of the home, the carpet tiles purchased for the corridors should be fitted. The resident’s bedrooms must have suitable locks fitted on the doors for privacy reasons. They should also be supplied with a lockable facility in their rooms. Sufficient staff must be employed to make sure consideration is given to residents in the nursing unit not being left unattended. To fully protect residents, the staff, and the management, staff employed in the home should have some type of formal agreement to abide by the homes policies and procedures and any code of conduct relevant to their work. To make sure staff are familiar with best practice in dementia care formal training must be provided. The manager should be registered under the Care Standards Act and an application for such must be forwarded to the Commission without delay. To support the manager to improve overall standards, more management hours should be allocated. This would help the manager deal with issues that have arisen from quality assurance monitoring, and oversee good professional conduct by staff. Residents should be encouraged to hold meetings. Staff should be given the opportunity to have meetings and staff supervision improve in frequency. To complete health and safety training, all staff should be trained in food hygiene. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 9 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 Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessments were carried out for residents prior to moving into the home. Residents were issued with a contract of residency. EVIDENCE: Written comments received at the Commission from residents showed they felt they were given enough information to help them make a decision about moving into the home. A number of residents had been admitted since the last inspection. Recorded information showed how a decision was made to admit someone into the home. Different professionals had completed assessments. For example people had an assessment of needs by a social worker or health professionals and in all instances an assessment of need, carried out by the manager. This gave everybody involved an opportunity to discuss the placement and see if needs could be met at the Beeches. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 11 Details of new admissions showed the information recorded on the assessment was sufficient to determine the home had the right facilities and staff to care for the resident. Comments sent to the Commission from residents confirmed they were issued with contracts that outlined the cost of staying at the home and terms and conditions of residency. Contracts should be made available when people are first admitted. This would help to make sure people know of any additional cost such as ‘top up’ of fees that may be required. By having this information, people can make a choice of whether they wish to live at the home and accept the extra cost. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans written for residents’ required further development in order for staff to provide the right personal care for residents. Healthcare was monitored. Residents were satisfied their care needs were met and they considered staff were mostly respectful to them. Medication was managed safely. EVIDENCE: Each resident had a plan of care. How identified needs were to be supported was not always clear and these read as statements rather than a working document. For example one resident’s care plan recorded ‘assistance with washing and dressing’. The service to be provided was ‘as much assistance as resident wants’. However the assessment identified other issues that needed consideration such as how osteoporosis would affect movement, and indications of being ‘unsteady’. As care planning is currently being developed, a couple of care files showed a brief record was made of residents past history. This helped staff to understand people as individuals, their likes, and dislikes. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 13 Communication, orientation, motivation, and interests and hobbies equally had only brief detail and risk assessments needed better clarification. Examples of this were managing aggression, and managing residents basic need of feeling secure. The manager said staff manages these incidents very well. However to make sure best practice is followed in these situations, clear instructions are needed. Entries in daily records showed how residents received care, however some entries read ‘care as plan’, and need to improve. Staff currently work to designate responsibilities given by the registered nurse on duty. One resident had a night care plan linked to pressure care. Some of the residents on the nursing unit said they sometimes ‘talked about their care with nurses.’ Staff has just had key working introduced. The manager said this should improve the all round care and include resident’s healthcare and mental health care needs. Medical professionals such as chiropodist and residents doctor visit when needed. Pressure relieving appliances were used such as airbeds and charts used monitored hourly pressure relief provided by staff. Clinical procedures such as dressings were carried out in the privacy of residents’ bedrooms by registered nurses. Those residents with cot sides fitted to their bed had bedrail disclaimers signed by relatives to show it was in the residents interest to use them. Residents considered staff were mindful of their privacy. Staff were observed keeping bathroom and toilet doors locked when they were helping residents. Staff also knocked on bedroom doors and waited to be invited in. Relatives visiting confirmed they were kept informed of matters that involved their relative. Written comments from relatives highlighted some problem with staff not being available, and residents’ dignity was sometimes compromised because of this. ‘Staff were very nice and caring however there were times during the day when they were not available to see to residents needs, for example when people request the toilet’. Residents who sent comments to the Commission show they usually receive care and support they need, and most felt the staff listen and act on what they say. The home operated a monitored dosage system for the administration of medication, which was dispensed into controlled dose packs by a local pharmacist. An appropriate recording system was in place to record the receipt, administration and disposal of medication. Staff responsible for the administration of medicaction were trained. Some aspects of medication management need to improve for example; eye drops did not have the date when opened written on and handwritten additions The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 14 to the MAR (Medication Administration Record) chart did not have two signatures on to make sure no errors have been made. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Resident’s lifestyle was to near to their expectations and they felt generally satisfied with their care in the home. Activities were varied. Visitors to the home were made welcome. Catering arrangements were satisfactory. EVIDENCE: There were mixed views by residents as to whether they had any real say in how they lived their lives. During inspection some residents said they had some say about their routine, for example what time they get up. Some said they were served breakfast in bed and after this staff came to help them get ready for the day. Residents need a daily living plan to show how they would like their routine. The use of agency staff meant there are times residents are cared for by people they may not be familiar with, and some residents are unable to express themselves sufficiently to give instruction. Comments from an internal review of services carried out in March show not all residents were satisfied, and some felt they had ‘little freedom to choose what they did with their day’. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 16 The residents’ preferences in respect of social activities had been recorded as part of their assessment. Activities provided were good. They were varied and catered for all tastes. Staff were observed walking in the garden with residents, other residents were having their nails manicured and some residents talked about baking sessions. Seasonal activities were provided with entertainment in the home. Some residents go out. An activities coordinator was employed for this purpose and she kept a record of who joined in the various activities. Comments from residents and relatives gave a positive view as to the arrangements for visiting. Residents felt they could see their relative in private. Relatives who posted comments and visitors during inspection said they were made welcome into the home. Some residents had pieces of their own furniture and personal belongings arranged in their rooms how they wished. The manager maintained a record of personal items brought into the home by residents and their families. Residents were supported to continue with their chosen religion. Representatives from local churches visited the home on a regular basis for prayers and communion. There were no arrangements made for residents to have meetings. The residents made good comments about the food. One resident said “the food is good, if I don’t like what is being served I can have something different’ and ‘I can’t remember what I had for dinner, but it’s soup for tea.’ There were no alternatives offered on the menu. The cook said although it is a set menu, there is always alternatives on offer for the residents. Records were kept of all the meals served. This was discussed, also the lack of a menu board in the nursing unit. Special diets were catered for. The manner in which meals are served was good. Staff were observed providing suitable assistance to residents. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents had access to a complaints procedure and staff were trained in Adult Protection topics. EVIDENCE: A copy of the complaints procedure was displayed and included in the information given to prospective residents. The procedure gave clear directions on whom to make a complaint to and the timescales for the process. However the complaints procedure needs to be promoted as a significant number of relatives/visitors to the home and comments from residents show people generally do not know how to make a complaint. Written comments from residents also show they were not sure who to speak to if they were not happy. The home had an appropriate internal procedure for staff to follow should they suspect or witness an incident of abuse. Staff spoken to confirmed that they had received training in respect to adult protection and procedures. Records made avilable show over 90 staff trained. Staff had a good understandiong of their duty regarding these issues. Management need to respond to results from quality assurance carried out in the home that identify some issues referring to residents protection, such as courteousness of staff. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents live in a clean well-maintained safe environment. Aids and adaptations were provided to maximise independence. Resident’s rooms were safe and comfortable. EVIDENCE: Requirements and recommendations made at the last inspection had been dealt with. This included the lounge and dining room carpet replaced. Some furniture in bedrooms had been replaced including commodes, with bedding, chairs and curtains and light shades fitted. Carpet tiles were in the home ready to be fitted on the corridors. The owners said the pipe work in the toilets is from source cold water, and is therefore not a safety issue. The new outdoor enclosed garden with sensory planting was popular with the residents; particularly residents with dementia care needs. It was safe and had seating provided. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 19 Other environmental changes had been made that included a ‘nurses station’. There is a non-smoking lounge. Keypad locks have been fitted to access the nursing unit, the entrance with a new reception, and the stairs and kitchen. The upper floor could be reached by using the passenger lift. The home was very clean, odour free and nicely maintained. One resident said ‘I have a lovely bedroom here, I’ve lived in Coppull all my life’. Other residents were pleased with their living accommodation and said everything they needed was at hand. Hospital beds were provided for residents who needed these for nursing. Bedroom doors should be fitted with appropriate locks that allow staff access in the event of an emergency. This would ensure residents privacy is respected and their safety considered at all times. All residents should be provided with a lockable facility in their room as a means to keep personal possessions safe. Lockable facilities has many uses such as for example storage of medication or personal letters or anything a resident wishes to keep private. Bedrooms had been personalised and residents were happy with them. There were sufficient toilets and bathrooms with aids available such as bath seats and hoist. The laundry was organised and managed correctly. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.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 at least once during a 12 month period. 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 the service. The deployment of staff within the home was not satisfactory to meet the needs of residents. Recruitment practices were good. Staff were trained to care for residents safely. EVIDENCE: At the time of inspection there were twenty one residents in the home. The manager said staffing was arranged according to a staffing notification. As resident numbers increase, staff increase and this was one reason why agency staff were employed. The manager had maintained a written staff rota, showing how staffing levels were maintained. It was noted that the nursing and residential units were not staffed seperately and how staff were deployed meant there were occasions when this situation was unsatisfactory as observed during inspection. Comments received at the Commission show some people felt there were insufficient staff on duty. Residents were generally happy with the staff in the home describing them as ‘good girls’ and ‘helpful’. One visitor said staff were ‘very nice and caring’. Other comments however, described staff as ‘sharp’ when you ask them for help, and ‘some staff are good, some shout if you don’t do what they ask’. Since the last inspection a number of staff had been recruited. Staff files showed good recruitment procedures followed that included checks required The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 21 for protection of residents carried out prior to employment. All new staff were given induction training that included essential training such as moving and handling, health and safety and fire procedures. Although staff were issued with a contract of employment, residents must be better protected by a formal agreement that staff in addition to working according to the terms of the contract of employment, they will abide by the The Beeches Code of Conduct and practice and policies and procedures.’ Staff training included National Vocational Qualification in care. the percentage of staff qualified was very good and six staff have enrolled bringing the total to 100 when they qualify. Records show all staff had done moving and handling, abuse in care homes, fire safety. Some health care staff had completed medication training. The number of staff trained in dementia care needs to improve. The manager said this is`planned. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Results of quality assurance systems in place were not used to improve services for residents. Resident’s financial interests were protected. Staff were supervised in their work. The health and safety of residents and staff was considered. EVIDENCE: The providers were present during part of the inspection and they discussed the recent environment improvements they had made. They were pleased with the progress achieved and said they hoped the new manager would stay. The acting manager had been in post since June. Her working hours are combined management and nursing duties. The number of management hours should be increased to provide a sustainable improvement in the care provided for residents. This was highlighted in the findings of the last yearly survey carried The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 23 out in March 2006, showing areas the manager could make improvements to the service. There were issues in this survey that would have benefited an action plan drawn up to deal with areas of practice needing to improve. Some residents indicated their main concerns are, courteousness of staff; not feeling valued as a member of the home; little responsibility for making decisions; little feeling of being valued as a member of the home; little freedom to choose what I want to do with my day. Registered nurses support the manager. When on duty they delegate responsibilities to the care staff. All staff meet at the beginning of shifts for a handover meeting. There are two communication books in use. One for the nurses and one for the health care assistants. The last formal health care staff meeting was in February, and there were no records of the Registered Nurses having any meeting. Supervision was given to staff daily, however formal supervision must be regular and given in addition to their yearly appraisal. Personal allowances for residents were not normally held at the home. However money brought in by relatives for residents use was kept in the safe. A number of these accounts showed money were managed properly and a random check of balances showed a clear audit trail. Accounts relating to the fees paid by residents were submitted. These showed the amounts payable by whom and method for payment. Residents/relatives were invoiced monthly for fee top up. Other payments such as chiropody were invoiced and receipts kept of all transactions. Arrangements had been made for staff to have mandatory training such as fire safety procedures, and first aid. Staff training records showed staff had nearly all completed mandatory training, however food hygiene remains outstanding for a high percentage of staff. Information contained in the pre – inspection questionnaire indicated that maintenance and associated records were kept up to date, for example a valid electrical safety certificate and regular fire alarm test. Policies and procedures were available and reviewed regularly. The required risk assessment for the control of legionella had been forwarded to the Commision following the last inspection. Water temperatures at source, and in bedrooms, were satisfactory. The storage of cleaning products was also satisfactory. Management kept the Commission informed of any significant incident. The home is visited regualrly by the providers who submit a report of their visit to the Commission. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 24 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 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 3 X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The written plan of care that shows how a residents needs in respect of his health and welfare are to be met must give clear instructions for staff to follow. Risk assessments must be properly completed showing how to manage, reduce, or eliminate potential risks. The manager must make suitable arrangements to ensure the dignity of residents is respected by making sure sufficient staff are available to attend to residents personal needs at all times. Bedroom doors must be fitted with locks to ensure residents privacy and safety. They must be of a suitable type that enables staff to access the room in an emergency. The manager must employ sufficient staff to meet the needs of the residents in both units. To protect residents from risk of harm or abuse, the registered provider must have formal agreements with staff regarding DS0000025548.V308877.R02.S.doc Timescale for action 14/10/06 2. OP7 13(4)(c) 14/10/06 3 OP10 12(4)(a) 14/10/06 4. OP24 23(2)(e) 13(4)(c) 21/11/06 5 6 OP27 OP29 18(1)(a) 13(6) 14/10/06 14/10/06 The Beeches Luxury Nursing Home Version 5.2 Page 26 7 8 OP30 OP33 18(1)(c) 12(5)(b) significant issues that can impact on the welfare of residents for example acceptance of gifts. The registered person must ensure that staff receive training in dementia care. The registered provider and manager must in relation to the conduct of the home create an environment that encourages and assists staff to maintain good personal and professional relationships with residents/representatives. 01/12/06 14/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8 9 Refer to Standard OP2 OP7 OP9 OP9 OP12 OP15 OP16 OP18 OP19 Good Practice Recommendations It is recommended to avoid any misunderstanding; people should be given a contract of residency to include full fees payable prior to moving into the home. It is recommended that daily records give better detail how care is given. It is recommended that eye drops are dated when first opened to help ensure they are not used for extended periods. Handwritten additions to the MAR (Medication Administration Record) chart should have two signatures to make sure no errors have been made. It is recommended residents have a daily living plan written to help staff know their preferred lifestyle. It is recommended a choice menu is introduced and a menu displayed in the nursing unit. It is recommended the complaints procedure be advertised better. It is recommended management respond to results of quality assurance to improve care practice for protection of residents. It is recommended the carpet tiles purchased for the corridors be fitted. DS0000025548.V308877.R02.S.doc Version 5.2 Page 27 The Beeches Luxury Nursing Home 10 11 12 13 OP24 OP31 OP31 OP33 14 15 16 17 OP33 OP33 OP36 OP38 It is recommended residents be supplied with a lockable facility in their bedroom. It is recommended an application to register the manager with the Commission be submitted. It is recommended management hours allocated be increased. The results of the quality monitoring system of satisfaction questionnaires completed by residents and relatives should be published outlining action to be taken to improve services within the home. It is recommended residents be given opportunities to have meetings. It is recommended all staff have regular staff meetings. All staff should receive formal supervision at least six times a year. It is recommended all staff have food hygiene training. The Beeches Luxury Nursing Home DS0000025548.V308877.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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