Inspection on 11/11/08 for The Beeches Nursing Home

This inspection was carried out on 11th November 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

The Beeches Nursing Home 21/05/08

The Beeches Nursing Home 07/11/07

The Beeches Nursing Home 05/09/06

The Beeches Nursing Home 09/02/06

The Beeches Nursing Home 16/09/05

The Beeches Nursing Home 21/10/04

The Beeches Nursing Home 09/06/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE The Beeches Nursing Home 320 Beacon Road Wibsey Bradford BD6 3DP Lead Inspector Catherine Paling Key Unannounced Inspection 11th November 2008 09:55 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 Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Nursing Home Address 320 Beacon Road Wibsey Bradford BD6 3DP 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) 01274 608656 01274 608656 beechesch@aol.com Victorguard Care plc Michelle Shannon Care Home 64 Category(ies) of Old age, not falling within any other category registration, with number (64) of places The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 64 The maximum number of service users who can be accommodated is: 64 21st May 2008 2. Date of last inspection Brief Description of the Service: The Beeches Care Home is a purpose built home situated in the Wibsey area of Bradford. It is registered to provide personal care with nursing care for up to 64 older people. The home is located in a residential area that is near to a regular bus route. There are pubs, shops and churches nearby. Adequate parking is available adjacent to the building. Accommodation is provided on two floors. All the rooms have en suite facilities. There is a passenger lift and the home has wide corridors making it good for wheelchair access. Communal lounge and dining rooms are on the ground floor. There are panoramic views over Bradford from one of the lounges. There is an accessible garden and patio Information about the services provided can be obtained from the home in information packs. The home also makes inspection reports available to people who live at the home and their relatives. The current fees range from £377.79 to £557.40 per week with additional charges payable for services like hairdressing, chiropody and newspapers. This information was provided at the November 2008 inspection. The home should be contacted directly for up to date information about charges. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit by one inspector who was at the home from 09:55 until 16:35 on 11th November and from 10:10 until 15:25 on 13th November 2008. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. We had requested an improvement plan following the last inspection and this was also looked at as part of the preparation. All this information was used to plan the inspection visit. We spent significant time with people who live at this home including a short observational framework inspection (SOFI) that lasted two hours and took place in the large lounge and dining room. Detailed observations were made of the care given and interaction with staff. These observations were followed up by discussions with staff and the manager. A number of documents were looked at during the visit and all areas of the home used by the people who lived there were visited. A good proportion of time was spent talking with the people at the home as well as with the acting manager, the staff and the provider. An Annual Quality Assurance Assessment (AQAA) had been completed by the home before the visit to provide additional information. This is a selfassessment of the service provided. Survey forms were sent out to the home before the inspection providing the opportunity for people at the home, visitors and healthcare professionals who visit to comment, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A number of surveys were returned by the time of this visit. Comments received appear in the body of the report. Surveys were completed and returned to us during the latter part of October. This means that some of the comments in the report do not reflect the very recent changes at the home. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The recruitment of permanent staff is crucial to the sustained overall improvement of the service and facilities at the home. The quality of life for people living at the home will be improved with stability and consistency among the staff group. The way staff work needs to be reviewed to make sure that they are working in the most effective way to care properly for people living at the home. Our observations were that staff can sometimes be working through a list of tasks rather than looking at care from a person centred approach. The individual care records need to be developed in a person centred way. This will mean that staff will have detailed personal information about how to care for and support people and people will be looked after in the way they want. Accessibility by care staff to the information about care needs should be addressed. This is to make sure that care staff have up to date information about how people want to be looked after. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 7 Nutritional risk assessments need to be reviewed to make sure that they are accurate. Where risk has been identified there must be clear plans of the action to be taken to address the risk and the plans must be fully implemented and evaluated. This is so that people at nutritional risk do not have their needs overlooked. The level of activities provided on a day to day basis, needs to be improved. This will provide people with occupation and stimulation so that they are not bored. People living at the home and their relatives should be kept informed about progress at the home. Any requirements and recommendations made as a result of this inspection appear at the end of the report. 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 Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 9 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 (Standard 6 does not apply to this service) People who use the service experience adequate quality outcomes in this area. Overall, people are provided with enough information so that they can make an informed choice about moving into the home. Everyone has their care needs assessed before they are admitted to the home but this is not always done in enough detail. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information in the AQAA states: “A full holistic needs assessment continues to be conducted by the nurse manager of all prospective service user prior to admission. The service user and next of kin are encouraged and invited to visit The Beeches prior to this. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 10 A change in approach have been implemented where the admitting nurse also conducts an assessment on admission of the individual.” “We have added several new risk assessment documents to cover gaps as discovered from our last inspection”. The provider and acting manager told us that they have decided to suspend admissions to the home. The reason for this is so that they can concentrate on addressing problems identified at the previous inspection and over recent months. We looked at the records of two people who were admitted recently. We saw that people had their needs assessed before admission by a senior member of staff and that information was also gathered from other healthcare professionals. The admission assessment tool in use is a comprehensive document that, if it was properly used and fully completed would provide detailed information about the care and support people need. We saw gaps in the information recorded with several areas of the form not completed. On admission to the home further assessment is completed. This document did not include enough detail about care and support. For example, there was no information about the emotional well being of the person and no social information. There was some good information such as the person’s ability to be able to wash their face with their right hand and that they did not like to be rolled. Some people felt that they had enough information about the home others felt that some of the information was not entirely accurate, particularly about the provision of activities. People said: “They only tell you what they want you to know”. “Had been shown around the home” “This home was chosen following a recommendation of someone having had a relative who had been a resident some two years previously”. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 11 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 People who use the service experience adequate quality outcomes in this area. The information in care plans is not always detailed enough. This means that there is a risk of some care needs being overlooked. People are protected by safe medication practices. Staff respect the privacy and dignity of the people they look after. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information from the AQAA: “All prospective service user receive a full holistic needs assessment prior to admission”. Evidence: “Ensure of monthly resident reviews are conducted for each individual resident The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 12 and noted in their care plans, this remain the responsibility of the named nurse. Residents are medically reviewed/assessed by their medical practitioner as needed. We endeavour that as far as possible care plans reflect cares delivered to the individual resident. The home is well equipt with devices to aid the comfort and well being of all service users. Policies are procedures are in place to ensure the safety of service users, visitors and staff. All staff are aware of their duty of care and accountability stauts within the remits of their individualised roles within the home in relation the client care are care delivery. All qualified staff are aware of their accountability in line with ukcc standards and medicine administaration. Policies held thinin the beeches. updates maintained via staff training. The Beeches currently have two link nuses to oversee medication ordering and returns each month via pharmacist. We have recently changed the medication system used to boots blister packs.This we feel may improve the quality of our service and quality of audits. All residents received dignified personal and medical cares by staff trained and qualified to do so, since last inspection some practices have changed. ie: the use of gloves whilst assisting residents to consume meals, blood sugar monitoring in dinning room. To promote greater safety in residents consuming warm drinks still proof cups have been implemented and used within the home, despite this implementation to greater fool proof the system the more vulnerable residents are provided with full assistance to consume all fluids. Clients are provided a safe and open environment in which to strive and where they can commune and interact socially with each other and receive visitors”. The information provided in the AQAA was not always easy to understand. It did make some reference to how the home has addressed the issues identified in the care records at the previous inspection. Comments received in surveys suggested that people still felt that there were issues about basic care, such as people waiting for the toilet and the availability of fluids. Our detailed observation of care over the two days of our visit and conversation with people and staff indicated that there had been some very recent changes but further review of practices and staff deployment is needed to further improve the quality of care for people living at the home. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 13 These are some of the comments people made: “ (my relative) Constantly complains about having to wait up to one hour before being toileted. By then he has soiled his self then feels very embarrassed” “Never give me enough fluid to drink at night” “Always thirsty” “ needs to keep asking to have teeth cleaned” “ Forgotten to put (relative) to bed” “Reviews not happening” “Ran out of drugs once” “Anything up to an hour before someone attends after pressing the buzzer” “Since my mother became a resident seven months ago I have noticed a varied level of the care she receives” “During my frequent visits I have regularly witnessed call buzzers not being answered for excessive periods of time” “The doctor is called quite quickly. I feel then I have to always ask for an update” “…named nurse now works on a regular part time night duty and is not available during my visits. I have been told that if I needed to speak to her I can ring at 8:45pm which I find unsatisfactory” “The staff at the home keep me up to date at all times” “Care is not as good as it used to be. Last six months or so a lot of staff changes and shortages. Lot of old staff have left wonder why? New ones don’t seem to stay” We looked in detail at a selection of individual care records. Everyone has care plans that provide some information about their care needs. These are developed by the nurses from information gathered at the pre-admission assessment and the further assessment carried out on admission to the home. There is a range of risk assessments completed by the nurses for everyone. These include the risk of falling, manual handling risks, nutritional risk and risk around the use of bed safety rails. The nutritional risk assessments we looked at did not accurately reflect the individual risk or the action taken by the staff. For example, one person had been calculated as being at ‘minimal nutritional risk’; however, this person had swallowing problems following a stroke, significant weight loss and it was documented that they were having difficulty in swallowing – they were at high nutritional risk. Despite the inaccurate risk assessment the correct referrals had been made for this person and arrangements were in place for medical intervention in hospital to maintain adequate nutrition in the long term. The information we saw in care plans was not person centred. This means it did not identify the strengths and abilities of the person and did not provide detail of how they wanted to be looked after. For example, “give all assistance with hygiene” without detail of what assistance or support is needed and no The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 14 information about personal preferences. In the case of someone who was visually impaired, care plans did not provide any detail about this person’s abilities or preferences simply stating “needs full assistance with hygiene as registered blind”. The lack of information in the care plans meant that the monthly reviews were not detailed. Care plans need to be detailed about the support needed to enable effective reviews to be made. Although daily records are made these did not always reflect the health and well being of the person. The nurses complete the records and rely on information from the care staff to complete them. Care staff do not refer to care plans and this means that care needs could be overlooked. Effective communication and accurate record keeping is an integral part of care to make sure that people are being looked after how they want to be and that care needs are not overlooked. There was no evidence that in-house reviews of care were being carried out with people and/or their relatives. There were good records of the input of other healthcare professionals and records show that advice is sought and referrals made when necessary. The home has very good support from their local general practitioner (GP). The GP visits every morning and does a ‘round’ at the home twice a week; “The service has always responded actively and appropriately to my suggestions and recommendations”. “I think that individual nurses/carers always provide the best care that they can offer on an individual basis”. Our observation of staff practice showed that staff respect people’s dignity. Where people were moved with the aid of the mobile hoist staff covered people’s laps with a blanket before to preserve their dignity and maintain privacy. Nursing staff were observed to take someone from the dining room to apply ointment discreetly. Occasionally staff spoke over people as they organised the lunchtime period and allocated tasks but overall staff were considerate and respectful. Since the last inspection a new medication administration system has been introduced. The dispensing pharmacy has provided training for staff on how to use the system. Staff said that there had been some initial ‘teething problems’ with delivery but these had been sorted out. Observed medication practices were safe. The Beeches Nursing Home DS0000029133.V372906.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. People are supported in maintaining contact with their family and friends. There is a lack of stimulation and occupation for people living at the home. This means that people could be bored. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information from the AQAA: “Provide venue for service users to voice opinion in relation to service they receive, via residents committee meetings”. Evidence: “Beeches have maintained in-house religious church services Maintained as far as possible individual client routine Maintained meal times and menue choices per client via committee wishes Maintained open visiting at Beeches enforcing social relationships with clients and family members. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 16 Maintaining clients choice of where visits are conducted. Maintaining and providing privacy to each client and their respective members during visits. Establishing and maintaining community imput within the care setting eg: salvation army,locate school in-house performances, outsde entertainment. Residents attending local theatre (Alhambra) and outings to Arndale Centre Bradford and local stores. All residents receive meals and alternative per four weekly rolling menu. All residents nutritional status adequately risk assessed and action taken accordingly. Regime and timing of meals in accordance to standards. All meals provided in a manner to entise appetite. All residents needing assistance to consume meal is provoided one-one assistance within a dignified setting reflective of diversity and cultural requirement as per client”. Information provided in the AQAA told us that people have the opportunity to take part in outings from the home. This is not the case and hasn’t been for some time. Several people told us that they missed going out. One person told us that the only time they went out was to attend hospital appointments. Another person said that they were “really disappointed when outings stopped”. The acting manager and provider told us that trips were being planned for Christmas shopping trips and to the pantomime. These are some of the comments people made: “No trips – no fresh air” “Too depressed to take part in any activities” “Loved going out in wheelchair, now been stopped” “Social side gone down, don’t do much” “Unable to take part in activities due to severe dementia” “insufficient (activities) due to lack of staff” On the first day of our visit some people were watching the Armistice Day service and one person was occupying themselves by colouring in some pictures, other were reading papers or chatting. The majority of people had no occupation or stimulation. In the large lounge the television was on but no one was watching it and people were either asleep or staring into space. Some people when approached by staff were instantly responsive suggesting that they would benefit from some stimulation. On the second day of our visit the activities organiser was working with some people to plant bulbs. She tried to encourage people to join in and some refused. This activity was in one lounge leaving more dependant people with nothing to do and nothing to stimulate them. The television was again on with no one watching. There was musical entertainment organised for the afternoon that people enjoyed. We saw people being offered a choice at mealtimes and staff trying hard to tempt those who were reluctant to eat. People made positive comments about the food: “Food excellent” The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 17 “Meals have been tailored to her needs and are satisfactory” Those people who needed help were given help in an appropriate way. The dining tables did not have tablecloths but were laid with placemats and condiments were available. There was no juice on the tables and people were offered a hot drink with their meal. We saw that fluids were not freely available to people. If people asked for drinks they were given promptly but many people would not be able to ask. We discussed with the acting manager and provider ways of making sure that people got enough to drink by having drinks freely available throughout the day. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 18 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 People who use the service experience adequate quality outcomes in this area. There is a complaints procedure and people can be assured that any concerns will be taken seriously. People do not always feel confident that they will be listened to. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information from the AQAA: “Discuss any concerns face to face. Resolving matters as quickly as possible to avoid distress”. Evidence: Complaints file:unfortunately we currently have an increased level of complaints over varying matters. We endeavour to resolve as quickly as possible”. Since the last inspection there have not been any complaints received at the home. One complaint made earlier in the year is being reveiwed by us following further contact from the complainant. The provider is aware of this and has provided details of their investagation to us. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 19 Everyone gets information about how to complain in the information they receive about the home. Comments received from people indicate that people do not always have confidence in the complaints process. People said: “lots of little issues” “Soon reverts back to the old problems” “ I have only raised minor issues with the carers, I have found them in the main to be receptive, however with more major issues I have found that when referred to some of the senior staff I have not received the help I expected” “When issues arise particularly at weekends there is no member of staff identified as the person to whom complaints should be made” Some staff have had training in adult protection and further training is planned for early 2009. There is information available to staff about the local authority procedures for safeguarding vulnerable adults. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 20 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 People who use the service experience good quality outcomes in this area. People live in a safe, comfortable and well maintained environment. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information from the AQAA: “Beeches being a purpose build facility facilitates easy access. The home is fitted with CCTV camera to specified entrances”. Evidence: “The fabric/cosmetic of the home is adequately maintained. Refurbishment is The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 21 continually being undertaken. Several rooms have been redecorated. CCTV maintained. CCTV cameras have been fitted to accommodate kitchen door exit and two fire door exits to the rear of the building. A full fire inspection of the premises were carried out by fire service inspector late last year and full fire risk assessment carried out within the home. We have appointed an in-house fire training officer. The grounds are maintained and kept tidy by the homes handiman four days per week. The home also have an on-call handyman, plumber and electrician in emergency situations. Contact telephone details for all useful services are held and accessible in the nurses office. The Beeches employ a team of mature and dedicated domestic staff who maintains high standards in hygiene throughout the home. The corridors and hall ways have been refurbished. These are kept clean and immaculate by our team of domestic staff, including the lounges and bedrooms. All equipment maintained been purchased to accommodate comfort needs of individual residents these are disinfected regularly on a daily basis. The laundry operates on a shift service to incorperate flexible working hours and needs of our residents. Infection control, coshh, moving and handling have been undertaken by all staff. The beeches have an in-house moving and handling trainer and firer officer. Cotside bumpers purchased have been maintained to replace those succummed to wear and tear. And several falls prevention devises have been purchased to safeguard our residents. The laundering and cleaning of these equipment is often undertaken by laundry staff for infection control and longivity of equipment. Regular electrical checks are carried out on all equipment within the home. relatives are advised should they which to use any electrical equipment not supplied by our home. This should be pat tested and certficated prior to use within our facility for the safety of all concerned”. We completed a partial tour of the building visiting many of the areas used by the people who live there. All areas were clean and fresh smelling. The corridors are wide and rooms spacious, allowing plenty of room for wheelchair users. People said: The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 22 “I have never had a issue with the cleanliness of the home and no smell at all of urine” “doesn’t smell, spacious and clean” The laundry was clean, tidy and well organised. We observed good infection control practices. The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 23 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 People who use the service experience adequate quality outcomes in this area. There are enough staff to look after the people living at the home although a lack of staff stability and consistency could mean that some care needs are overlooked. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information from the AQAA: “Staffing levels have recently depleted due to home office screening procedure. The number of RGN each mane consist of a total of three RGNs excluding the manager to five pm each evening three rgn remain. The night shift range between two and three rgns Care assistants on a morning we endeavour to meet between 10-12. All over 18yrs old. afternoon care staffing range beween 7-8 care assistant excluding RGN in each instance. however, this has been difficult without agency cover. Recruitment is ongoing and is carried out following strict guidelines towards protection the vulnerable. Interviewed by two members of staff. Once selected full induction followed by a probationary period of three months to The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 24 gauge suitability. Staff training remains a compulsary requirment in line with maintainig all post at The Beeches to deliver best up to date care towards it residents. Victorguards training is now predominatly delivered via in-house training coupled with those delivered by Bradford Council”. The provider and acting manager have taken the decision to suspend admissions to the home on a temporary basis to allow time to re-build the staff team following a number of staff resignations within a short space of time which was having a detrimental effect on the home. These are some of the things people said: “4 short yesterday” “only 4 care staff one at night and only one nurse” “there is not enough staff and there are people leaving all the time” “ residents have been going to bed at 2am” “Let down by night staff” “Lack of staff especially on night duty” “Some of the staff are very caring and support the residents very well. While others appear to have little interest” “Staff are friendly and approachable and most considerate” “I do feel there is definatley a ‘them and us’ feeling between nurses and carers” A recruitment drive is well underway and we were told that there had been a good amount of interest in the vacancies. Until permanent appointments have been made, any shortfalls are being filled by regular agency staff. Staff are feeling much more confident in the managemnt of the home and the acting manager is being proactive in her support for them. All the staff we spoke to said that they felt that things had improved at the home over the last few weeks particularly since the arrival of the acting manager. The overall number of staff available appears to be adequate for the number of people currently at the home. However, people’s perceptions were that there continues to be insufficient staff to look after people. The number of staff on duty reduces after 14:00 even though the work load does not. We discussed with the provider and acting manager the need to review the way staff work to make sure that they are working in the most effective way for the benefit of the people living at the home. Our observations were that staff can sometimes be working through a list of tasks rather than looking at care from a person centred approach. There is a good level of training on offer for staff and the acting manager was in the process of familiarising herself with staff training needs. The programme of formal staff supervision has lapsed recently but the intention is The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 25 to re-organise and reinstate this as soon as possible to make sure that staff are supported in their work. We looked at recruitment practices all the required checks are carried out before people start working at the home. The Beeches Nursing Home DS0000029133.V372906.R01.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 and 38 People who use the service experience adequate quality outcomes in this area. The management of the home is committed to making sure that practices promote and safeguard the health, safety and well being of people living at the home. This will improve the quality of life for people living at the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information from the AQAA: “Manager reinforces shared accountability towards all staff by assigning link The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 27 role to qualified staff. super-numery days to qualified staff have been reestablished to ensure demands of work load is covered. Manager endeavouring to carry out audits several areas to monitor quality assurance…2008 reviews ongoing. Ensuring adequate supervision and appraisal of all staff are carried out Staff training and up dates currently ongoing to ensure good practice of staff towards all service users. Maintain accurate records of all health and safety inspections and check. Ensuring dates do not lapse safeguarding all occupants and visitors to the home. The manager ensures all reportable incidents are reported to the appropriate bodies concerned. where guidance are needed this is swiftly sort after to ensure safe competent practice”. “The nurse manager (Michelle Shannon) is a first level registered nurse on part 12 of the UKCC register. And has held deputy management post at three previous homes including The Beeches. She has completed two managers award courses and possess extensive experience within the elderly and acute medicine care settings. The nurse manager ensure annual resident/relative reviews are upheld and maintains open lines of communication as residents and relative require Immediate action is taken to rectify any concerns expressed and is progress monitored. The nurse manager endeavour to share a vision for good delivery of care is achieved throughout the workforce and remains open to suggestion/feedback and opinions from stakeholders via multi-disciplinary team, relatives, friends or from more experienced colleagues. The nurse manager remains professional and upkeeps her nursing code of conduct throughout her practice. Service users who have capacity to manage their own finances are encouraged to do so. Any financial responsibility relinquished by a resident is done so with input from an external advocate acting on the service users behalf and she ensures medical expertise is sort to assess the individual capacity to do so. Any monies kept for resident is recorded and secure within a vault at The Beeches. Only two people having access. This agreement is reached following consent by one or more parties”. What we could do better: - “Maintain good standards” How we have improved: - “Manager in post” Our plans for improvement in the next twelve months: - “Manager open to suggestion to better guide practice and widen experience”. We felt that the information supplied in AQQA demonstrated a certain lack of understanding and insight into the shortfalls at the home. The registered manager, who is now on extended leave, completed the AQAA. To provide stability at the home and in recognition of the shortfalls, the provider has The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 28 made arrangements of an experienced manager from a sister home to run the home in the absence of the registered manager. This will be for a period of approximately twelve months. People said: (need) “More effective leadership” to “bring together and lead a cohesive team” “this home lacks structure and direction, I feel stronger management is needed” The acting manager is a qualified Registered General Nurse and is an experienced, qualified manager. She managed the home some years ago and is well able to provide stability and leadership. She has only been at the home for a week but has already had a positive effect. We spoke with the provider who acknowledged that she had “taken her eye off the ball” and this together with poor direct management of the home had resulted in the poor experience for people over recent months. She showed us copies of recent reports of her visits to the home and these showed us that she does visit and talk with staff and some of the people who live there. She and the acting manager are committed to improving the quality of life for the people who live at the home. The acting manager told us that a letter has been sent to all relatives explaining the management changes and inviting contact. She plans to meet with relatives soon. A residents meeting is planned and will be run by the activities organiser. The home is required to provide three monthly returns to Bradford Commissioning Unit about areas such as the number of falls, any unplanned hospital admissions, issues around nutrition and skin damage. The Commissioning Unit carries out their own inspections of the service. The provider told us that the most recent was carried out around Jun/July and they were satisfied with their findings. The home does not manage finances for people. They do however help some people to manage small sums of personal monies. The records were clear and easy to follow. We suggested that two signatures should be recorded for any transactions. The Beeches Nursing Home DS0000029133.V372906.R01.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 The Beeches Nursing Home DS0000029133.V372906.R01.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. 1 Standard OP8 Regulation 13(4) Requirement Nutritional risk assessments must be reviewed. This is to make sure that they are accurately calculated and that those at risk are clearly identified. Where risk has been identified there must be clear plans of the action to be taken to address the risk and the plans must be fully implemented and evaluated. This is so that people at nutritional risk do not have their needs overlooked. Timescale for action 31/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans should be developed in a person centred way so that people can be confident that they will be looked DS0000029133.V372906.R01.S.doc Version 5.2 Page 31 The Beeches Nursing Home after properly in the way they want. Care plans should include accurate information about a person’s health and well being. A review of the provision of fluids should be carried out. This is to make sure that people are having enough to drink throughout the day and night. The level of activities provided on a day to day basis, should be improved. They do not always meet people’s needs, which means that some people are left with little stimulation. Recruitment should continue to establish a permanent staff team and reduce the amount of agency staff at the home. This will provide stability and consistency for the people living at the home. A review of the way staff work should be carried out. This is to make sure that there are enough staff and that they are working in the most effective way for the benefit of the people living at the home. The AQAA or self-assessment of quality should be reviewed to make sure that it accurately reflects what is happening in the home. This will help the home identify the improvements they need to make. 2 3 OP8 OP12 4 OP27 5 OP27 6 OP33 The Beeches Nursing Home DS0000029133.V372906.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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