Inspection on 21/05/08 for The Beeches Nursing Home

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Poor 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 11/11/08

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Beeches Nursing Home 320 Beacon Road Wibsey Bradford BD6 3DP Lead Inspector Sughra Nazir Key Unannounced Inspection 21st May 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Beeches Nursing Home DS0000029133.V365943.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.V365943.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 Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Physical of places disability (1), Physical disability over 65 years of age (64) The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The place for MD(E) is specifically for the service user identified in the application dated 26.8.4 One specific service user under the age of 65 named on variation dated 8th September 2006 may reside at the home. 7th November 2007 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 provides care for 64 elderly people with physical disabilities over the age of 65 years. 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, in 62 single rooms. 60 have an ensuite facility. There is a lift and the home has wide corridors making it good for wheelchair access. Communal space is provided in the spacious lounge/dining room on the ground floor of the home. This has panoramic views over Bradford and where residents can access the patio area. A second lounge is also located on the ground floor at the opposite end of the building. 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 weekly fees for services provided in the home vary depending on whether people are funded by the local authority, have nursing needs and their fees are partly supplemented by the health authority or if they pay privately. Information provided on the day of the visit was that fees range from £422.79 to £557.40 depending on the level of care people need. Additional charges are payable for services like hairdressing, chiropody, newspapers etc. These details were provided by the home on 19th June 2008. The Beeches Nursing Home DS0000029133.V365943.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 0 stars. This means the people who use this service experience poor quality outcomes. This report is based on information gathered in a number of ways. • • • A review of the information held on the home’s file since its last inspection. Information sent to us by the registered provider in a document called the Annual Quality Assurance Assessment (AQAA) We left surveys at the home for people who live at the home, their relatives and for staff. Three surveys were sent back by relatives, four came back from people who live at the home. We got one survey back from a member of staff. The last survey was returned on 26th June 2008. Contact with 4 health professionals who visit the home regularly. An unannounced visit to the home, carried out by two inspectors. This visit included a tour of the premises and talking to people who live at the home, their friends/relatives, staff and management. We also looked at menus, staff rotas, people’s care plans and watched staff looking after people over lunchtime and throughout the day. • • The information we received helped us to form a judgment about the quality of care people who live at the home receive. In each of the sections in the main report we look at whether the quality of care is poor, adequate, good or excellent. Overall this home provides a poor quality of care for the people who live there. What the service does well: The home is very clean, homely and well maintained. One relative said, “very clean and pleasant smelling” The home has good access and there is a lift and wide corridors that meet the needs of people with mobility problems. The home supports some people to stay in touch with their relatives. “ My mother will soon have a BT landline connection in her room, but the Beeches will ring me and mum is able to speak to me whenever she wishes” The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 6 I have a weekly meeting with my mother’s named nurse and several times a week I look at her notes and discuss any issues that might arise.” “My views are that they try to do everything well.” What has improved since the last inspection? What they could do better: Everyone should receive a legible copy of the terms of conditions or contract. The contract should be signed and discussed with the person and or their relatives. This will let people know what the home provides and what they need to pay for themselves. In order to make sure that staff have an accurate picture of people’s care needs and know what to do to meet those needs, everyone who lives at the home must have a detailed care plan in place. People’s healthcare and nutritional needs must be met so that their wellbeing is not put at risk. Record keeping of wound care must improve so that people are not put at risk of infection. Staff must pay attention to people’s rights to privacy and dignity and provide personal and medical care in private. Activities and opportunities to engage with staff and other people who live at the home would improve people’s mental well-being. “ Mother and other residents would benefit from more in-house activities, mum is often bored and her day drags.” The arrangements for providing and monitoring drinks must be improved to make sure that people are not at risk of dehydration or at risk of scalding. People’s access to information about the complaints process must be improved. The manager must carry out a review of complaints received and review the issues raised. Staffing levels need to be reviewed and adequate staffing levels put in place so that people’s health and wellbeing is not put at risk. People told us about buzzers not being answered and lots of people complained about the time it takes to get help with toileting. “For many months now there have been staff shortages in most areas and this has caused many difficulties” Recruitment checks must include taking up to references so that people are not put at risk. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 7 The manager should make sure that lines of accountability are discussed so that there are more robust systems in place for monitoring record keeping and care practice The home must notify the Commission of key events that affect the wellbeing of people who live at the home. The registered person must monitor the quality of the service by carrying out monthly visits. This will help them to make sure that people are getting the care they need. The AQAA or self-assessment we send out should be completed accurately and reflect the level of service provided in the home, this will help the service identify the areas that need to be improved. Safe working practices for moving and handling need to be reinforced so that there is no risk of injury to staff or people they are moving. The risk assessments and fitting of rails (cotsides) need to be reviewed to make sure that all rails are fitted properly and that there are robust arrangements in place to check rails on a regular basis. 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.V365943.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.V365943.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): 2, 3 . The home does not provide intermediate care. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People do not move in without getting their needs assessed. People have access to adequate levels of information to help them make a decision about the home. EVIDENCE: We saw an information pack that is made available to people who may want to stay at the home. This tells them about the care provided but does not give people enough information on how to raise concerns or make a complaint. One person told us that although they had received a contract it “was a photocopied unsigned version received in the post. Though neither relatives or The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 10 resident have been invited to sign it nor has there been any discussions about it.” Another person told us they had not received a contract. Without a contract people cannot be sure of what their fees cover and what they need to provide for themselves. Information the home sent us tells us that they carry out an assessment of people’s needs before they come to stay. We had one complaint from a family who felt their relative’s needs had not been properly assessed before they moved in. All but one of the files we looked at showed us that the home carries out a detailed assessment. The assessment document could be improved so that any equipment people need is clearly identified. People and their relatives or friends are encouraged and invited to visit the Beeches before making a decision. The Beeches Nursing Home DS0000029133.V365943.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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Detailed care plans are not in place for everyone and this means people’s care needs are not met. For staff to look after people properly they should have information that tells them about the person’s background, their abilities and their needs and how to meet them. Medication practice puts people at risk. EVIDENCE: We asked for the care plans for 7 people. This was to help us to see how well the home is identifying and meeting people’s needs. Two people who had moved into the home in the last month had no care plans. One person’s relative told us that they had not had a bath in three weeks. The assessment the home did before the other person moved in told us that the person had a pressure sore, was incontinent and needed two people to help them move. This means staff do not know what care to provide and there is a risk that people’s needs are not met. This is poor practice. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 12 The other five people’s files had been arranged into an order that means staff can more easily find the information they need. Some of the information about people’s needs was not up-to-date so the home cannot be sure that people’s needs are being met. One person’s file we looked at showed that all of the papers had not been reviewed since March 7th. They were last weighed in March even though there was a care plan that said, “ Occasionally misses meals through choice action includes ensure weight monitored monthly.” One person’s file did not show whether they still had a temporary catheter in place and what care was needed to look after the catheter. Daily records showed that they were being “barrier nursed” but there was no care plan for this. Staff told us that nurses complete the care files and that care staff do not have access to these files. We saw that one person who needed to be moved using a hoist was moved without it by two care staff. We saw several examples telling us that the fluid intake and build-up drinks people get are not recorded. One person’s record for 19th May 2008 showed that they had a total fluid intake of 160 mls for the day. The next day the total intake was 150 mls. This person’s care plan said that staff should encourage more fluids. In information the home sent us after our visit they told us “ each resident care plan reflects accurately all cares being delivered”. This means that some people are not getting the care they need. This puts people’s health and wellbeing at risk. We looked at a wound record for one person. There was a photograph of a wound dated 21st April 2008. The wound care chart was not dated. There were no entries on the wound progress chart to help staff to monitor the size and appearance of the wound. The last record of the wound getting a new dressing was dated 16th May, but staff told us that they had changed the dressing twice since then. People who live at the home told us that they usually get the medical support they need but • • • “sometimes lack of communication when problem raised and doctor seen about what happens next” “They often run out of tablets, at home we were always told to keep a week’s supply in hand.” “Would have liked to have kept my own family doctor.” The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 13 A health professional who was visiting told us that there had been two examples of the home not chasing up healthcare issues they had raised. One was where there was a referral to a specialist service at the hospital. The other was a request for some equipment to do a test. This was not followed up by nursing staff at the home. One health professional told us that nursing staff do their best but the home could do better by speeding up actions, introduce medication prescribed or set up fluid charts when advised and make sure people are checked. Staff told us that medication ordering and delivery had improved. The pharmacist is asked to order medicines based on a repeat prescription list. This is unsafe practice because it means the home does not double-check what medicine is being ordered from the doctors. This also means that some people who need medication that is not on the repeat list – do not always get their medication. We saw two examples of this, one where the cream needed for dressing wounds and another where someone’s eye drops were not ordered and not given. This puts people’s health at risk. We saw unsafe medication practice on all three trolleys including, • There were gaps in the records showing if people had been given their medicine. One person who was receiving Oramorph – did not have this signed for in the medication chart. Another person on the same drug had no entries filled in, staff told us that this was because this had been stopped, but the medication record had not been updated. We saw several examples on charts showing that the amount of medication carried forward from last month and the amounts received this month were not written down or signed. This is poor practice. We looked at the record for a person on antibiotics, the home had received 28 tablets, the records showed that 20 had been given but there were only 7 left in the bottle. The records for when creams are applied or fortified drinks are given were blank. This means the home does not have a full record of the care being provided. Staff told us verbally that they had changed people’s dressings but the records did not reflect this. • • • • We told the people in charge of the home about these errors. In information they sent us after the visit the home said “ The Beeches currently have two link nurses to oversee medication ordering and returns each month via pharmacist. Random audits are carried out including a weekly audit of MDA drugs by two qualified staff.” We know these arrangements are not working. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 14 We saw that several people were seated in one area because they were considered to be at risk. We heard one relative say, “is this the naughty corner?” The deputy manager told us that tests came back to show that there was no infection and therefore no risk of this affecting others. Some people’s bedroom doors had notices on them telling everyone that the person was being “barrier nursed”. Labelling people in this way compromises their dignity, compromises confidentiality over health issues and choice as to whom people wish to sit with and where they have lunch. We saw that one person was given medication via a feeding tube in her stomach, in front of other people. Staff told us that they check blood glucose levels and give insulin injections in the lounge or dining room. This practice compromises people’s right to privacy and dignity. The Beeches Nursing Home DS0000029133.V365943.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. We have made this judgement using a range of evidence, including a visit to the service. People have access to some activities but more staff support and better record keeping is needed to make sure people’s fluid intake is maintained. EVIDENCE: We saw a notice board in the reception area that tells visitors about activities. This told us that the activities for that day were a walk, and a mass service. There is a regular church and communion service and this meets the religious needs of people who live at the home. People we spoke to told us they enjoyed the religious service. One person who lives at the home told us that the home sometimes arranges activities that they can take part in. They said “Very few activities organised most entertainment is tv or usually the same videos. Though this past week or so a few things such as carpet bowls have been arranged”. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 16 Another person said, “Shopping trips have been stopped. There is a bus but wheelchair users won’t get in” One relative said “mother and other residents would benefit from more inhouse activities, mum is often bored and her day drags.” In the a-z of life at the home, visitors are told they are welcome to join in with any entertainment booked for the home. They are also asked to “please try and refrain from visiting during the following hours due to mealtimes 12.151.15 and 16.15-17.15.” Information the home sent us after the visit states that the home has “maintained open visiting enforcing social relationships between clients and family members” One relative told us, that staff do not always take care when selecting clothes, they said “Staff look after the person they are now and forget about who they were and what they did” People who were being nursed in their rooms due to infections did not get a drink at lunchtime. A number of other people sitting in the lounge did not get a drink. Staff cleared drinks away without asking people if they had finished. We saw two drinks rounds and although there were biscuits in the trolley none were offered to people. We saw evidence that a number of people were not being encouraged to take fluids in accordance with the care plans. We saw that kitchen staff leave drinks on tables or wedged in the chairs of people who do not have access to tables. This leaves some vulnerable people at risk of scalding. This practice continues despite a recent episode resulting in a serious injury. Some people who had a thickening agent in their drinks were given beakers with straws; this may mean they struggle to get the fluid they need. We observed lunchtime. There was a choice of menu and on one side of the dining room there are now pictures of other food choices people can make. We saw staff helping people to eat. They did not speak to the person they were helping and carried on talking to each other. This is a missed opportunity for staff to engage with people. The Beeches Nursing Home DS0000029133.V365943.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People cannot feel confident that their views will be listened to or acted upon. The service has received a high number of complaints. EVIDENCE: We have received 10 complaints since the last inspection. This is high. We have had 2 complaints that have shown that people have waited 16 minutes and 25 minutes for their buzzer to be answered. This puts people’s health and wellbeing at risk. Not all the complaints we sent to the home were responded to in a timely manner. The home needs to do more to acknowledge the issues raised and to identify action they need to take to prevent further complaints. Three relatives sent us surveys back, one told us that did not know how to make a complaint. Two relatives told us that staff are reluctant to accept complaints. One staff member told us in a survey that they did not know what to do if a service user/relative has concerns about the home. We saw that there is one copy of the complaints process displayed in the main reception area. This is not visible to everyone who lives at the home. People who come to stay get a copy of a document called an a-z of life in your new home “ There is no information in this to tell people how to complain other than stating that the manager is approachable to discuss any concerns or issues you may have.” The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 18 One person told us that they were “aware that if not happy need to speak to the nurse in charge” but they also said they did not know how to make a complaint. We spoke to two members of staff who told us they had been on training that would help them to keep people safe from abuse. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 19 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, 22, 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a home that is well furnished but more care is needed to handle mobility and safety equipment and to make sure that infection control practice follows the latest guidance. EVIDENCE: During the visit to the home we looked at all of the public areas, some bedrooms, and the bathrooms. In general the home is very clean and smelled fresh. There are wide corridors and bedrooms are spacious giving people who use wheelchairs lots of room to move. One relative said, “very clean and pleasant smelling” The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 20 One person told us “wheelchairs are frequently dirty and in a dangerous and unsafe condition both for the residents and the staff. There seem to be a lack of hoists there’s always a wait for one.” We saw that there were a large number of wheelchairs outside the lounge which presented a hazard. Systems are in place to prevent the spread of infection; this includes colourcoded cleaning equipment, visiting restrictions if required, staff training and barrier nursing protocols. We saw that people had notices on their doors and that some people who were declared not at risk of passing on infection were still sitting separately from other people. Staff told us that they did not have access to the latest health guidance on essential steps for infection control. The manager should make sure that this is available and that staff follow the guidance. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 21 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People do not always get the care they need because of staff shortages. Recruitment checks and staff practices need to be improved so that people are not put at risk. EVIDENCE: One health professional told us that “care staff are caring and some of the staff know people well. “ The papers people get when they move in inform people that all rooms and lounges have a nurse call system in place so they “can call for assistance” if they wish. They are also reminded “do not think you are troubling care assistants if they need assistance. From the information the home sent us we saw that they endeavour to provide 10-12 care assistants in the morning. On the inspection day there were 8 care staff on duty. The home’s information tells us that 58 people need the help of 2 or more staff during the day. This tells us that there are a lot of people with high levels of need. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 22 People told us there were sometimes delays in the mornings, as lots of people need help with breakfast and getting washed and changed. They said “Very short-staffed.” “toileting is a big problem nothing is being done.” “I get the care and support the staff can afford the time to give and not what I need” Frequent long delays answering buzzer calls or acting on requests for help and assistance “long delays on occasion before someone comes or told “you will have to wait” One staff member said there are never enough staff to meet the individual needs of all the people who use the service. Photographs of staff are displayed ensuring that people can identify staff and the job they do. This is good practice. During the visit we saw a training matrix and training plans for all staff. There are lots of training certificates displayed in the corridor and dining room. These confirm that staff have had training to help them provide good quality care. This training includes adult protection, food hygiene, COSHH (Control of Hazardous substances) and RIDDOR. (Reporting of Injuries Diseases and Dangerous occurrences) One relative confirmed, “If the certificates on the walls of the Beeches are correct it points that they have a policy to ensure that the skills and experience is given great consideration. “ However we saw two examples of poor moving and handing practice, which tell us that not all staff are putting the training they receive into practice. We looked at 5 staff files. On 3 files there was only one reference, in one instance the reference did not recommend that the home employed that person. No other references were taken up and there was no record of any discussions with the referee or applicant. We shared our concerns with staff in charge. Information the home sent us after the visit said the home “recruitment is ongoing and is carried out following strict guidelines towards protection of the vulnerable. “ We know that in practice the recruitment practices could leave people vulnerable. One person told us “Whilst most staff seem good and honest there are untrustworthy staff as there have been many instances of thefts from residents. This is very The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 23 unsettling for all residents especially as there seems to be a fairly casual attitude from management when things are stolen”. We know from papers sent to us and to other agencies that the home is taking action on the issue of thefts. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are not always receiving the care that they need. Management and record keeping needs to improve to ensure that people’s health, safety and wellbeing is not put at risk. EVIDENCE: The manager has now registered with the Commission. We saw poor examples of care plans, unsafe medication practice, poor record keeping of fluid intake and unsafe care practice. The information the home sent us tells us that there is shared accountability for some tasks and that named qualified staff are responsible for carrying out random audits of records and medication. This is not happening and is creating an unsafe environment for people. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 25 One person who lives at the home said, “Staff need stronger management” The home should tell us about all the important changes or events at the home but have not done so. We saw in staff files that there were records of two medication errors and one nurse was dismissed. These incidents affect the wellbeing of people who live at the home and should have been reported to the Commission. We are concerned that even after we had pointed out some gaps in the service at the end of our visit, the self-assessment the home filled in afterwards does not recognise these issues. There are factual inaccuracies throughout the document. We tried to get an accurate picture of the number of staff and the number of people living at the home but the information the home sent us gave us different numbers in different sections. For example the total number of residents given for the day the form was filled in was 51, however, the number of people described as needing help with washing/dressing was 58. In information the home sent us they said that they “ensure adequate supervision and appraisal of staff” The records we saw showed that supervision of staff was not up-to-date, two staff members told us that they do not have supervision and one staff member who sent us a survey back said that the manager never meets with them to give support and discuss how they are working. If a care home provider is not in day-to-day charge of their care home, the law says they must make a monthly, unannounced visit to it. At the visit, they need to check on the quality of service provided at the home. We asked the home to send us copies of the provider’s last two reports. The reports we received were dated 31st January 2007 and 19th May 2006. This tells us that the provider is not regularly monitoring the quality of service provided in their care home. We looked at two sets of rails that stop people falling out of bed. Both sets of rails weren’t fitted properly and the gaps could mean someone gets injured. We looked on one person’s file to see if there was a risk assessment. We found a risk assessment but it was not signed. It did not tell staff who was responsible for checking the rails, how often and where they should record the checks. We saw two examples of unsafe moving and handling, which put staff or the people they are moving at risk. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 26 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 2 X X X 2 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 Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 14, 15 Requirement Timescale for action 30/08/08 2 OP8 12 Everyone living at the home must have a detailed care plan setting out the person’s goals abilities and care needs. The plan must be drawn up with the involvement of the person together with family, friends and/or advocate as appropriate, and relevant agencies/specialists. This will mean that people get the care they need. People’s healthcare and 31/07/08 nutritional needs must be met so that their wellbeing is not put at risk. People must be weighed regularly and weights recorded and monitored. Recordkeeping of wound care must be improved. To make sure that people get the 31/07/08 medication they need, the manager must make sure that there are robust systems in place for ordering, recording and administering medication. Staff must pay attention to 31/07/08 people’s rights to privacy and dignity and provide personal and DS0000029133.V365943.R01.S.doc Version 5.2 3 OP9 13 4 OP10 12 The Beeches Nursing Home Page 28 4 OP15 16 5 OP16 22 6 7 8 OP27 OP29 RQN 18 19 37 9 RQN 26 10 OP38 13 11 OP38 13 medical care in private. To make sure that people are not at risk of dehydration, the arrangements for monitoring and recording fluid intake must be made more robust. There needs to be a review of arrangements to make sure that people get the assistance they need with warm drinks to minimise the risk of harm. People must receive clear information about how to complain. Any complaints made must be responded to in a timely way. Complaints should be analysed so that the service can learn and improve. Staffing levels must be reviewed and increased to make sure that people get the care they need. In order to keep people safe, two references must be obtained for new staff. The home must notify the Commission of all events that adversely affect the wellbeing of people who live there. This includes medication errors and the dismissal of staff following allegations of misconduct. This will make sure that we can check that the proper action has been taken. In order to make sure that the people are getting the care they need, the owners must carry out monthly visits and provide the CSCI with copies of the reports from these visits. Safe working practices for moving and handling must be followed by all staff so that they do not put people at risk of injury. The risk assessments and fitting of rails (cotsides) must be reviewed to make sure that all DS0000029133.V365943.R01.S.doc 15/08/08 30/09/08 31/07/08 31/07/08 31/07/08 31/08/08 31/07/08 31/07/08 The Beeches Nursing Home Version 5.2 Page 29 12 RQN 24 rails are fitted properly and that there are robust arrangements in place to check rails on a regular basis. The owner must send to the 31/07/08 CSCI an improvement plan detailing how and when the issues raised in this report will be resolved. 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 Refer to Standard OP2 OP12 OP13 OP10 OP26 Good Practice Recommendations Everyone should receive a legible copy of the terms of conditions or contract. The contract should be signed and discussed with the person and or their relatives. The range of activities available should be increased so that people have opportunities to engage with staff and each other. The home should consider removing restrictions on visiting during mealtimes. This may allow visitors to play a part in their relatives care. The manager should make sure that all staff know about and follow the latest guidance for infection control. This will help make sure that they only separate people when necessary and do not compromise people’s privacy and dignity Consideration should be given to the storage and cleaning of wheelchairs so that they do not pose a risk to health and safety. Supervision of staff should be maintained so that staff can be reminded about the importance of safe moving and handling, better recordkeeping and paying attention to issues of privacy and dignity. Supervision will help make sure that staff understand and act upon any training they receive. The lines of accountability in the home should be reviewed to make sure that qualified staff carry out their agreed tasks, audits and supervision of care practices. The AQAA or self-assessment of quality should accurately reflect what is happening in the home. This will help the DS0000029133.V365943.R01.S.doc Version 5.2 Page 30 5 6 OP22 OP30 OP36 7 8 OP31 OP33 The Beeches Nursing Home home identify the improvements they need to make. The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI The Beeches Nursing Home DS0000029133.V365943.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!