Inspection on 10/05/06 for The Beeches Residential Care Home

This inspection was carried out on 10th May 2006.

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

The inspector 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 Residential Care Home 14/10/08

The Beeches Residential Care Home 01/10/07

The Beeches Residential Care Home 23/05/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Beeches Residential Care Home 12 Higham Road Rushden Northamptonshire NN10 6DZ Lead Inspector Ms Sarah Jenkins Unannounced Inspection 10th May 2006 08:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 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 Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Beeches Residential Care Home Address 12 Higham Road Rushden Northamptonshire NN10 6DZ 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) 01933 318498 01933 386811 Manonmany Wragg Vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (4) The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total numbers of service users must not exceed 24 No service users with a physical disability may be admitted to the home when there are already 4 such service users in the home No service user with dementia may be admitted to the home when there are already 24 such service users within the home Date of last inspection Brief Description of the Service: The Beeches home is centrally located in Rushden with easy access to shops and services. The home is a converted older property with character, and has a large and pleasant garden area. One wing of the home was built after the original building and is more modern. There are several areas where service users can spend their time during the day including a conservatory. The home cares for elderly people some of whom have a physical disability and a large number who suffer from confusion, or diagnosed Dementia conditions. There is mixture of single and shared room facilities, some of which have en suite toilet and bathroom. The fees charged at the home range from £375 - £400 per week with extra charges for hairdressing, chiropody and newspapers. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting 3 service users and tracking the care they receive through meeting with the service users, a review of their records, discussions with the care staff and observation of care practices. The Inspector visited during the morning to observe practices by staff and to meet with service users. A number of Service users have diagnosed dementia conditions and thereby communication for many is difficult. Establishing Service Users choices and informed decisions is dependant to some extent upon the consistency of staff, service users relationships with staff, and the quality of communication. Feedback obtained from Service Users in this report was in part through observations of their relationships with staff, and also through interpretations of their general levels of happiness with their routines. The Inspector spent six hours on the site visit to the home. No comment cards or self-assessment questionnaire was available at this Inspection. What the service does well: What has improved since the last inspection? Improvements were noted in Service Users Care plans. Individual staff training plans have been drawn up and staff training needs are being addressed. There is some evidence of recently improved management of the home. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission procedures need to be improved to ensure that all Service Users needs and choices are fully met from the time of their admission. EVIDENCE: There was no up to date Statement of Purpose or Service Users Guide to inform Service Users about the home and two Service Users could not remember being given any information about the home. They were however happy with the arrangements that had been made on their behalf and remembered that they had been welcomed by staff to the home and enabled to settle in. Staff had a good understanding of Service Users needs on arrival. One Service User had been admitted with hospital discharge information but without a full written assessment of all their care needs, and several weeks after admission there was no detailed care plan available for staff to follow. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users health and personal care is properly delivered. EVIDENCE: Service Users were seen to be well presented and appeared comfortable. Service Users care plans were detailed and included choices and preferences. There is a need to evidence the regular review of care plans to ensure that current care needs are being met. Service Users said that they were mainly fully satisfied with personal and healthcare at the home although they couldn’t remember talking about this with staff. Records showed regular input from community health services as needed. Medication was properly stored and staff were aware of the importance of correctly following procedures. Service Users said that their medication was delivered on time and there were no problems identified. Some refinement of records is needed as detailed in the recommendations. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 10 Service Users felt that staff were generally appropriately respectful and cared for them properly. Two Service Users commented that most staff were good but that when one or two staff were “tired” the quality of care from them was not quite so respectful as they might wish, for example they felt hurried, or “told” to do things rather than being given gentle help and guidance, although they assured the inspector apologetically that they understood just how busy staff were, and were unwilling or unable to identify the staff concerned to the inspector. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities do occur but are limited due to staff resources and there is a need to ensure better stimulation for Service Users throughout the day. EVIDENCE: Several Service Users spoke of boredom, “sameness”, and being “resigned to it” (in relation to the lack of stimulation). Some spoke of a yearning to be enabled to go outside in the sunshine. Some who were placed in the lounge area where music was being constantly played informed the inspector that it wasn’t to their taste. It was observed that a priest came to offer communion to one Service User. No other visitors were seen at the time of the inspection. One Service User told the Inspector that staff were sometimes too busy to offer refreshments to visitors and that this service was sometimes “a bit grudging”. Staff shortfalls appear to restrict the choice and control that Service Users currently have over their lifestyles. The Inspector received comments from Service Users such as “We have to make the best of things”, and they related The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 12 this to either staff shortfalls or a question as to whether staff were not properly organized about things. There were lots of positive comments about the catering at the home. Service Users felt that the food was appetizing and nutritious. The cook explained how she ensured choices were available by actually presenting some Service Users with a choice of plated food when it was served. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users need to be encouraged to speak freely with staff and management. EVIDENCE: The Commission for Social Care Inspection received anonymous concerns about the home in April, which have been reviewed at this inspection. Some areas raised have been substantiated (heating problems, poor admission processes, staffing). Other areas such as management and some personal healthcare issues seem to have been resolved recently. Several Service Users told the inspector that they did not feel confident to complain to the staff or management of the home. Most were not familiar with the (Acting) Manager (there have been a number of recent changes), and felt that staff were already too busy to listen to their personal concerns and problems. There was a consistent, and disturbing attitude of resignation amongst a number of Service Users. Staff are trying to be alert to Service Users needs but were also concerned about the lack of time that they had to do this. Not all staff are fully trained or aware about Protection of Vulnerable Adults procedures The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment of the home was clean, comfortable and safe. EVIDENCE: Service Users expressed satisfaction with their rooms and the general areas of the home. There are pleasant gardens but Service Users do not feel enabled to use these at present. The home was clean and tidy throughout and Service Users felt that this aspect of the home was always well attended to. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was understaffed for the needs of the Service Users at the time of the inspection. Staff are caring, competent reasonably trained and mainly do their best. EVIDENCE: Service Users needs are not currently being sufficiently met due to staff shortfalls. Both staff and Service Users commented on this to the inspector and the Inspector observed for herself issues that arose due to these shortfalls. There were long periods when staff were not attending the large lounge and Service Users in this area were apparently unable to seek help and were therefore helping each other, sometimes inappropriately and causing risk. There was evidence in the accident report book of several accidents in the lounge area where a Service Users had fallen when no staff were in attendance. At the time of the inspection there were 3 care staff and the Acting Manager on duty and cleaning and catering staff supported them. However staff have washing and bed making duties in addition to care duties and the care needs of many Service Users are high. It was also evident that there are some problems in some staff teams. The home has had a large turnover of staff since the new ownership and there has evidently been some friction among staff. This has The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 16 not been fully resolved and both staff and Service Users are aware of “moodiness”, “competition” and staff being “a bit funny”. These issues need immediate and ongoing input from the Registered Owner. Staff supervision is being set up but has not yet been fully implemented. The Acting Manager was aware of the shortfalls in staffing and was advised to discuss these issues with the Registered Owner as they need action. Whilst there is currently a recruitment drive there is also a need to make suitable interim arrangements. A staff member recently recruited described the recruitment procedure and process, which was judged to be satisfactory. Staff training is being addressed and there was evidence of this in both interviews and notices. Some staff have not yet received Dementia training or feel that they need to be updated in this area and this is possibly another component of the staff shortfall. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management within the home has been insecure over a number of months; a risk to Service Users has arisen as a result of this. EVIDENCE: Since the new Registered Owner took over, the Registered Manager has left and there have been two Acting Managers. The second Acting Manager is in post but has only been functioning as Manager for about a month. Staff feel that the current Acting Manager is working well to resolve some of the identified problems but there has been much disruption recently and the previous Acting Manager was considered to be less capable. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 18 Senior Carers are assisting the Acting Manager with the backlog of work but these duties take them “off the floor” when they are aware that they are needed. The Registered Owner is said to be at the home regularly, approximately two or three times a week, but was not available at the time of the inspection. Service Users are aware of staff changes and this has affected their quality of life to some extent. (See previous sections) Service Users need to be encouraged to express their various dissatisfactions to staff within the home so that these can be properly addressed. This too requires staff time in order that better trust is established. Individual staff supervision needs to be fully implemented as soon as possible. The Acting Manager is already aware of this and is about to start the programme. Not all areas of risk are being properly managed at present. For example the accident book shows a number of accidents, but follow up in relation to checks on Service Users a day or two after accidents are not evident. At the time of the inspection there has been insufficient response to the identifiable risk in relation to the lack of staff in the lounge area. A Service Users bedsides had been altered by the maintenance man in response to a staff request but the District Nurse had not then reassessed the suitability of these bedsides. There was no evidence in records as to when they were last assessed by the District Nurse. The maintenance book does not show how quickly issues arising are responded to. A staff member had had a recent accident relating to a piece of furniture, which had apparently not been properly maintained. Accidents and Incidents that require notification under Regulation 37 have not been being notified, and advice was given. Service Users and staff were aware that there have been problems with the heating of the home which are now resolved. However the management of these problems when they occurred was insufficient to prevent risk to Service Users. The Inspector was informed that although small heaters had been used these were not adequately safeguarded give the disabilities of Service Users. Financial Procedures were not inspected, as the Registered Owner was not available to discuss these. It is understood that relatives generally manage Service Users finances, and expenditures made on behalf of Service Users by staff are invoiced. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 19 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 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x 2 x 1 The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? N/A 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 OP27 Regulation 18 Requirement Staffing at the home must meet the needs of residents. To this end a full review of the staffing at the home must be undertaken, and details submitted to the Commission for Social Care Inspection. This review should take into account the levels of care needs of Service Users, the experience and qualifications of staff, the duties that staff are undertaking that may impinge on Care duties and the layout of the home. Notifications required by law as indicated in Regulation 37 must be made to the Commission for Social Care Inspection on each occasion without delay. Timescale for action 21/06/06 2 OP38 37 21/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 21 No. 1 2 Refer to Standard OP3 OP9 Good Practice Recommendations A full and detailed assessment of prospective Service Users needs and wishes should be completed prior to their admission. Directions on medicines should be clear and unambiguous and should avoid terms such as “as directed” and “when needed”. There should be detail of what the medicine is for, the maximum dosage in 24 hours and the minimum period between dosages. Service Users should be offered improved and more regular activities. Proper consideration should be given to how individual Service Users may be sufficiently interested in their surroundings and lifestyles to maintain adequate stimulation. Service Users comments as detailed on this report in relation to the hospitality offered to their visitors should be considered and appropriate action taken. Quality Audit measures should be improved. There should be increased interaction by management with Service Users to nurture trust, and thereby honest feedback from Service Users. Staff should be trained in relation to the Protection of Vulnerable Adults Additional staff should be employed in peak periods to ensure the wellbeing of Service Users. The deployment of staff should be considered in relation to risk. (Areas of the home, Time of day etc) All staff should be properly qualified to meet the needs of Service Users with Dementia. Staff training should be maintained. Where training shortfalls emerge it may be necessary to offset this by the deployment of additional or agency staff on duty to ensure the safety of Service Users. The Acting Manager should be fully supported in her duties given the issues being addressed at the home. To this end additional staffing hours are needed so that Senior staff may sometimes assist or be delegated to some management duties, whilst supervision “on the floor” is properly maintained. Staff supervision issues as identified on this report should be formally addressed as soon as possible. Staff should be alert at all times to Health and Safety issues and proper procedures should be implemented to ensure a prompt response to issues identified DS0000066337.V291889.R01.S.doc Version 5.1 Page 22 3 OP12 4 5 OP13 OP33OP16 6 6 8 7 8 OP18 OP27 OP27 OP28 OP30 9 OP31 10 11 OP36 OP38 The Beeches Residential Care Home 12 OP38 A procedure should be implemented giving guidance on matters that should be notified under Regulation 37. This should include Accidents requiring medical intervention, and staff suspensions, as well as all other relevant issues. The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Beeches Residential Care Home DS0000066337.V291889.R01.S.doc Version 5.1 Page 24 - 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. 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