Care Home: Beckside Nursing And Residential Home

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What the care home does well The home provides a pleasant, homely and clean environment for people who live there. Those spoken to made positive comments regarding the care they received and said they felt their needs were being met. The activities organiser provides a varied programme of stimulation that people said they enjoyed. Records available showed an extensive programme is offered which includes sailing and bowling. Leadership in the home is good and quality assurance systems are in place to ensure the home is run in the best interest of people living there. Comprehensive policies and procedures are in place to instruct and guide staff and these are regularly reviewed. What has improved since the last inspection? The one requirement made regarding care plans being clearer has been addressed and new care plans have been written and are more person centred. The Statement of Purpose and Service User Guide have been amended to include the necessary information about equality and diversity, current fees and how people can contact us and access our reports. A new position of `Head of Care` has been implemented to support the care leaders and four volunteers have been taken on to assist the activity co-ordinator. The hours worked by the activity co-ordinator have increased to enable more choice in activities available. What the care home could do better: If care plans are to be written in the first person they must invlove input from the person and should indicate this. They should also include more information about the Mental Capacity Act. Records should show that the chef and cook regulary speak with people about their satisfaction of the food provided. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beckside Nursing And Residential Home Middle Street North Hykeham Lincs LN6 9QX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elisabeth Pinder     Date: 0 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Beckside Nursing And Residential Home Middle Street North Hykeham Lincs LN6 9QX 01522693461 01522682032 manager.beckside@osjctlincs.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Kim Patricia Goldby Type of registration: Number of places registered: The Orders Of St John Care Trust care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Beckside Care Home is registered to provide personal care to service users whose primary needs fall within the following category:- Old age, not falling within any other category (OP) - 58 The maximum number of service users to be accommodated at Beckside Care Home is 58 Date of last inspection Brief description of the care home Beckside Care Home is situated in the centre of the village of North Hykeham and is within easy reach of local shops, community facilities and public transport; this transport also runs to Lincoln city centre, some three miles away. The home, a former Local Authority home, is owned by the Orders of St. John Care Trust, a registered charitable organisation managing 15 other homes in Lincolnshire. The single-storey building, comprising four quadrangles each with its own enclosed courtyard garden, is set in its own grounds and there is space for car parking to the front of the building. Care Homes for Older People Page 4 of 25 Over 65 58 0 Brief description of the care home Beckside is registered to accommodate 58 people over 65 years, for General Nursing and Residential care. The current fees are between £351 - £541 with additional costs of hairdressing, chiropody, newspapers and personal toiletries. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit and it formed part of a key inspection, focusing on key standards which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection (CSCI). The visit lasted just under seven hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the acting manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people before we visited the service and these are Care Homes for Older People Page 6 of 25 mentioned throughout the report. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of people living in the home through their records and assessing their care. We spoke to people who use the service and saw rooms of some of those who said we could and spoke to two staff members. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming into this service have access to a range of information to help them make a decision about moving into the home and procedures are in place to ensure people are only admitted after a full needs assessment has been carried out. Evidence: Information sent to us prior to the inspection told us that people have access to a range of information about the service and this was confirmed during the visit. The Statement of Purpose and Resident Guide have recently been updated and include information to tell people how they can access our reports and the current fee rates. They also tell people how differing needs, such as religion and culture will be met and how the service considers the Mental Capacity Act. Both documents can be produced in different formats if needed and the Residents Guide is written in an easy read format. Residents living in the home also receive a copy of the Trust magazine. Care Homes for Older People Page 10 of 25 Evidence: Care records examined showed that a full needs assessment had been carried out prior to admission. Prospective residents are written to by the manager after their assessment confirming that they can or cannot meet their needs. Three residents surveys returned to us confirmed that they had received enough information about the home before moving in and all had been given a contract of residency. One person told us they had only come into the home for two weeks respite care but enjoyed it so much they decided to stay permanently. Another person told us they had looked around a number of homes before deciding on this one and we have been happy overall with our choice of home. Other people told us they were very happy. The service does not cater for people with intermediate care needs. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are well written identifying needs of people living in the home and the action staff need to take to meet these needs. There are satisfactory policies and procedures in place about the administration of medication and the privacy and dignity of people is respected. Evidence: Before we undertook our visit the manager told us about Advance Care Planning and the Liverpool Care Pathway used as a practical tool throughout the dying phase ensuring that the highest standards of holistic care is given. The manager also said that care staff have become more proactive in managing and delivering End of Life Care. Four of the six care plans looked at had completed an Advance Care Plan, so through sensitive discussion their end of life wishes had been recorded and a legal decision anout their personal wishes made. The manager said that the two other people had been offered an Advance Care Plan discussion but had declined the invitation. Care Homes for Older People Page 12 of 25 Evidence: Care records looked at gave clear information to enable staff to know about their individual needs and how to meet them. Since the last inspection care plans have been revised to ensure they are more person centred and have been written as if the person had completed them themselves. However, they do not tell us whether the person has written these or the level of their involvement. Records included medical profiles, life histories including hobbies and interests, detailed risk assessments, personal preferences and appointments with healthcare professionals. Various assessments have been completed on subjects such as, manual handling, pressure risk and nutrition. Care plans had been reviewed at least once a month and daily notes written to show that people receive the correct level of care and support. However, some evaluations read no change and do not show that people have been given the opportunity to be involved in their care plan review. Records make reference to the Mental Capacity Act and staff told us they had received training but were still unclear what to record in care plans. A discussion was held with the acting manager and the County Manager who was visiting the home and we were shown new policies and procedures including a flowchart for staff and were told that more training has been arranged for January. Information taken from the AQAA told us that policies and procedures concerning the receipt, storage, administration and disposal of medications were available. We looked at medication records of the people whose care was being followed and observed medications being administered at lunchtime, these showed that the people were receiving their medications correctly. People were happy with the level of support given and told us they felt their needs were being met. Staff spoken to had a good knowledge of the needs of people who use the service and how to meet them and were observed to be responsive to needs and were respectful and kind. There is a key worker system giving staff some responsibilities for specific people who use the service and information was available about advocacy services should people who use the service need it. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in various recreational activities and maintain contact with family and friends as they wish. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: Information sent to us prior to the visit indicated that a range of activities are provided to meet individual needs and an activities co-ordinator is employed for 30 hours each week. Records are kept of events and activities held and these were looked at during our visit and showed that a wide range of activities is offered. There are four volunteers who work alongside the activities co-ordinator and part of their role includes one to one time with people who are too poorly to come out of their rooms. During the visit a number of people were making Christmas decorations using fresh leaves and a volunteer with experience in flower arranging was helping. Regular activities include bowling and curling, painting, musical movement, dominoes, hand massage and manicures and rock and roll singers. In the summer six people went sailing with a local sailing club. People said they were able to keep in touch with family and friends and have visitors whenever they choose and this was evident throughout our visit. One visitor spoken to said she was always made to feel welcome and was Care Homes for Older People Page 14 of 25 Evidence: very satisfied with the care and support provided. Meals are served in various areas to ensure people receiving nursing care have the help they need to ensure they receive a nutritious diet. The large dining room is accessed mainly by the more able people and during our visit we observed the lunch time meal being served. Tables were nicely laid with place mats/napkins and condiments and the meal looked appetising. We spoke to a number of people and received mixed comments about the food, some people were happy with the variety and choices offered whilst others felt the menu could be more imaginative. One person told us that he had not had the opportunity to talk about dietary needs with the chef at the home. However, the chef confirmed that he has been to see the person twice since admission; once soon after arrival just to briefly introduce himself and again when the person had an issue with salmon being on the menu. Information providered confirmed that on notice was on the chefs board in the kitchen dated 24th October 2008 showing his agreed preference for an alternative dish when salmon was the dish on the menu. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the procedures in place for handling complaints and allegations of abuse and are confident that their complaints or concerns will be taken seriously. Evidence: Information taken from the AQAA tells us that people are given the complaints procedure on admission and it was on display on one of the corridors. People told us they feel able to raise issues with their relatives, key worker, care leader, head of care or manager and felt these would be taken seriously. Surveys received prior to the visit all indicated people know how to make a complaint and who to speak to if they were unhappy. One specific comment read, staff are always happy to help where possible. Staff spoken to had a good knowledge of the complaints procedure and told us what they would do should an allegation of abuse be made. Training records showed that relevant training had taken place in relation to safeguarding adults. A number of complaints and safeguarding referrals have been received since the previous inspection and records available showed us that these had been dealt with sensitively and appropriately. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home live in a clean, comfortable and homely environment. Evidence: We took a partial tour of the home which included looking at the bedrooms of the people whose care was being followed and some communal areas. Bedrooms had been personalised by the residents or their families with photographs, mementoes and small items of furniture. There were no unpleasant odours detected in the home. Three surveys completed by residents told us that the home is always or usually fresh and clean and one comment read cleaners are very good. Although some areas are showing signs of wear and tear, we were told that a complete re-furbishment is due to commence and will include a complete re-wiring and telephone system, new lighting, carpeting and painting. Staff told us protective aprons and gloves are always available to use when needed and various pieces of equipment were in use during the visit including hoists, specialist mattresses, raised toilet seats and grab rails. The service has received a 4 star award for food safety from the Environmental Health Officer. Care Homes for Older People Page 17 of 25 Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers are in sufficient quantity for them to be able to care for people living in this home. The service recognises the importance of training to ensure staff are knowledgeable and equipped to meet the needs of people living here. Evidence: On the day of the visit 58 people were living at the home, 1 of whom was in hospital. Duty rotas were looked at for the past two weeks and these showed that there were two qualified nurses and nine care staff on duty most mornings, one qualified nurse and eight carers each afternoon and one qualified and four carers throughout the night. In addition to this there is an acting manager, head of care, care leader and administrator on duty. A mixed response was given from both staff and residents surveys received prior to our visit with specific comments of, they do the best they can considering there never seems to be enough staff, particularly in the last few months and it would be nice to have more staff on each shift as you could spend more time with residents. People spoken to during the visit also gave a mixed response, some people felt there were enough staff on duty whilst others felt extra staff were needed, however, everyone spoken to felt their needs were being met and staff said they had enough time to complete their tasks although they are very busy. A discussion was held with the acting manager who told us that staffing levels are regularly reviewed according to peoples changing needs and acknowledged that Care Homes for Older People Page 19 of 25 Evidence: staffing levels sometimes drop due to unforeseen sickness, however, where possible shifts are covered by existing staff or agency staff. Surveys also gave a mixed response regarding staff listening to people and acting on what they say, comments read, some do, some dont and it depends how busy they are. However, during our visit only positive comments were received from residents and relatives. The records of two staff recently employed were looked at and these showed that staff were being recruited safely with essential checks such as written references and C.R.B. (Criminal Records Bureau) checks being undertaken and we were told that future plans include involving people living in the home in the recruitment of staff. Information received told us that over 70 of staff have achieved a nationally recognised vocational award in care and the service is now using E-Learning training for induction and medication training. One member of staff spoken to confirmed they had received training including induction, moving and handling, health and safety, equality and diversity and fire. Awareness of the Mental Capacity Act training had been provided using a computer and staff spoken with had a basic knowledge of the Act. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is well managed and the staff are supported and supervised in carrying out their roles. The audit and policy systems ensure that peoples views are listened to and acted upon. Evidence: The home is currently being managed by an acting manager as the registered manager is covering for another of the organisations services. The acting manager told us she has recently completed the Registered Managers Award (RMA) and this is currently being verified. Prior to working as acting manager she was Head of Care in the home and she also has eight years experience of working as a nurse manager for an agency. Surveys received raised no concerns regarding the current management arrangements within the home and staff told us they felt supported and valued by the acting manager and said she has an open door policy and is always available and easy to talk to. Care Homes for Older People Page 21 of 25 Evidence: Discussion and records showed that there are various systems in place to monitor the quality of the service being provided. This includes seeking the views of people through meetings and questionnaires. Minutes of the last meetings for residents, staff and volunteers were looked at and these showed that various topics were discussed including staff issues, environmental issues, activities and training. Information provided in the AQAA told us that there are a range of policies and procedures in place and those recently updated included health and safety, infection control, nutrition and fire risk assessments. We were also told of equipment maintenance and service dates. Building risk assessments are in place and monthly health and safety audits are completed. There are satisfactory arrangements in place to ensure any valuables or monies held on behalf of people living in the home are kept safe and we looked at records held for the people whose care was being followed and these were all up to date and accurate. Generally records required by law to be kept about the operation of the service were up-to-date and well maintained. Someone from the Company had visited the home at least once a month and completed a report on their findings which included talking to people living at the home and to staff. The service attained the ISO9000/2000, which is awarded by an independent company who audit the homes systems against expected standards. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans that are written in the first person should involve input from the person and indicate this. Care plans should include more detail regarding the Mental Capacity Act. Records should be available to show that the chef and cook talk to people about their satifaction of the food provided 2 15 Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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