Care Home: Beech Care

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What the care home does well People receive the support and assistance they need . Support staff know what they are doing and have a detailed knowledge of what each person needs and wants. There are plenty of activities and things for people to do as a group or individually, at the home and in the community. Staff acknowledge and respect peoples individuality. They encourage people to express their choices and things are not taken for granted or assumed. The house is well furnished and decorated. people`s rooms can be personalisedaccording to their choice and preferences. staff have all been checked and references have been taken about their suitability to work with vulnerable people. What has improved since the last inspection? We were told that, since being taken over by Care Tech, access to additional resources, expertise and facilities has improved the service being offered. We were told that the new format for support plans is clearer, easier to understand and is person centred. What the care home could do better: The home acknowledges that progress is still in the early stages with the new `My Plan` person centred approach. Staff need to demonstrate how service users have been involved and engaged in the process. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Beech Care 99 Dunes Road Greatstone New Romney Kent TN28 8SW     The quality rating for this care home is:   two star good 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: Geoffrey Senior     Date: 2 8 0 5 2 0 0 9 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. that people have said are important to them: They reflect the things 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 27 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Beech Care 99 Dunes Road Greatstone New Romney Kent TN28 8SW 01797362121 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Beech Care Ltd care home 6 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 6 6 The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD). The registered person may provide the following category/ies of service only: The maximum number of service users to be accommodated is 6. Date of last inspection Brief description of the care home Beech Care, 99 Dunes Rd, Greatstone, is registered as a Care Home for up to six adults with a learning disability. Beech Care Ltd. is the registered Provider. The Registered Manager, Mr David Hussey is in day-to-day control of the functioning of the Home. The home is a detached property set in a residential area of the seaside village of Greatstone. The accommodation comprises six single bedrooms for the service users. There is a large lounge/dining room with access to the enclosed rear garden. Car parking is available to the front of the property. Local facilities (shop, pub, post office and GP) are all within walking distance. Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home The fees range from £510.00 to £1102.29 per week. Care Homes for Adults (18-65 years) Page 5 of 27 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home on 28th May 2009. The Manager and three staff were in the house as well as the six people who live there. We talked with two staff who have worked at the home for a number of years and with a new member of the team. We sat and observed staff interacting with service users and were helped by staff to understand what people who cannot speak very clearly were saying. Staff told us that they enjoy working at the house and things continue to go well following some changes to procedures and administration brought about when Care Tech acquired Beechcare Ltd. We spoke with the manager who helped gather the information that we asked for. As well as the information gathered on the day we also looked at the Annual Quality Assurance self Assessment (AQAA).The manager completed this prior to the visit and verbally confirmed that the checks and service certificates were still in date. we had a Care Homes for Adults (18-65 years) Page 6 of 27 look round the home and garden and sampled a range of records. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not admitted to the home until a full assessment has beeen carried out. Prospective service users and their family are able to visit prior to admission to help them decide about the move to the home. Evidence: The majority of people who live at Beech Care have been there for a number of years. There has only been one recent admission. We discussed the admission process with the manager and staff and found that they understood the importance of getting as much information as possible prior to admission. We looked at the assessment of the person who had most recently moved into the home. It contained information from the persons previous placement, psychologist and health care professionals. This information, together with with the homes own findings and input from family, contribute to the care support plan. We were told that people who are interested in living at the home are invited to visit so they can meet the people who already live there and the staff and look around the home. They can see which room they may have and find out about what goes on in the home. We saw from the case files that Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: family members had visited the home and the service user had been able to stay for a weekend. This helped the assessment and decision making process. We spoke with one service user who said that she was happy at the home. We also spent time observing service users who have communication difficulties. The manager told us that the majority are unable to express themselves verbally but things are never taken for granted or assumed. We saw the staff and service users interacting in a positive way with lots of smiles and laughter. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Peoples support plans are based on good information and assessment. Staff acknowledge and respect each service users individuality. Evidence: We looked at three care plans. The manager told us that they have changed the format to accomodate the organisations new My Plan person centred approach. There is space for pictures and the writing is more straightforward. Keyworkers are spending time with each person to find out what is important to them and to write it in their care support plan. They need to include descriptions of how each person communicates so that staff can respond to facial expressions, noises and behaviour. This is particularly important as only one service user is able to say what she wants. Staff have recorded what they, through experience and observation, consider to be important to the person and how much support they need with their personal care. Risk assessments are included as part of the plan. This is so that if people want to do something they are not stopped because it is thought to be unsafe. Instead staff will Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: work out how to minimise risk and make it possible. We were told that there is currently some ongoing dialogue with a service users family member who has objected to a proposed activity. We saw that one care plan that, whilst noting the limitations of an individuals abilities as reported by the previous placement, had been written in order to encourage the persons potential. We saw that the plan had been reviewed regularly as the person was developing skills at a good rate. We also observed aspects of the plan being put into action during interaction with the staff. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 have opportunity for an active and occupied lifestyle. They are helped to keep in touch with family and friends. Varied and balanced meals are served. Evidence: The staff said that they try to make sure that they spend time with each person during the day, doing something that the individual likes or has indicated they want to do.We observed one member of staff giving a hand and foot massage to someone and another engaged in knitting. Records seen indicated that everyone has done something each day, usually with a staff member, that they enjoy and that occupies their time. We were told that there is a general plan of activity for each person and that this reflects their age and requirements within the theme of being an individual in a communal placement. The plans are however not rigid and staff said that afternoon activities are as mood dictates. An activity lady supports one service user on a one to Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: one basis during the week and at weekends. The home has its own transport that can accomodate all the service users, and wheelchairs if necessary, with support staff. Service users enjoy trips out and shopping, plans have already been made for special holiday week trips going further afield. Each person is supported to maintain contact with their family and friends. Names of people important to them are written in their support plans. Visitors may come to the home at any reasonable time but may be asked to check first that the person they want to see will be in. There are routines in the home and mealtimes are generally at set times. these are however flexible as are times that people get up or go to bed. We found from the records that people are offered a varied diet. Staff get them to help plan the menu and make their choices by using picture cards and photos. Staff said that they monitor what people have but at the moment no one has any special dietary requirements. The kitchen is limited in size but people were seen being helped to get drinks Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People living in the home receive personal and healthcare support and are helped to attend appointments. Evidence: Staff have got to know each person well and and have found out and recorded what they need and how they like to be supported. Routines have been established and guidelines for staff written in the support plans so that every one should be doing the same thing. Each persons care plan includes details about their health needs and the support they require. There is information and monitoring charts for the people who have epilepsy so that details are available if the GP or specialist need them. People are supported to access community and specialist health care facilities and appointments. Staff were able to able to talk in detail about the current health of the individuals and where progress had been made. Peoples health status is also monitored as part of the support plan review process so that any changes can be acted upon with minimum delay. Medication is stored in a locked cupboard in a locked room. At present no one looks Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: after their own medication. The records relating to medication administration were seen to be complete and up to date. There is information about what each person is taking and possible side effects to be aware of. The manager said that all staff who are involved in medication have received training and he is satisfied with their competency. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. There are systems in place to protect service users from the risk of harm. Evidence: The organisation has provided service users with a pictorial and easy to read complaints procedure. Staff said that they have got to know each person with communication difficulties and can usually understand what the person is trying to communicate to them through facial expression, noises and behaviour. We saw staff responding to people and taking time to understand what the individual was expressing. Staff said that they would seek to resolve any thing that caused distress to the service user and try to reassure them. Staff have received training in the protection of vulnerable adults and were clear in their explanation of what they would do if they had any cause for complaint or concern. There were no entries in the complaints record and the manager confirmed that none had been received. The manager described the procedure for supporting people to manage and spend their personal monies. Each has an individual account held centrally by the organisation. No one at the home is able to manage independently. All monies received or spent by service users or on their behalf are recorded and signed by staff. Receipts are obtained and kept for auditing purposes. Care Homes for Adults (18-65 years) Page 18 of 27 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. The home provides a comfortable physical environment. It is clean and maintained to a good standard. Evidence: Staff said that they work hard to make sure that Beech Care provides a clean and homely place for the service users to live in and for them to work in. The home is furnished with good quality fixtures and fittings. The decor is a neutral colour in the communal areas and carpets and flooring are in good condition. Service user bedrooms are furnished and decorated in keeping with the occupants style and personality. We saw rooms with favourite items displayed, one has sensory equipment as part of the decoration and another has a mural reflecting the occupants favourite subject. There is a reasonably sized rear garden that is accessed from the communal lounge.There is room to sit on the lawn or shaded patio and a swing. There are few restrictions in the home. The service users may enter the kitchen with staff support and supervision. Bathrooms were seen to be freely accessible and in good condition. The manager told us that the maintenance department is available to sort out any problems and all service checks are up to date. He also said that the organisation is considering options to provide more communal space. Care Homes for Adults (18-65 years) Page 19 of 27 Care Homes for Adults (18-65 years) Page 20 of 27 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Service users are supported by well informed and trained staff in sufficient numbers. Robust recruitment systems are in place. Evidence: The AQAA told us that that there is a good and established team at Beech Care and staff have a good relationship with service users who, in turn, are comfortable with the staff. We talked to staff about their roles in the home. The long established members spoke about some of the changes that have occurred since the change of owners and how they have had to embrace new ideas and paperwork. They emphasised however, their ongoing commitment to the service users and intention to ensure minimum disruption for them. Staff said that there is a good range of training provided by the organisation. This most recently included courses on medication management and epilepsy. We spoke to one of the new staff. He said that he was enjoying his work and, having worked through the initial induction, was looking to start the LDQ (Learning Disability Qualification). The AQAA told us that 13 of the 15 staff have NVQ at level 2 or better. The home has a robust recruitment process and staff do not work unsupervised until all checks and references have been processed and they have had health and safety training. We saw that there are enough staff on duty to support the people in the home so that Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: individuals can do different things. We found that staff have opportunity to attend regular meetings and one to one meetings with the manager. This means that they have support and supervision in their work and the chance to communicate ideas and learn about any changes that need to be made so that everyone is supporting service users in a consistent way. We found that the manager promotes autonomy by giving staff particular responsibilities so that they are all involved. Staff were friendly and morale appeared to be good. Service users were seen to respond well to staff attention. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. The home is run in peoples best interests. There are quality monitoring systems in place. The health welfare and safety of service users, staff and visitors is promoted. Evidence: The Manager is registered with the commission. This means that he has the qualification and experience to satisfy the fit person process. He spoke with knowledge and understanding of the service users needs and has a good awareness of the national minimum standards. The manager completed the AQAA ( annual quality assurance self assessment ). This gives evidence and information telling us what they do well, how they have improved and how they intend to improve further. The manager told us that he uses an open style of management and utilises the individual skills of staff to help run the home. He supports the team to support service users in an individualised way, based on person centred planning. We observed a harmonious relationship between staff, manager and service users where banter was easy going and included everyone. We found that line managers carry out regular checks on how the service is running. They interact with staff and service users and produce a report. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The organisation also carries out an annual quality assurance audit. As noted earlier, the manager said that the service users are unable to verbally express themselves. It was clear however that the staffs understanding of the individuals and the day to day reviewing makes a positive difference for people using the service. Views are sought from relatives and other professionals and are given due consideration in the evelopment of the service. The AQAA was completed by the manager who also confirmed verbally that regular service and maintenance checks are in place and up to date. Staff have health and safety training including, first aid, moving and handling, food hygiene and infection control. Care Homes for Adults (18-65 years) Page 24 of 27 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 Adults (18-65 years) Page 25 of 27 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 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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