Care Home: Beech House

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What the care home does well People that live at the home are treated with respect and their views are listened to. The interaction between staff and people who lived at the home is respectful, caring and professional. The staff that work at the home have a good knowledge about the individual needs of the people that live at the home. Staff are provided with the training that they need to meet the individual needs of people. People are provided with the opportunity to participate in a meaningful activities programme that interests them. Visitors are made welcome in the home and they are encouraged to take an active part in the home, such as participating in activities. The home is clean and well maintained, which provides people with a comfortable and homely place to live in. The service user surveys asked what the home did well and comments received included `I think it all does very well, I can`t complain about anything`, `I think the care here is very good`, `everything, really get on with the carers`, `they do everything, I`m quite happy with them, I can`t ask for anything more I`m happy` and `keeps me busy, keeps the home clean and tidy, gives us the care we need`. What has improved since the last inspection? There is a sensory garden in the grounds of the home, which provides people with the opportunity to enjoy their surroundings. The home has undertaken a phased expansion and is currently registered to provide care and support for 49 people. In the development of the home the laundry has been moved and improved, providing a separate clean room for ironing, which minimises the risk of cross contamination from dirty laundry. What the care home could do better: It is recommended that the care plans include the specific information regarding the support that people may require with diabetes care, to ensure that the staff are aware of possible changes in condition and behaviour and the actions that they should take to meet their needs. Key inspection report Care homes for older people Name: Address: Beech House Beech Close Halesworth Suffolk IP19 8BQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Small     Date: 2 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Beech House Beech Close Halesworth Suffolk IP19 8BQ 01986872197 01986874638 tpic.access@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Partnership in Care Limited Name of registered manager (if applicable) Ms Lorraine Elphick Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 49 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 49, Dementia - Code DE, maximum number of places: 49 Date of last inspection Brief description of the care home Beech House, owned by The Partnership in Care Limited, provides care for up to 49 older people and people who have a dignosis of dementia. The purpose built home, is set within a residential area, within walking distance of Halesworth town centre. There is a footpath, which leads straight to the towns market place, where there is a range Care Homes for Older People Page 4 of 36 Over 65 0 49 49 0 Brief description of the care home of amenities. These include shops, church, banks, post office, eating and drinking establishments. Public transport links include railway and bus services. At the time of this key inspection the fees at the home ranged from £495 to £620 per week, dependant on if residents were private customers or social care customers and the type of care they received. The manager advised that the fees were due to be reviewed 1st April 2010. Care Homes for Older People Page 5 of 36 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: The unannounced inspection took place Monday 29th March 2010 from 09:55 to 18:40. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The manager was present during the inspection and they provided us with the requested information promptly and in an open manner. Five staff members, five people that live at the home and four visitors were spoken with. We tracked the care and care of three people that live at the home, which included viewing their care records and speaking with them. Further records that were viewed are identified in the main body of this report, which included staff recruitment records and training records. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and was returned to us within the required timescale. The surveys from four Care Homes for Older People Page 6 of 36 health care professionals, ten service users and eight staff members were received. Care Homes for Older People Page 7 of 36 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 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 Older People Page 8 of 36 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 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be provided with the information about the services that are provided at the home to enable them to decide if it is the right place for them, to be provided with a needs assessment prior to moving in and to have their needs met. The home does not provide an intermediate care service. Evidence: People were provided with information about the services that were provided at the home, which enabled them to decide if the home was able to meet their needs in the Statement of Purpose and the Service Users Guide. The Statement of Purpose was viewed, which was displayed in the entrance hall of the home for visitors and people who lived at the home to refer to as they chose to. The document included information such as the homes aims and objectives, details of the management team, which had been updated to show the current management arrangements, staffing, organisational structure, the age range and numbers of the Care Homes for Older People Page 10 of 36 Evidence: people living at the home, which had been updated to reflect the phases of increased beds, however, it needed to be further updated to reflect the current registration numbers, the service that were provided at the home, the complaints procedure and fire safety. The Service Users Guide was viewed and it included information such as staffing arrangements, management details, how peoples needs and preferences were met, the services and facilities provided at the home and the outcomes of recent satisfaction surveys, which included individual testimonials of the home. Nine service user surveys said that they had been provided with enough information about the home before they moved in so that they could decide if it was the right place for them and one said that they did not. Two people that lived at the home that were spoken with told us that they had visited the home before they decided if they wanted to move in. Two people told us that their relatives had visited on their behalf. Two visitors to the home that were spoken with told us that they had visited the home before their relatives had moved in. This provided people with the opportunity to make informed choices of where they chose to live. The manager told us that people were provided with the opportunity to visit, meet other people in the home and the staff and to experience a meal time in the home. The care of three people who lived at the home was tracked, which included viewing their care records. Each of the care records that were viewed held a pre-admission needs assessment and care plans which identified how their assessed needs and preferences were met. The AQAA stated pre-assessments remain an important part of the admission process to ascertain as to whether the needs of individuals can be met. Added to this process is the important information required in order for an individual to make an informed choice about their future. This information in conjunction with other assessments provided by local or distant authorities plus any referred health assessments is then used to devise an initial care plan which is reviewed once the resident or the information indicates it is incorrect. The system is reviewed as required initially so any changes in care needs are met instantly rather then being delayed. Residents are actively encouraged not only to participate but to also take ownership of these records. The health professional survey asked if the services assessment arrangements Care Homes for Older People Page 11 of 36 Evidence: ensured that accurate information was gathered and the right service was planned for people, two answered always and two answered usually. One survey stated always prompt to assess new residents needs. Care Homes for Older People Page 12 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to have their needs and preferences set out in an individual care plan, to have their needs met, to be protected by the homes medication procedures and to be treated with respect. Evidence: The care of three people that lived at the home was tracked, this included viewing their care records and speaking with them. The three care records that were viewed included care plans, which were stored on the homes computer system and a paper copy was kept in the persons room. The care plans detailed the care and support that people preferred and needed to meet their assessed needs in areas such as with their personal care and manual handling. The care plans identified the areas of care that people could attend to independently and how their independence should be respected, which showed that their dignity was respected. The AQAA stated we provide a very detailed and well constructed care plan. It is accessed and utilised by all relevant persons who need to know. All care plans show an auditing process especially in relation to social nutritional and other health needs Care Homes for Older People Page 13 of 36 Evidence: and that improvements made int he last twelve months included the computerised care planning system has been updated to level 2, and continues to be developed, thus promoting more uniqueness and the importance of each individualised care plan. Individuals are at all times to be involved in the care plan and also encourage to take ownership of them. They have accessed their records via the computer system to ensure them of confidentiality. Each care plan included peoples choices and decisions that they had made regarding their end of life care, which included their chosen funeral arrangements, which showed that their choices were listened to and acted upon. The AQAA stated residents have advanced directives and when necessary end of life care plans on their personal files as part of the Gold Standards framework requirements. The senior team have full understanding and awareness of these documents and the importance of these documents in carrying out their wishes to the end of life. This again promotes values and control of personal life decisions made by the individual and communication is maintained to the highest level with our multi-disciplinary team to ensure the palliative care provided to individuals nearing their end of their life cycle is of the highest and most respectful standard possible. This care extends to other family members or close people who may be effected. Each record held a manual handling risk assessment and there were risk assessments in place for skin viability, falls and nutrition for those who were at risk. The risk assessments included methods of minimising the assessed risks. The care plans and risk assessments were reviewed on a monthly basis and when changes in peoples needs arose. It was noted that one person was diabetic, which was controlled with medication. We discussed the persons condition with the manager and it was noted that the care plans did not identify the specific details of their condition, where the staff should observe for changes in their well being and behaviour and the actions that they should take if they became ill. The manager agreed that this would be beneficial to the staff and assured us that they would liaise with the district nurse and ensure that the information would be included in the care plan. Daily records were completed on the homes computer system, which detailed the care and support that people had been provided with on a daily basis. We observed staff updating the records throughout the day of the inspection. We looked at one persons care plan with them in their bedroom and they told us that they had been consulted with about the care that they were provided with and that Care Homes for Older People Page 14 of 36 Evidence: the care plan clearly identified the care and support that they received on a daily basis. They told us that the staff referred to the care plan. Their care plan was stored in a plastic box that was attached to their bedroom wall, they told us that they could not reach the care plan as they were a wheelchair user. We spoke with the homes manager about this and they told us that they would consider ensuring that the care plans were in a more accessible place for people. The computer based care records held clear detailed information of the outcomes to health care appointments that people were provided with, such as with the dentist, doctor and optician. One person that was spoken with told us that they had seen an optician on the day of the inspection. Another person told us about the support that they were regularly provided with by a district nurse. Both people told us that they were provided with an appointment with their doctor if they felt unwell. A staff member showed us a note book, in which issues were recorded for the attention of the visiting health professionals, which showed that information was passed on effectively to health professionals, such as the visiting district nurses. All people that were spoken with told us that they felt that their needs and preferences were met. They were complimentary about the care and support that they were provided with. This was confirmed by visitors that were spoken with. The service user survey asked if they received the care and support that they needed and if they received the medical support that they needed, nine answered always and one answered usually. Comments made in the surveys included I think the care here is very good, care for the residents needs, individual needs, take care of my needs and they do everything, Im quite happy with them. I cant ask for anything more Im happy. The health professional survey asked if peoples social and health care needs were properly monitored, reviewed and met, two answered always and two answered usually. The survey asked if the home sought advice and acted on it to meet peoples social and health care need and improve their well being, one answered always and three answered usually. Comments made in the surveys included very organised, approachable and well informed seniors, communication with other professionals is always excellent, overall residents appear to be well cared for, help given with personal care, feeding etc. and senior carers communicate well with visiting health care professionals re; residents needs. Staff that were spoken with had a good understanding and knowledge of peoples Care Homes for Older People Page 15 of 36 Evidence: needs and preferences and they had a good understanding of their role and responsibilities in meeting peoples needs. Eight staff surveys said that they were always provided with up to date information about the people that they cared for. The survey asked if the ways that they passed on information about people who used the service between staff worked well, six answered always and two answered usually. Comments made in the staff surveys included it meets the individual needs of all staff and residents within the home, provides a good service to all, Beech House makes the residents feel at home, comfortable and safe. Meets residents needs as well as they can. Hand overs which inform carers about all care issues, promotes independence, dignity, choice, listens to residents and staff and support the residents each day and night, also the staff. Make the residents feel supported at all times. During the inspection we observed that the interaction between staff and people that lived at the home and visitors was excellent. There was lots of laughter from both staff and people who lived at the home. Carers were attentive to people needs and they spoke with them in a caring, respectful and professional manner. They greeted people when they walked past and where people asked for assistance, this was given promptly. Staff were observed to position themselves at peoples eye level when speaking with them at all times. The AQAA stated the environment is calm and comfortable and creates an atmosphere which promotes health, fun and well being. Individuals feel a sense of involvement and belonging which contributes towards health and well being also. People looked well groomed and clean, which showed that their dignity was respected. At lunch time it was noted that people were provided with specialist equipment, such as plate guards, which showed that where they could independently eat they were provided with the the opportunity to do so. Where people chose to, they were provided with aprons whilst eating their meals to ensure that their clothing was kept clean. Staff were observed to knock on bedroom and bathroom doors before entering to ensure that peoples privacy was respected. People confirmed that this was usual practice and that they felt that their privacy was respected. People and visitors that were spoken with told us that they were always treated with respect and they were complimentary about the approach of the staff. The health professional survey asked if peoples privacy and dignity was respected, two answered always and two answered usually. Comments made in the surveys Care Homes for Older People Page 16 of 36 Evidence: included the resident comes first and is well respected and staff create a good atmosphere and rapport with residents. People were protected by the homes medication processes and procedures. We observed part of the lunch time medication administration round. The staff member who was undertaking the round, clearly explained the procedures for the safe handling of medication. It was noted that they had a good knowledge of the expectations of their role to ensure that cross contamination and that the medication was administered to ensure that people were safeguarded. The staff member was observed to wash their hands often, when administering the medication. They removed the medication from the MDS (monitored dosage system) blister packs into clean pots, which they then gave to people. They spoke with the people and asked them if they wanted their medication, they observed them taking their medication and then signed the MAR (medication administration) charts to show that it had been taken. The staff member explained that they always observed people taking their medication as there were risks that others could pick up the medication and take it. The staff member asked people if they wanted their PRN (as required) pain relief medication and where it was refused the appropriate codes were recorded in the MAR charts, the use of codes was explained to us by the staff member. They told us that they had been provided with medication training and this was confirmed in the training matrix that was viewed, which showed that all staff that were responsible for medication administration were trained to do so. Eight staff surveys said that they were provided with training which gave them enough knowledge about health care and medication. The MDS medication was stored in secured medication trolleys, that were attached to the wall in the senior office when they were not in use. The MAR charts were viewed and it was noted that the medication was accounted for. The MAR charts included each persons name and a photograph of the person, the staff member explained that this was to ensure that the medication was given to the correct person. The controlled medication was stored in an appropriate secure controlled drugs cabinet. The controlled medication book viewed, which identified the name of the person who was prescribed the medication, two signatures when the medication had been administered and a running total of the medication. We randomly selected three controlled drugs and checked the balance with the records, which was correct. The staff member who was spoken with told us that they were responsible for auditing the medication on a monthly basis and completing repeat prescriptions to ensure that Care Homes for Older People Page 17 of 36 Evidence: peoples prescribed medication was available. They showed us the medication storage and medication fridge temperature checks, which ensured that all medication was stored at the appropriate temperature. There was a locked fridge in the senior room, and the staff member told us that there was no medication that required refrigeration at the time of the inspection. The health professional survey asked people were supported to administer their own medication or if it was managed correctly where this was not possible, three answered always and one answered usually. The AQAA stated we have worked with employees to ensure that those accountable for medications are adhering to policies and procedures, thus any knowledge deficits identified has alerted the registered manager to allow access to appropriate training to be gained. The senior team has become involved in the auditing of medication, care plans and other health and safety systems, this has proven to be invaluable as they have a full understanding of requirements and take more of a sense of responsibility. Care Homes for Older People Page 18 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be provided with a varied activities programme which that they can choose to participate in, to be supported to maintain their chosen contacts and to be provided with a balanced and varied diet. Evidence: People who lived at the home were provided with the opportunity to participate in a varied and interesting activities programme. Activities were provided at the home seven days a week, which included armchair exercises, bingo, board games, poetry and reminiscence. There were three activities coordinators that worked at the home, one was spoken with and they explained how they worked together to ensure that a varied activities programme was provided to ensure that people were provided with meaningful activities that were of interest to them. They showed us a folder that they kept that showed the activities that had been provided, such as St Patricks day celebrations, a garden party and a farm day. There were also photographs of a recent garden party and the homes annual participation in the local carnival, which their walking float of the tennis elbows won. Since the last inspection a sensory garden had been built, which the manager told us had been designed by a local school. We looked at the garden through the window, which included a vegetable garden, wind chimes and flowers and a new summer house and bench that had been donated to the Care Homes for Older People Page 19 of 36 Evidence: home. There was a notice board in the home which included the activity programme, the bonus ball competition and details of a castles topic, which was currently being undertaken. A staff member told us that they regularly looked at topics, which was researched by people in the home, one included Egypt, where people sampled Egyptian food and a belly dancer was the visiting entertainment. On our arrival to the home on the day of the inspection a group of people were making Easter biscuits, one person gave us a biscuit when they had cooked, which we ate together. It was noted that the home was decorated with Easter decorations that people had made and a person told us that they had also made Easter bonnets. We observed people talking to the manager about the gardening that they had been working on, the manager told us that people that lived at the home, their relatives and staff had been working on the borders in the garden, such as planting flowers. On the afternoon of the inspection people were observed to be singing old time songs, such as my old man said follow the van. It was noted that there was lots of laughter and loud singing. People who were not taking part in the group activities were observed to be reading their daily newspaper, watching television, entertaining their visitors and chatting to staff and each other. People were also observed to have their hair styled by a visiting hairdresser in the homes hair salon. It was noted that there were lounges that people could choose to use, which included a quiet lounge and a lounge with a television. There was a pet gerbil, that we were told sometimes runs around in a ball. Peoples care records that were viewed showed the activities that people had participated in, which included group and individual activities. The manager told us that recently a person had said that they wanted to attend church, which they were supported to do so. This led to interest by other people and a group of people attended the Sunday service at the local church. People who were spoken with told us that there was always activities that they could participate in, which also included outings to local garden centres, coastal towns and pub lunches. Nine service user surveys said that there were always activities arranged Care Homes for Older People Page 20 of 36 Evidence: that they could take part in and one said that there sometimes were. The survey asked what the home did well and comments included activities, keeps me busy and provides activities. The staff survey asked what the home did well and comments included activities i.e. great trips, films, days out etc., daily activities, provide a lovely sensory garden and activities every day and two evenings a week. A health professional stated lots of social activities going on. The AQAA stated we boast about our activities programme, as it is seven days a week and two evenings per week also. There is individual time put aside for people who prefer one to one time or for people who may benefit from it. Activities at Beech House can be beneficial, meaningful and also fun to many who participate. The programme is based around not only existing ideas but also new ones that residents and staff have put forward, care staff are encouraged to spend time with residents doing not only social activities but also assisting with daily living skills, whether it be dusting or making some cakes and the dining area now has dual purpose and doubles up as a cinema, shopping area, function area and games area, the new patio doors installed in this area improves independence allowing residents in wheelchairs to go out into the lovely grounds to enjoy the views and to participate at their leisure in outdoor activities. There was a computer in the home that was allocated for the use of the people who lived there, which they could use to maintain contacts with their relatives and friends. The AQAA stated the internet with online communication opportunities for residents who have family or friends abroad. Also the ability to access other services if required is now available. A comment made in a health professional survey was very supportive to families which can be extremely difficult for them to cope with when loved ones have to become residents. One staff survey stated involves family and friends in decision making. People that were spoken with told us that their visitors were always welcomed into the home, this was confirmed by visitors who were spoken with and our observations of the welcome that was provided at the time of the inspection. One visitor told us that their relatives friend visited each weekend and that they enjoyed a meal together. The manager confirmed that people could dine with their friends or relatives for a small charge. The menu was viewed and it was noted that people were provided with a nutritious and balanced diet. On the day of the inspection the lunch time menu included a choice Care Homes for Older People Page 21 of 36 Evidence: of cold meats, mashed potato, leeks in creamy onion sauce, beef lasagne, corned beef salad, rhubarb crumble and custard and jelly and ice cream. We observed people eating their lunch, which smelled and looked appetising. The dining room was attractively furnished and decorated and it was noted that the meal time was a calm and social event. The staff that were on duty sat at the tables and ate their meals with the people that lived at the home. People that were spoken with told us that the food at the home was of good quality, that they were always provided with a choice of meals and that they were provided with enough food. The service user survey asked if they liked the meals at the home, eight answered always and two answered usually. People were provided with sufficient drinks throughout the day to ensure that they were hydrated. We observed that people were provided with a choice of hot drinks from the drinks trolley in the morning and afternoon of the inspection, however, people were also provided with hot drinks when they asked for them. There were jugs of cold water, bottles of squash and glasses in each communal area that people could help themselves to and each person had a jug of cold water and a glass in their bedrooms. Care Homes for Older People Page 22 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be protected from abuse and to have their complaints listened to and acted on. Evidence: The AQAA stated the home maintains its clear complaints procedure and it is situated in the entrance hall. All residents have a copy of the procedure which is handed out on admission within their welcome pack. The home adopts the policy that complaints are a form of feedback about the service being provided and staff are encouraged not to take things personally. If a person shows or indicates any sign of a grievance, they are informed of the procedure and encouraged to use it. The AQAA told us that there had been no complaints made in the last twelve months, which was confirmed by the homes manager. People and visitors to the home that were spoken with told us that they were aware of how to make a formal complaint and they told us that if they had any concerns that they would approach the homes management. A person told us that they attended regular residents meetings where they could share their views about the service that they were provided with and they shared an example of how their comments had been listened to and acted upon. Ten service user surveys said that they knew who to speak to if they were not happy. Seven surveys said that they knew how to make a formal complaint and three said Care Homes for Older People Page 23 of 36 Evidence: that they did not. The health professional survey asked if concerns were responded to appropriately, two answered always and two answered usually. Eight staff surveys said that they knew what to do if a person had concerns about the home. The home provided a detailed safeguarding and whistleblowing procedure which clearly explained the roles and responsibilities of staff in relation to ensuring that people who lived at the home were safeguarded. Staff that were spoken with told us that they had been provided with safeguarding training and that they were aware of actions to take if they had concerns about a persons well being and safety. One staff member told us that they had attended a train the trainers safeguarding course and that they regularly provided safeguarding and refresher training to the staff that worked at the home. A training matrix that was viewed showed that the staff that worked at the home had been provided with safeguarding training, including domestic, kitchen and activities staff, which showed that all staff were aware of their roles and responsibilities in ensuring that people were protected. The AQAA stated any relevant training is undertaken to ensure staff are fully aware of any issues relating to abuse, expected practice and procedures of them whilst working with residents. The AQAA explained the improvements that had been made in the last twelve months, which included the implementation of training on the Mental Capacity Act, as well as Deprivation of Liberty Safeguarding for senior staff is part of our establishments mandatory training and all new staff are expected to have completed this within 12 weeks of employment. The training matrix that was viewed confirmed that the Mental Capacity Act training had been provided to all staff and that the Deprivation of Liberty Safeguarding had been provided to senior staff. Care Homes for Older People Page 24 of 36 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 who use the service can expect to be provided with a clean, comfortable and well maintained environment to live in. Evidence: A tour of the building was undertaken and it was noted that the home provided a clean, homely and well maintained environment for people to live in. There were no offensive odours in the home. Nine service user surveys said that the home was always clean and fresh and one said that it usually was. Since the last key inspection there had been several rooms refurbished to become bedrooms with en-suite facilities. Applications for variations to increase the numbers of people that could be accommodated on their registration had been received and the home was registered for 49 people. The AQAA stated the physical appearance of the building has been changed considerably both internally and externally. All paintwork has been redecorated as well as a new fire escape and a sensory garden has been created. This has developed for many individuals a sense of value, promoted quality of life as well encouraging the feelings of involvement and belonging. During the inspection it was noted that a corridor in the home was being repainted by Care Homes for Older People Page 25 of 36 Evidence: the homes maintenance staff, one told us that the job was never ending, they said that as they redecorated one area another was in need of redecoration. This showed that the home continued to ensure that the home was well maintained. The manager told us that there were further plans to update areas of the home, which included the refurbishment of one toilet to become a wet room, which would provide further bathing choices for the people that lived at the home. There were several lounges in the home, which provided areas for people to entertain their guests, watch television, read their newspaper or chat to each other. There was a large dining room, which people could use to play games. All rooms were attractively decorated and furnished. At the previous inspection it was noted that the dementia unit was accessible to the people that lived there, for example there were bright colourful pictures on the wall, which directed people to areas, such as the dining room. They were not present at this inspection. The manager told us that the unit had recently been redecorated and that the signs would be replaced. The AQAA told us about the improvements that had been in the last twelve months which included a new chair stair lift has been installed to promote safety in the event of a fire emergency or the breakdown of the master lift. This also encourages independence and value and the internal decor is beneficial to the residents as it is calm, not too busy but has the required 15 colour differential between doors and walls, doors and door frames and windows and sills for those with visual impairment. There was large secured garden, which included a sensory garden, summer house and seating, which people could enjoy in good weather. People that lived in the home and the manager told us that they had been planting flowers in the garden, however, the rain on the day of the inspection had prevented them from continuing with their activity. We visited several people in their bedrooms and it was noted that they were personalised with their personal items of memorabilia. All rooms were clean and attractively decorated. Each bedroom door held a name plate, which included a picture that was meaningful to the person, which enabled them to identify their bedroom. People that were spoken with told us that they were happy with their bedroom, which was cleaned regularly. The manager told us that since the last inspection they had responded to suggestions of a visiting health professional and they had provided each bedroom with hand wash liquid and paper towels, which minimised the risk of cross infection. Care Homes for Older People Page 26 of 36 Evidence: Since the last key inspection the laundry had been moved to another room, the laundry was large and clean and held two large drying machines and washing machines. There was a separate ironing room, which minimised the risk of cross infection from the dirty laundry. Each bathroom and the laundry held hand washing facilities, including hand wash liquid and disposable paper towels, which minimised the risk of cross infection. The training matrix that was viewed showed that staff had been provided with infection control training. During the inspection they were observed to undertake good infection control procedures, such as wearing gloves and aprons when dealing with food and personal care and regularly washing their hands. Care Homes for Older People Page 27 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be supported by staff that are trained and qualified to meet their needs and to be safeguarded by the homes recruitment procedures. Evidence: People that lived at the home and visitors that were spoken with were complimentary about the approach of the staff that worked at the home. People who lived at the home told us that the staff were attentive to their needs and that they answered call bells promptly. This was confirmed in our observations on the day of the inspection. It was noted that staff were polite, respectful and professional when communicating with the people that lived at the home and their visitors. Staff that were spoken with told us that there were enough staff on duty to meet peoples needs. The staff survey asked if there were enough staff to meet the individual needs of the people who lived at the home, four answered always and four answered usually. The recruitment records of three staff members were viewed and it was noted that the appropriate checks had been undertaken to ensure that people were safeguarded. The checks included CRB (Criminal Records Bureau) checks, two written references, identification and a record of their previous work history, which was detailed in their Care Homes for Older People Page 28 of 36 Evidence: application forms. Eight staff surveys said that their employer carried out checks, such as their CRB and references before they started work. The homes training records that were viewed, which included certificates and a training matrix, that showed that the staff had been provided with the training that they needed to ensure that peoples needs were met. Training included the Common Induction Standards induction, safeguarding, manual handling, dementia, infection control, Deprivation of Liberty, Mental Capacity Act and health and safety. One staff member told us that they had attended the train the trainer safeguarding training and that they provided safeguarding training to the staff at the home. Another staff member told us that they had been provided with training to enable them to provide the Common Induction Standards induction training, they showed us a completed work book for one staff member that had recently completed their induction course. This showed that the staff that worked at the home were given the opportunity to develop in their work roles and that there were staff that were knowledgeable in specific subjects that could advise their colleagues in their daily activities to meet peoples needs. During the inspection we observed a group of staff that were undertaking manual handling refresher training. They were practicing their lifting techniques on each other using a hoist. The manager told us that the training was delivered by a staff member who was a manual handling trainer. The AQAA stated the workforce is very diverse as some staff are selected mentors, some are selected trainers who deliver safeguarding of adults, dementia care, moving and handling, health and safety to employed staff as well as volunteers. Care staff are encouraged to learn about the senior role and shadow, which then gives them the opportunity to learn and have a realistic chance of achieving the next level. This allows the manager and senior team to recognise individual skills as well as possible resources. Staff that were spoken with told us that they were provided with training and refresher training that they needed which informed them of how they should meet peoples needs. The staff survey asked if their induction covered everything that they needed to know to do the job when they started, six answered very well and two answered mostly. Eight staff surveys said that they were provided with training which was relevant to their role, gave them enough knowledge about health care and medication, helped them to understand and meet peoples individual needs and that kept them up to date with new ways of working. Care Homes for Older People Page 29 of 36 Evidence: The health professional survey asked if the homes management and staff had the right skills and experience to support peoples social and health care needs, two answered always and two answered usually. The home had exceeded the target of 50 of staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 as identified in the National Minimum Standards relating to older people. The AQAA told us that thirty five permanent care workers worked at the home and twenty five had achieved a minimum of NVQ level 2, this was confirmed in the training matrix that was viewed. The manager told us that a further five staff were working on their awards and four were due to start their award. They also told us that staff were also supported to undertake an NVQ level 3 if they had shown an interest in further developing in their role and senior staff were supported to undertake a level 4 Leadership and Management Award (LMA), which was previously the RMA (Registered Manager Award). One senior staff member that was spoken with told us that they had achieved an RMA. The AQAA stated the home has an excellent training record with at least 80 of care staff trained to the a level 2 in care, many staff both at senior level and care level have also achieved a level 3 in care and all of regular senior team have either completed or started level 4 in care. Care Homes for Older People Page 30 of 36 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. People who use this service can expect for the home to be managed in their best interests and to have their health and safety promoted and protected. Evidence: The previous registered manager had left the home and the current managers registered manager application was being processed by CQC (Care Quality Commission) at the time of the inspection. The manager was previously the deputy manager of the home and they had worked at the home for over twenty years, which shows that they had experience in the management of a care home. The manager told us that they had achieved the RMA (Registered Manager Award) and that they had attended several training courses, such as Mental Capacity Act and Deprivation of Liberty Safeguards, which kept their knowledge up to date. The manager and a senior carer that were spoken with told us that the three senior care staff supported the manager in the day to day running of the home. The senior carer told us that they each undertook managerial duties, such as the medication audits. They told us that they had achieved the RMA award, were supported in their role and that they were Care Homes for Older People Page 31 of 36 Evidence: supported in their personal and professional development. The people that lived at the home and staff were complimentary about the approach of the homes manager. The AQAA stated the organisational management structure is strong and very supportive. It consists of manager, deputy and administrator internally with the added support of a clinical manager, financial manager and a training and development officer as well as colleagues from other establishments. This proves to be invaluable to the management team of Beech House as well as the organisation as regular auditing of records are carried out which work in conjunction with the external audit of care practice. The homes quality assurance systems provided people that lived at the home with the opportunity to express their views about the service that they were provided with, which showed that the home was run in their best interests. The monthly Regulation 26 visit reports were viewed and it was noted that the running of the home was monitored and that people that lived at the home were routinely spoken with. Annual satisfaction questionnaires were undertaken and the results from resident, staff and professional questionnaires were displayed in the entrance hall to the home. A summary of the results from the residents satisfaction questionnaires were provided in the Service Users Guide. A person that lived at the home that was spoken with told us that they attended regular residents meetings and that their views were listened to and acted upon. The service user survey asked if the staff listened and acted on what they said, eight answered always, one answered usually and one answered sometimes. The AQAA explained the quality assurance processes such as regular service user meetings. Yearly service user and relative meetings. Quality Assurance Questionnaires. Work on positive praise given. Listen to individuals needs and how best to apply. Give individual time to allow people to discuss issues in private. Observation of practice and feedback. The AQAA said that improvements made in the last twelve months included continue to address issues or problems identified through regulatory 26 inspections and although these may not be a requirement in the future, to therefore adapt this process so it becomes more person centred focus. The health, safety and well being of the people that lived at the home was promoted and protected. The records of peoples spending money was viewed, which included the running total of the finances, their transactions and receipts, for items such as hairdressing and newspapers. Care Homes for Older People Page 32 of 36 Evidence: The homes health and safety records were viewed, which included regular fire safety checks, a fire risk assessment, electrical appliance checks, water temperature checks and services of the lift, hoists and chair lift. Staff that worked at the home were provided with the information that they needed to ensure that people were safeguarded in the homes health and safety polices and procedures and training, such as manual handling, infection control and safeguarding, which was confirmed in the training records that were viewed and discussions with staff that worked at the home. Care Homes for Older People Page 33 of 36 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 34 of 36 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 It is recommended that peoples care plans include the specific details of the support that people should be provided with regarding their diabetes and to include the areas of their condition that staff should be observant of to ensure that they are provided with the support that they need, should they become ill. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 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. Copyright © (2009) Care Quality Commission (CQC). 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. 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