Care Home: Beech House

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What the care home does well This service works well with the people living in the home and their relatives. There is an emphasis on listening to the views of the people using the service and involving them in the development of the service. We found that people`s needs were assessed before being offered a place in the home, and that they were given sufficient information to help them in making an informed decision about their future care arrangements. Good professional relationships are maintained with healthcare professionals and the people living in the home can access medical support in the community. The provision of food is good, meals are served in a pleasant and relaxed environment, and staff are on hand to provide discrete and sensitive support when needed. Individual menus are available on each table setting to inform people of the choices available. A variety of activities are available each day and there is an activities co-ordinator who works with the staff team to provide activities which suit individual lifestyle preferences. We received many positive comments about the general management of the home and of the staff team. Comments included: "The staff are very good, they do anything to help you right away. Visitors can come anytime and I have my own room, it`s very nice". "The meals are very nice, if you don`t like something they will get you something else". The meals here are A1". "The staff do a fantastic job". "The staff treat residents lovely and respond quickly to their requests". "When we looked at this home it just felt right. I liked the way the staff interact with the residents, and I like the way staff help people to be as independent as possible". Staff who were spoken to were very motivated and keen to develop their knowledge and skills through training. One member of staff said, "We are very focused on consulting with people about what they want to do and their individual preferences". What has improved since the last inspection? All the requirements and recommendations from the last inspection visit had been addressed. There has been an improvement in the day to day management of the home, and this stable management has had a positive impact on care practice. Systems are in place to monitor care practice and the staff supervision programme has been developed so that training needs are identified and appropriate support is provided to staff when needed. A manager has been appointed and it is anticipated that she will take up post in February. We have been told that the new manager will be applying to the Commission to be the registered manager of the service. Some improvements had been made to the decor. What the care home could do better: Decorating and refurbishment needs to be ongoing in order to improve the environment for the people living in the home. The acting manager told us this was part of the business plan for the year. A recommendation had been made to look at layouts in the large lounge to provide a more `homely` environment. Key inspection report Care homes for older people Name: Address: Beech House Radcliffe Park Crescent Salford Gtr Manchester M6 7WQ     The quality rating for this care home is:   two star good 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: Ann Connolly     Date: 2 9 0 1 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 27 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 27 Information about the care home Name of care home: Address: Beech House Radcliffe Park Crescent Salford Gtr Manchester M6 7WQ 01617458373 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): beechhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross BC OpCo Ltd Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 33 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 32 Physical Disability - Code PD, maximum number of places 1 Date of last inspection 0 1 Over 65 32 0 Care Homes for Older People Page 4 of 27 Brief description of the care home Beech House is a purpose built home offering residential care to a maximum of 33 older people. The home is situated in a residential area of Salford and has a pleasant garden area. Car parking is available at the front of the building. The cost of the service in January 2010 was between three hundred and eighty pounds ninety nine pence and four hundred and eighty four pounds per week. Care Homes for Older People 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 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 quality rating for this care home is a two star good service. This was a key inspection that included a visit to the home. The manager was not told beforehand that we were coming to inspect, this is called an unannounced inspection. The inspection looked at all the key standards and included a review of all available information received by the Commission about the home. During the visit, a selection of records, care plans, policies and procedures were looked at. Discussion took place with the acting manager, staff working in the home and relatives who were visiting. We also spoke to some visiting healthcare professionals. We spoke with people living in the home to find out what they felt about the service and how staff supported them. A tour of the building took place and people in the home were asked for their comments and views about the environment. Before the inspection we asked the acting manager to complete a form call the Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well and what they needed to do better. The information provided on Care Homes for Older People Page 6 of 27 this occasion was detailed and comprehensive and gave us the information we asked for. The service has good systems in place for monitoring complaints. The information in the AQAA informed us that they had received one complaint in the last 12 months and that this had been addressed in the 28 day timescale. The Commission has not received any recent complaints about this service. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? All the requirements and recommendations from the last inspection visit had been addressed. There has been an improvement in the day to day management of the home, and this stable management has had a positive impact on care practice. Systems are in place to Care Homes for Older People Page 8 of 27 monitor care practice and the staff supervision programme has been developed so that training needs are identified and appropriate support is provided to staff when needed. A manager has been appointed and it is anticipated that she will take up post in February. We have been told that the new manager will be applying to the Commission to be the registered manager of the service. Some improvements had been made to the decor. 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 9 of 27 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 10 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 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. There is a good system in place to introduce people to the home, with information provided and needs assessments done, so that they know that their needs can be met at the home. Evidence: There is a wide range of information about the home which helps people to make an informed choice about their future care and support arrangements. A service user guide, statement of purpose and other useful information is located in the entrance hall to the home. Other information included the monthly newsletter, information on recent quality assurance audits, menus and information about dignity in care which the home are actively involved in. A pictorial display on the findings of the recent quality audit was in a prominent place in the reception area. Relatives and people living in the home can see at a glance the feedback about what people thought about the quality of the home. Care Homes for Older People Page 11 of 27 Evidence: The manager told us that a senior member of staff usually visited people in their own home or hospital to carry out a pre- admission assessment. We looked at the files of three people, including the file of a person recently admitted into the home. Each file contained a detailed assessment of social and healthcare needs, including appropriate risk assessments and nutritional screening. The information in the assessment was then used to develop a detailed care plan. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Promotion of health is taken seriously, the welfare of people living in the home is monitored and health needs are met. Evidence: We looked at three care plans including the file of a person recently admitted into the home. The care plans were detailed and comprehensive and provided staff with the necessary information to help them in supporting people appropriately. The care plans were person centered and included the views of the individual about how they wanted to be supported. The information also included a useful background history and details about individual lifestyle preferences. One of the care plans we looked at provided very detailed guidance on how to support a person with complex communication needs. During this visit, staff were observed interacting with this person. It was evident that they following the guidance in the care plan, they used good communication techniques and the experience for this person was very positive. Care Homes for Older People Page 13 of 27 Evidence: Information and recordings in the care plan files provided evidence of ongoing healthcare support from general practitioners and a range of healthcare services. People we spoke to told us that they were able to see their G.P. whenever they needed to. One relative told us that staff were always available to support people to attend hospital out patient appointments. District nurses were seen visiting throughout the day. Feedback from them was positive and they stated that staff were always helpful and followed guidance and instruction appropriately. One visiting healthcare professional told us that the staff always seemed to have a good knowledge and understanding of individual care needs and that referrals to the G.P. practice were always appropriate. Policies and procedures were in place for the receipt, storage and safe handling of medication in the home. The medication records were looked at and included sample signatures of the staff who were responsible for administration of medication. Medication Administration Records (MAR) were appropriately maintained and medication was locked and stored in a secure place. Observations of staff in the process of administering medication showed us that they adhered to policies and procedures to ensure that people living in the home received their medication safely. There was evidence to demonstrate that medication and the procedures for administering medication were regularly reviewed and including regular audits of medication practices in the home. During the visit we saw very positive and meaningful interactions between the staff and people living in the home. There was a relaxed approach and people were supported in a positive and respectful manner. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are both well managed and provide daily variation for people living in the home. Evidence: A part time activities organiser is employed by the home. She works 20 hrs per week. Activities are also carried out by care staff on a day to day basis. One relative told us that she was impressed by the way staff slipped activities into the day to day routines, for example, supporting individuals to take a brief walk around the building throughout the day. During this visit the activities co-ordinator was supported by staff to provide a games afternoon followed by a reminiscence session. Records were maintained to demonstrate what activities had taken place during the day, and the activities on offer were displayed and advertised throughout the building. During discussion with the activities organiser, she told us that there was an emphasis on listening to people and seeking their views about how they wanted to spend their social and leisure time. There was evidence of a creative approach to providing Care Homes for Older People Page 15 of 27 Evidence: activities and good use of local community resources such as loan equipment from the local library. It was evident that good links had been established with local community groups who visited the home. Recent activities included a pub lunch and a recent visit from a musical entertainer. Residents and family meetings are arranged regularly and people are encouraged to contribute ideas and suggestions about leisure activities, meals and a range of other services in the home. The manager said that the focus was to involve people in the development of the service at Beech House. The home actively promotes and encourages visits from family and friends. There were numerous visits from relatives throughout the day. When we spoke to them, they told us that the staff team always made them feel welcome. Minutes from residents meeting showed that their views had been listenend to in the development of menu planning. We sampled the meal during the visit, and the mealtime occasion was a relaxed social event. Tables were well presented with table decorations and pleasant music was played in the background at an appropriate sound level. Improvements had been made to the timing of meals which were served in a timely manner with no long waiting period. There meals was served in a relaxed an unhurried way with plenty of time to support people in a discrete and sensitive manner. During the meal, we observed excellent communication and interaction between staff and people living there. It was evident from these observations that the staff had a good knowledge about each individual person. There was an individual menu on each table displaying the meals for the whole day. The meal served today offered a choice of fish, potato and vegetables or bacon. The meal was tasty and well presented. People we spoke to confirmed that there was alway a choice of meals available. All people we spoke to were complimentry about the quality of the meals served in the home. Comments included: The meals are very nice, they ( the staff ) are not offended if you dont like something, they just get you something else. The meals are not bad, If I dont like something then I can always have something different. The meals are A1. Care Homes for Older People Page 16 of 27 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. There are good procedures so that people who live in the home are able to express their concerns and be listened to, their rights are protected and they are safeguarded from abuse. Evidence: Policies and procedures were in place to promote good practice in managing complaints and safeguarding referrals. In addition to this, residents meetings provided an additional forum for expressing views and opinions about the service. Minutes from meetings were seen and provided evidence of a service that actively promotes an open exchange of ideas. We spoke to a number of people living in the home and their relatives and all of them expressed confidence in raising issues of concern of making a complaint. They told us that they knew that their concern would be listenend to and responded to in an appropriate manner. People we spoke to told us: I have never had to make a complaint, but if I did, I know the staff would listen to me. If I have had any concerns, I only have to mention it and it is sorted out straight away. Care Homes for Older People Page 17 of 27 Evidence: A record is maintained of all comments and complaints made and the action take to resolve the problems. The information in the AQAA stated that the service had received one complaint and that this had been resolved within the 28 day time period. Nine safeguarding referrals had been made using local safeguarding procedures. The Commission has not received any recent complaints about this service. Training records and information in the AQAA provided confirmation that staff had received updates in safeguarding adults. There was evidence to show that training in safeguarding, Deprivation of Liberty and the Mental Capacity Act was ongoing. When we spoke to staff, they were able to demonstrate a good knowledge and understanding of safeguarding adults and issues surrounding abuse. Care Homes for Older People 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, 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. A clean and comfortable environment is provided for people living in the home. Evidence: During this visit a tour of the building took place. This included communal areas and a selection of bedrooms. The building presented as being maintained to a reasonable standard, although there were some areas of the home that were tired and worn, and would benefit from re-decoration and replacement of some soft furnishing. Information in the AQAA identified that there were some areas of improvement required in the ongoing re-decoration of bedrooms and in the upgrading of bathroom facilities. These were included in the plans for improvement over the next 12 months. The garden areas provided pleasant outdoor facilities for people to enjoy in the warmer weather. The information in the AQAA stated that outdoor areas were scheduled for further improvement. The whole building presented as being clean and tidy with no unpleasant odours. People living in the home told us that they liked the facilities and enjoyed their private bedroom space. The main lounge was a large open space but the layout looked institutional, with large Care Homes for Older People Page 19 of 27 Evidence: group living areas. It was recommended that some thought should be given to considering an alternative layout with small group living areas in an attempt to achieve a more homely feel. This should be done in consultation with the people living in the home to seek their views and preferences. Care Homes for Older People 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 staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported by a trained staff team who have gone through a thorough recruitment process, so that peoples need are met and they are safe from poor practice or possible harm. Evidence: During this visit there were sufficient staff on duty to meet the needs of the people living in the home. On duty during this visit were 3 care staff, 1 deputy member of staff, the manager, 1 activities organiser, 1 domestic and 2 laundry staff. Staff were seen spending time with people, just chatting, meeting specific needs as set down in the care plan, and supporting the activities organiser with various activities. There were sufficient staff during the mealtime which enabled them to provide one to one support when necessary. In addition to the care staff, a full time cook and her assistant took responsibility for providing and serving a cooked meal, and domestic and laundry staff had their own specific job roles for ensuring that the home was clean and that the laundry was managed efficiently. We looked at the training records and these showed that the manager had prioritised staff training. There was evidence of that staff had received updated training in food hygiene, health and safety and safeguarding, and that further training was scheduled Care Homes for Older People Page 21 of 27 Evidence: for infection control. When we spoke to staff on duty they told us that training for staff had significantly improved and that the manager had prioritised training programmes. We looked at three staff files and these contained appropriate paperwork, including two written references, employment history, records of training and a Criminal Record Bureau disclosure (CRB). These staff records provided evidence that staff were fully vetted prior to commencing employment. We spoke to a number of people living in the home, some healthcare professionals and some relatives who were visiting. All of them were very positive about the standard of care provided by staff. Comments included: Staff are always helpful and make appropriate referrals to the clinic. Staff seem to know the residents well. The staff are always helpful, they follow instructions well, we have no problems with this home. The staff are lovely, they do anything for you with a smile. The staff here are excellent. I like the way staff interact with the residents, they encourage people to be independent when they are able to be so. Care Homes for Older People Page 22 of 27 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. Beech House is being run in the best interests of the people who live there and their welfare is promoted and protected. Evidence: At the time of this visit the home was being managed by the project manager for the company. She has the relevant skills and qualifications for this post. She is supported by the operations manager and we were told that she visited the home on a regular basis. A new manager has been appointed to the post and was due to take up position on the 1st February 2010. The acting manager told us that there would be a transitional period whilst the new manager was supported through her induction. We were told that the new manager would be making an application to the Commission to be the registered manager of the home. The current acting manager had worked hard to establish good systems to monitor quality of care practice in the home. There was evidence of a strong focus on staff supervision, consultation with people in the home and relatives, and on monitoring Care Homes for Older People Page 23 of 27 Evidence: systems. There were systems in place to monitor medication practice, quality of care plans and day to day care practice through regular staff supervisions. Staff and the people living in the home were positive about the managers open and approachable attitude. The manager told us that safe working practices were maintained and this was reported in the AQAA. Staff told us they were provided with the appropriate equipment and protective clothing to help them to carry out their job safely. Care Homes for Older People 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 Older People 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 1 19 Consideration should be given to improving the layout of the large lounge area to provide a homely environment. People in the home should be consulted regarding their preference to layout. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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