Care Home: Beech House (Binfield)

What the care home does well The staff work hard to ensure that residents` care is planned to ensure that their needs are met, whilst encouraging and enabling residents to maintain their independence where possible. The carers demonstrate a good knowledge of each individual resident`s needs, abilities and preferences in how they wish their care to be delivered. Residents` right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. When asked on the survey forms what the home does well, comments received from residents included: `the care and food are excellent`, `the meals are good`, `look after me` and `they look after me very well and my family is always welcome at any time`. Comments received from relatives on survey forms included: `care and well being of residents` and `create a welcoming, warm and friendly atmosphere for our vulnerable family members. I am happy that my relative is so well cared for and settled`. All interactions observed between the management, staff and residents evidenced that the home has a close and caring staff team. What has improved since the last inspection? The ongoing maintenance, redecoration and refurbishment programme provides residents with a comfortable and homely environment in which to live. In the AQAA the manager described improvements made to the premises over the past year: `A wealth of improvements have been made over the last 12 months. These are numerous, but examples include: complete restructuring of the front of the home, including creating a car park, creating a staff room, creating a food storage area in the kitchen, building a front porch, re-wiring, new bedroom door locks, new furniture, new fire safety system, and new corridor carpets.` Three of the four requirements made at the last inspection have been met in full. Prospective residents can now be confident that they will not be offered a place at the home unless the home has assessed in advance that they will be able to meet their needs and the recent appointment of an activity coordinator is leading to more varied and individualised activities. Recruitment practices have been changed and residents can now be confident that they are supported and protected by the home`s recruitment policy and procedures. The redesigning of the kitchen and staff room layout and the full introduction and ongoing monitoring of safe food practices means that residents can be confident that their health and wellbeing is being protected as far as possible. One social and healthcare professional commented on their survey form: `Beech House has improved immensely lately having new owners and extra managerial staff. The staff work hard and do their best for the residents.` and another commented that the home has: `Improved significantly since new ownership. A good residential home providing care to residents.` What the care home could do better: So that residents can participate in and be part of the local community the registered person must make arrangements to enable residents to engage in local, social and community activities and a requirement has been made. No other requirements were made as a result of this inspection as the manager demonstrated a good understanding of areas that the home needs to improve and has plans in place to address these. Planned improvements over the next year include: reviewing the statement of purpose and service users` guide and developing a welcome pack; re writing care plans with residents using a more person centred model; building on the improvements started on activity provision and carrying out the kitchen refurbishment planed for last year but postponed. Key inspection report Care homes for older people Name: Address: Beech House (Binfield) London Road Binfield Bracknell Berkshire RG42 4AB     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: Denise Debieux     Date: 0 5 1 0 2 0 0 9 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 30 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) 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Beech House (Binfield) London Road Binfield Bracknell Berkshire RG42 4AB 01344451949 01344864709 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Charnley Care Ltd care home 28 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: 28 The registered person may provide the following categories of service only Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Beech House is located in Binfield, Bracknell and is registered to provide care and accommodation to up to twenty-eight older people and people with dementia. Communal areas include a large lounge and separate dining room, individual bedrooms are located over three floors with a lift providing access to the upper floors. The home has a large and well-maintained garden to the rear of the premises with car parking facilities provided to the front. Care Homes for Older People Page 4 of 30 2 2 1 0 2 0 0 8 0 0 Over 65 28 28 Brief description of the care home Bracknell railway station and town centre are approximately 2 miles away and the home is close to local bus routes and the M4 motorway. Fees range from £550 to £650 per week. This information was provided on 5th October 2009. Care Homes for Older People Page 5 of 30 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 Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 5th October 2009 starting at 9.45am. The registered manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CQC/CSCI has received about the service since the last inspection on 22nd October 2008. The people who live at this home prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. On the day of this visit twelve of the twenty four residents were involved in the inspection and information was gained from six on duty staff. Prior to the inspection, survey forms were sent to fifteen residents, ten social and health care professionals Care Homes for Older People Page 6 of 30 and to ten members of staff employed at the home. Survey forms were returned by nine residents, two social and health care professionals and seven members of staff (who returned survey forms on the day of this visit). These survey forms were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation and shared with the manager. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a pro active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for residents living at the home. It also gives us some numerical information about the service. The AQAA was clear, well written and gave us all the information we asked for. Residents care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents, social and health care professionals and staff who provided additional information and participated in the surveys. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: So that residents can participate in and be part of the local community the registered person must make arrangements to enable residents to engage in local, social and community activities and a requirement has been made. No other requirements were made as a result of this inspection as the manager Care Homes for Older People Page 8 of 30 demonstrated a good understanding of areas that the home needs to improve and has plans in place to address these. Planned improvements over the next year include: reviewing the statement of purpose and service users guide and developing a welcome pack; re writing care plans with residents using a more person centred model; building on the improvements started on activity provision and carrying out the kitchen refurbishment planed for last year but postponed. 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 30 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 30 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. Residents can be confident that the 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. This home does not offer intermediate care. Evidence: We were advised that, on the first enquiry from a prospective resident or their representative, the resident or their representative will be invited to visit the home. Following the initial visit to the home, and if the resident wishes to continue, the manager or the deputy manager will visit the resident and carry out a pre admission assessment to ensure that the home can meet the residents needs and wishes. At the last inspection concerns were raised regarding the pre admission assessment procedures at the home and a requirement was made. In their AQAA to demonstrate Care Homes for Older People Page 11 of 30 Evidence: improvements made in the past year and what they do well, the manager stated: We have a comprehensive pre-admission assessment format, and we ensure we undertake an assessment of every residents prospective needs before admission. We also obtain care managers assessments for anyone funded before admission. We believe our assessment tool covers a full range of care areas. Further to the requirement raised in the last inspection report, we have ensured that pre-admission assessments are now only carried out by myself or my experienced deputy. This statement is supported by the findings at this inspection and the previous requirement has been met. Four care plans were sampled during this visit, in each case comprehensive pre admission assessments had been carried out, by either the manager or the deputy manager, to ensure that the home could meet the residents identified needs. Six of the nine residents who returned survey forms felt they had received enough information to help them decide if the home was the right place for them before they moved in, two people answered no and one resident left this answer blank. Of the seven members of staff who returned survey forms, six said that they were always given up to date information about the needs of the residents and one answered sometimes. In the AQAA the manager set out their plans for improvement over the next twelve months: Statement of purpose/service user guide, a degree of further amending and clarifying of some information is required, which will be carried out this year. Welcome pack, we plan to create this over forthcoming months, to give more specific detail about daily life in the home. Care Homes for Older People Page 12 of 30 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. Residents health and personal 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. Residents right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Evidence: The home has a small and close care team and the staff demonstrate a good knowledge of each individual residents needs, abilities and preferences in how they wish their care to be delivered, resulting in three residents stating on their survey forms that they always receive the care and support they need, five answered usually and one person left this answer blank. One resident commented: they look after me very well and my family is always welcome at any time. In the AQAA, to demonstrate what the home does well, the manager stated that: Staff use care plan files daily and keyworkers have a good appreciation of the care Care Homes for Older People Page 13 of 30 Evidence: plans in place for their residents. We are supported by a good range of local services to meet residents health needs, including two GP surgeries, district nursing, chiropody 6 weekly, hearing aid clinic, optician, and dentistry as needed. This statement is supported by the findings on the day of our inspection. The four care plans sampled during this visit were all based on pre admission assessments, had been drawn up shortly after each residents admission to the home and included appropriate risk assessments. These care plans set out the actions which need to be taken by care staff to meet the health, personal and social care needs of the residents. Care plans are reviewed on a monthly basis and daily notes are kept that reflect the care given. These daily notes demonstrated that any changes or new concerns are promptly acted upon. In the AQAA, to demonstrate what the home does well, the manager stated that: staff administering medication have been trained in this area. We believe our records relating to medication are maintained well. Residents who wish to self-medicate would have an assessment carried out of their abilities and capacity, and we would promote self-medicating where appropriate, including providing lockable storage. This statement is supported by the findings on the day of this inspection. The lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in order. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. On the day of this visit staff were observed to always knock before entering the residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. When asked if residents social and healthcare needs are properly monitored, reviewed and met by the home and if the staff respect residents privacy and dignity, the two social and health care both answered usually. All residents spoken with said they felt their privacy and dignity was always respected and residents who returned survey forms said that they always/usually receive the care and support they need. In the AQAA the manager set out their plans for improvement over the next twelve months: We are starting to give attention to re-writing care plans now our new deputy is in post, and this will continue over the next year. We are implementing a new tool to sit alongside current care plans, which is a person-centred model for Care Homes for Older People Page 14 of 30 Evidence: ascertaining important things in residents lives, activities, ways of communicating etc. These will be completed with/by residents. Care Homes for Older People Page 15 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident is treated as an individual and the care home is responsive to his or her social needs. The home supports residents to follow personal interests and activities within the home but activity provision needs to be further developed so that residents can participate in, and be part of, the local community. Residents are able to keep in touch with family, friends and representatives and are supported to be as independent as they can be and have the opportunity to make the most of their abilities. Meals are well balanced and varied with individual choices and preferences catered for. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by residents spoken with. The activity log/programme was sampled at this visit. There is a two week schedule of activities, with the schedule for that week being advertised on the notice board in the lounge. At the last inspection social activities were identified as an area needing improvement and a requirement was made. In August of this year an activity coordinator was recruited and took up post. She works an average of twenty hours a Care Homes for Older People Page 16 of 30 Evidence: week on activities. In their AQAA the manager stated: the new activities co-ordinator is currently re-assessing needs of residents around social care. We then need to implement activities based on needs and wishes, both group and one-to-one, and give consideration to activities for those with dementia. Whilst we have not fully met the requirement raised last year, this is not through want of trying - we have attempted to recruit to the activities co-ordinator post on several occasions. We believe we are now making significant progress in this area. This statement is supported by the evidence seen on the day of this inspection, all residents had individual activity care plans in place and it was seen in the daily notes that one on one activity time had been provided for one resident who did not wish to participate in group activities. At the last inspection we were advised that funds have just been agreed for the home to purchase its own transport for outings, this has still not been actioned and it is disappointing that the residents are still not able to take advantage of local facilities or be part of the local community unless they have friends or family that can take them. The previous requirement has been partly met in that the activity provision within the home has improved and plans are in place to build on that improvement. The home still need to put arrangements in place that will enable residents to engage in local social and community activities and a new requirement has been made. Residents are able to choose which activities they attend or participate in and their individual rooms were all seen to contain many personal possessions which were arranged to suit their individual wishes. Four of the nine residents surveyed stated that there were always activities they could participate in, three answered usually, one answered sometimes and one answered dont know. One relative added a comment: A new activity leader has been employed. I feel sure she will work hard to encourage as many people as possible to take part in routines. The future looks very promising for everyone. There are no restrictions to visiting times and staff support and encourage residents to maintain family links and friendships inside and outside the home. Menus sampled showed that the home offers a varied and well balanced menu, with residents able to choose alternatives if they do not want the dish that is on the menu on the day. The lunchtime meal was taking place during this visit with the main course being rabbit stew. Two of the residents explained that this had been their request and that they had mentioned it to the chef the previous week as something they would like. Many of the residents had chosen this option and after the meal everyone said how much they had enjoyed it. The atmosphere in the dining room during lunch was pleasant and relaxed and there were ample staff available to provide help and assistance where needed. Of the nine residents surveyed, three said that they always Care Homes for Older People Page 17 of 30 Evidence: liked the meals at the home, four answered usually one answered sometimes and one left this answer blank. In the AQAA, to demonstrate improvements in the last twelve months, the manager stated that: we have appointed a new head cook following our inspection of last year, with another supporting cook working under her, and have also rewritten menus over the last year. We believe the standard of diligence in meal preparation and choice has significantly improved recently. For example, we have given a great emphasis on preferences. The standard of meals has definitely improved. This statement is supported by the evidence seen and comments made to us by residents on the day of this inspection. In the AQAA the manager set out their plans for improvement over the next twelve months: We will be moving forward significantly with activities and activity provision over the next few months given that our activities co-ordinator is now in post. Due to other priorities, larger refurbishment of the kitchen has not yet started. This is planned for the forthcoming year. We intend to evidence meal choices and alternatives offered more cohesively over the next few months. Care Homes for Older People Page 18 of 30 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. If residents 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 residents from abuse and neglect and takes action to follow up any allegations. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives and is also included in the residents guide. Residents spoken with said that they knew who to talk to if they were not happy, with one resident adding that: the staff are very helpful. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. The contact number for the local safeguarding team was clearly displayed on the notice board in the office. Training in safeguarding adults is included in the homes staff induction and all staff receive regular updates on any changes to the local safeguarding procedures. All staff surveyed stated that they knew what to do if anyone raised concerns about the home. In the AQAA, to demonstrate what the home does well, the manager stated that: Our complaints procedure is displayed in the hallway of the home, and we have a copy of the local authority complaints procedure. The procedure is also in the statement of purpose/service user guide. Residents are confident in raising any issues with Care Homes for Older People Page 19 of 30 Evidence: keyworkers or families, which we pride ourselves in responding to promptly and resolving informally. However, we have systems for managing any formal complaints and responding within 28 days, including recording all details of complaint management on a complaints log. We believe we manage complaints and less formal concerns well. We attend safeguarding adults forums every four months. No referrals to social services have been necessary since the last inspection. We believe staff have a good understanding of what constitutes abuse. We also believe staff practice promotes safety, wellbeing and minimises the risk of harm. This statement was supported by the evidence seen on the day of this inspection. All residents spoken with said that they felt safe at the home with one resident adding very and another commenting I feel very safe here. In the AQAA the manager set out their plans for improvement over the next twelve months: We will be amending the complaints procedure in the statement of purpose/service user guide, to ensure the guide contains the same procedure as that displayed in the home. Mental Capacity Act and Deprivation of Liberty Safeguards, whilst I have attended training, we want more staff to attend training in this area and will be arranging this in the near future. Care Homes for Older People Page 20 of 30 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. The location and layout of the home and gardens are suitable for their stated purpose. An ongoing maintenance and redecoration programme provides the residents with clean, pleasant and homely surroundings in which to live. Evidence: Residents spoken with expressed their satisfaction with the accommodation provided at the home. Five of the nine residents surveyed said that the home was always fresh and clean and four answered usually. In the AQAA, to demonstrate what the home does well, the manager stated that: A wealth of improvements have been made over the last 12 months. These are numerous, but examples include; complete restructuring of the front of the home, including creating a car park, creating a staff room, creating a food storage area in the kitchen, building a front porch, re-wiring, new bedroom door locks, new furniture, new fire safety system, and new corridor carpets. This statement was supported by the evidence seen on the day of this inspection when we were shown around all areas of the home and grounds. The furniture and furnishings were seen to be of a good quality and personal bedrooms were all seen to be personalised to the individual residents wishes. One of the social and health care professionals commented on their survey form: New refurbishments and a much larger car park have added to the standard of Beech House. Comments received from staff on survey forms included: Care Homes for Older People Page 21 of 30 Evidence: Vast improvements have been made to the appearance of the home inside and out, the home has had a complete makeover, the look of the house is much better and more inviting and the improved car park at the front of the house has greatly improved the overall appearance of the home. Laundry facilities are sited on the ground floor with washing machines suitable for the needs of the residents at the home. In the AQAA, to demonstrate what the home does well, the manager stated that: We keep the home very clean and tidy through the work of our housekeeping staff, and all staff have a good understanding of working in ways which minimise the risk of contamination. For example, staff use personal protective equipment well, and we have antibacterial hand-wash around the building. Our laundry works well and has appropriate equipment, and staff manage laundry appropriately. We recently achieved accreditation from Berkshire East Community Health Services under the cleaner safer care homes award. This involved being inspected by them and achieving a score of 93 . In the AQAA the manager set out their plans for improvement over the next twelve months: It remains planned to give focus to kitchen refurbishment over the next few months. Care Homes for Older People Page 22 of 30 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. Residents have safe and appropriate support as there are enough competent staff on duty at all times. They can 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. Evidence: The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the residents at the home. The morning (8am to 1pm) shift is covered by five carers plus either the manager or her deputy, three cover the afternoon/evening shift (1pm to 8pm) with a fourth carer working 6pm to 8pm to provide additional support at this busy time. The night staff consists of two waking carers with a manager on call if needed. Of the nine residents surveyed, two said that staff are always available when needed, six answered usually and one answered sometimes. One relative commented that: I am very happy that my relative is so well cared for and settled. At the last inspection concerns were raised relating to staff recruitment practices and a requirement was made. During this visit the files of three recently recruited members of staff were sampled. All files were seen to contain the required checks and Care Homes for Older People Page 23 of 30 Evidence: information e.g. proof of identity, two references, a completed application form and Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list checks had been obtained. The previous requirement has been met. Staff induction is in line with the mandatory Skills for Care common induction standards and we were advised that staff are supervised until they have completed their induction. Staff are booked on additional training and updates as the courses become available. Confirmation of upcoming training was seen in the office for mandatory health and safety training updates, as well as additional training for staff in subjects specific to the needs of the residents at the home e.g. dementia and managing challenging behaviour. Confirmation was also seen that the new activity coordinator has been booked on two training courses this month, related specifically to her new role, one is an activity study day provided by the Berkshire Care Association and the other is entitled Chair based movement and fitness improvement training. We were advised that the new chef has attended a course on nutrition and is planning to start a related NVQ training course soon. In the AQAA, to demonstrate what the home does well, the manager stated that: Out of a care staff team of fourteen, nine are qualified to NVQ 2 or above. Three staff are currently doing NVQ 3. Recruiting procedures are robust and we use the Skills for Care induction standards. We do not need to use agency staff. Rotas are laid out well in advance and staff cover each other if time off is needed. This statement is supported by the findings on the day of this inspection. Of the nine residents surveyed, two said that the staff always listened and acted on what they said and six answered usually, one person left this answer blank. Additional comments made by residents included: The care and food are excellent and they look after me very well. Of the seven staff members who returned survey forms, six said they were provided with training that keeps them up to date with new ways of working and that is relevant to their role, one person left this answer blank. When asked what has improved at the home in the last twelve months, one member of staff commented: we have more staff training and another that understanding of residents with dementia has improved - more training provided. Care Homes for Older People Page 24 of 30 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. Residents can have confidence in the care home because it is led and managed appropriately. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents. Policies and procedures are in place to protect residents financial interests. Residents control their own money and choose how they spend it. If they cannot manage their money a relative or representative manages it for them. The environment is safe for residents and staff because appropriate health and safety practices are carried out. Evidence: The manager is a registered nurse, holds her Registered Managers Award and also holds a certificate of dementia awareness. She has been the manager at Beech House for the past twelve years and has over twenty years experience working in care. Her management style is inclusive and the residents benefit from the ethos, leadership and clear management approach of the home. Care Homes for Older People Page 25 of 30 Evidence: All staff who returned survey forms said that their manager gives them enough support and meets with them to discuss how they are working and that they feel they have enough support, experience and knowledge to meet the different needs of the residents living at the home. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents and their relatives. We were advised that the home carry out yearly resident and relative surveys, correlate the responses and then take action to address any issues that are raised. The report from the survey carried out in April this year was sampled and it was seen that areas that residents indicated a need for improvement (e.g. activities) have been included in the homes plans for improvement over the next year. In the AQAA, to demonstrate changes made as a result of listening to the residents, the manager stated: Menus - we have worked this year to be more pro-active in ascertaining residents preferences. After discussion with residents, we now have a much more comprehensive list of likes and dislikes. Our new cook is now much more involved with residents, asking their thoughts on a daily basis, and seeing if they require alternatives to the main menu. Activities - our surveys received from residents showed this is an area we can continue to develop. We have been mindful also of the requirement raised last year in the CSCI report. Consequently, we have tried on several occasions over the last year to recruit an activities co-ordinator, but without success until recently. We have now recruited to this post, and activities therefore are being taken forward in line with residents requests and the requirement raised. Individual residents requests - whenever we are asked to provide something different, we strive to provide this. Recent examples based on residents requests would be: a bird table in the garden, music in the hairdressing room, and providing tomato plants for a resident, reflecting her interests. Policies and procedures are in place to protect residents financial interests. The manager stated that the home does not handle the financial affairs for residents, any expenses incurred, e.g. hairdressing, are paid by the home and then billed on a monthly basis to the resident or their representative. At the last inspection concerns were raised relating to the safe handling, storage and preparation of food and hygiene standards in the kitchen and a requirement was made and it was also recommended that the provider consult with the local environmental health officer. Following the inspection, the provider consulted with environmental health and took action to rectify the concerns. In January this year we were advised: Care Homes for Older People Page 26 of 30 Evidence: Safer Food, Better Business forms the basis for kitchen procedures and is now strictly adhered to. Records are up to date and comprehensive. The kitchen has been deep cleaned and the standard of cleanliness will be upheld. An environmental health inspection was carried out. All recommendations were complied with. A new store room and staff room have been built. There is now no thoroughfare through the kitchen, which was a major problem. The findings on the day of this inspection supported this information. The kitchen was found to be clean and hygienic and it was seen, from Safer Food, Better Business records sampled, that all required food safety checks are routinely carried out and recorded. All staff have received required safe working practice training and updates. Staff were observed to be following appropriate health and safety practices as they went about their work. All interactions observed between the staff and residents were inclusive, caring and respectful. In the AQAA the manager set out their plans for improvement over the next twelve months: To streamline the general management of the home now we have a complete management structure which will improve the overall running of the home. Care Homes for Older People Page 27 of 30 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 28 of 30 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 1 12 16 The registered person must make arrangements to enable residents to engage in local, social and community activities. So that residents can be confident that they will be supported to maintain and develop local community involvement. 05/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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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