Care Home: Beech Lodge Residential Care Home

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What the care home does well Lots of people told us what a friendly home it was and how helpful they found the staff. In their survey, one visiting professional wrote `staff are always friendly and treat the residents with dignity and respect`. One person living in the home told us `I can`t fault the care and I can`t fault the staff, everyone is friends here`. People told us the care was good, and visiting professionals were happy with the way the home was run. One wrote that the home `has very caring sensible staff. Our patients are content here and do well in this home. We get appropriate requests for visits`. What has improved since the last inspection? A member of staff had been nominated to co-ordinate activities, thus improving the amount of social care that people received. The menus had been improved so that meals provided people with more variety and were better suited to their needs. Areas within the environment had been improved. A bathroom had been refurbished and many windows had been replaced, making it a nicer environment for people to live in. What the care home could do better: More attention to detail was needed in care planning to ensure a contemporaneous record of the care given was made. Also to ensure care plans were updated. Windows and the external walkways needed risk assessment and remedial action to make them safer for people. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beech Lodge Residential Care Home 418 Burton Road Derby Derbyshire DE23 6AJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Macukiewicz     Date: 0 8 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Beech Lodge Residential Care Home 418 Burton Road Derby Derbyshire DE23 6AJ 01332348118 Telephone number: Fax number: Email address: Provider web address: jackie@goldenkeyhomes.co.uk Name of registered provider(s): Type of registration: Number of places registered: Golden Key Homes Limited care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Beech Lodge is a 15 bedded home that provides personal care for people aged 65 years and over. The home is located in a residential area, on a main route into Derby City Centre. Service users accommodation is located over two floors, with access to the first floor via stairs or a stair lift. The home has 11 single occupancy rooms and two shared rooms. Bathing and toilet facilities are located on each floor. Beech Lodge has separate lounge and dining areas located on the ground floor. Service users may smoke in the enclosed porch area at the front of the building. There is a copy of the Inspection report in the foyer. The Registered manager confirmed that the weekly fees for the home ranged between 373.00 GBP and 432.00 GBP. 0 Over 65 15 Care Homes for Older People Page 4 of 24 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: We last Inspected this service on 11 September 2007. The inspection was unannounced and involved a visit to the site on at 9.40am. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people using the service and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Where possible, we include evidence from other sources, notably General Practitioners and Social Workers. We also use information gathered throughout the year, to support our judgments such as notifications from the provider, complaints or concerns. We also Care Homes for Older People Page 5 of 24 use information from an Annual Quality Assurance Assessment (AQAA), referred to throughout this report as the pre-inspection self-assessment, which the provider is required to complete prior to a visit to the service. This provides evidence for us to make informed judgments when assessing the National Minimum Standards (NMS). The primary method of inspection used during the visit to this service was case tracking. This involved selecting three people and tracking the care they receive through review of their records, discussion with them where possible, the care staff and observation of care practices. Time was spent in discussion with the Manager and staff. Relevant records belonging to the home were also examined such as complaints and policy documents. A brief tour of the home took place including some bedrooms. All of the key standards were inspected on this occasion. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 24 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 8 of 24 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 have enough information to be able to choose a home that will meet their needs. Evidence: The manager had updated the information about the home contained within the statement of purpose and service users guide. This ensured that people had accurate information about the services that the home offered. In their completed pre-inspection surveys people told us that they had enough information to help them decide if the home was the right place for them. Those who could remember also confirmed they had been given a contract, stating terms and conditions of their stay. People told us that they were happy with their choice of home. One persons preinspection survey said it is always very friendly, and looks after our interests very Care Homes for Older People Page 9 of 24 Evidence: well. One relative in their completed survey wrote it is always very friendly, and tries to make as much as possible like your own home. They went on to write I think Beech Lodge is a very good place and tries its best to make residents as comfortable as possible. On the day of this visit one person told us that the home is lovely and the staff are very nice and you cant fault them. Everyone is friends here. Another person, and their visitor said it is a very caring home and a very friendly place. We found that all new admissions had been made following an assessment by a suitably qualified person, although the pre-admission forms did not follow a set proforma. This meant there were inconsistencies in the standard of recording although this did not affect outcomes for people using the service. Upon their admission to the home people had a more comprehensive assessment of their needs undertaken, this covered all areas of potential or actual risks and flowed well from the information gathered at the pre-admission stage. One care file had omitted to record the marital status of the person or whether they had any allergies, although staff could demonstrate a sound knowledge of the individual concerned when asked. Care Homes for Older People Page 10 of 24 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. People have their needs met in a private and dignified way. Evidence: In their completed pre-inspection surveys people told us that they receive the care and support they need, including medical care. In their survey, one visiting professional wrote staff are always friendly and treat the residents with dignity and respect. Another wrote I visit as a GP lots of homes. This one has very caring sensible staff. Our patients are content here and do well in this home. We get appropriate requests for visits. We looked at the care files for four people, all had a plan of care in place that followed on logically from their assessment of need. These provided clear instructions for staff. They also supported that people were receiving services from G.Ps, District Nurses and other health professionals in the community. Wherever possible, people had been asked to sign to agree their care plans and subsequent reviews. At each review, people had been given the opportunity to make a Care Homes for Older People Page 11 of 24 Evidence: comment about their care. One person had recorded the comment I am happy at Beech Lodge. We found that some care needs that had arisen following the development of the original care plan, had only been recorded on the progress notes. Not all new problems arising had been incorporated within the main plan of care; this left the potential for needs to be overlooked, although the progress sheets did indicate that the care required had been given. Peoples medications were well managed. All medication charts were appropriately signed, supporting that people received the medications they needed. The home did not have a separate storage area for medications that needed to be kept in the Fridge. This meant that such medications could not be stored correctly, although there were none in use at the time of this visit. People told us that staff treated them with dignity and respect, and that they were afforded privacy within the home. One person told us that staff always knocked to request permission before entering their bedroom. Relatives and friends of people living in the home told us they were very satisfied with the care given and that people were always helped to look clean and smart. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to lead a fulfilling lifestyle of their choosing. Evidence: In their completed pre-inspection surveys people told us that there were activities arranged that they could take part in. Staff were engaging people during the day in various activities and people were sitting or wandering in the garden area. People told us they had been growing fruit over the Summer and had been on various trips out. Visitors told us they were also able to join in trips out. In the managers pre-inspection self-assessment she acknowledged they needed to provide more social events outside of the home but had nominated a member of staff to co-ordinate activities. Care plans contained a life story sheet to enable staff to have a better understanding of peoples individual needs, and care plans also recorded what activities people had undertaken. Menus had been revised to allow people more choice and hot and cold options each day. In their completed pre-inspection surveys people told us that they enjoyed the food and described it as good. One relative wrote in their survey meals quite good, and served in an excellent way. Care Homes for Older People Page 13 of 24 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 have their rights upheld and are kept safe. Evidence: In their completed pre-inspection surveys people told us that they knew how to complain and that there was someone they could talk to about informal concerns. Complaints records at the home showed that they had received one official and one informal concern since we last visited. Concerns had been responded to appropriately. People on the day told us they knew who to see if they had any complaints, one visitor said the owner had also told him he could be contacted anytime should there be any concerns. Staff had the right training to enable them to keep people safe, and had access to the relevant procedures. There had been no safeguarding incidents at the home. Care Homes for Older People Page 14 of 24 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 live in a home that meets their needs. Evidence: There had been improvements made to the environment since we last visited. Many of the windows had been replaced or refurbished; a bathroom had been refurbished and some new carpets fitted. In their completed pre-inspection surveys people told us that the home was kept clean and that they were happy with their surroundings. One wrote my room is comfortable. One staff survey stated keeps well maintained, decorated and clean. People could lock their bedroom doors and had lockable space within their bedrooms to keep their personal possessions safe. Due to the fact the home is a former private residence and not purpose built, the environment does pose certain restrictions on people living in the home. There is no dedicated hairdressing room and certain facilities cannot be accessed by people who are immobile as there is a short walk between stair lifts to access the first floor. The manager confirmed that she made people aware of such restrictions before they moved into the home. One bedroom contained a urine odour, although feedback on the day and through pre-inspection surveys supported that the home is usually kept clean and tidy. One bathroom floor on the first floor was in need of replacement or Care Homes for Older People Page 15 of 24 Evidence: repair, but the manager stated this was identified for replacement. There was adequate equipment in place for the laundering of clothes and maintenance of infection control. Care Homes for Older People Page 16 of 24 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. People are cared for by sufficient numbers of competent, suitable and skilled workers. Evidence: Staffing rotas showed there were sufficient numbers of staff on duty at all times to care for people. One person told us that staff were very quick to answer the call bell. Gaps in the rota were filled by the existing staff team, or the manager, thus ensuring people received continuity of care. People told us they got on well with staff and that they cared for them well. One said all staff work well together and co-operatively and all staff are very good, they know if something is not right and get the doctor to see you. A visitor described staff as marvelous. In their completed pre-inspection surveys people also told us that there were staff available when needed. One person wrote that staff created a friendly surrounding where both staff and residents are friends, as well as carers. Another wrote the staff are friendly and helpful and kind. Staff training records, and discussion with them showed they were receiving regular programmes of training. Most staff were qualified to National Vocational levels 2 or 3 in care subjects. In their completed surveys, staff told us they had the right induction, training and Care Homes for Older People Page 17 of 24 Evidence: support to enable them to do their jobs properly. One wrote we have a good team that are given all training to meet high standards of care. We saw induction records for staff, but the ongoing foundation training that staff received was not as well evidenced. Recruitment files showed that all the necessary pre-employment checks had been carried out on staff in order to keep people protected from unsuitable workers. Care Homes for Older People Page 18 of 24 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. The home is run in the best interests of the people who live there. However, people are not fully protected by existing systems for identifying and managing risks within the environment. Evidence: The manager is a registered nurse with a recognised management qualification. She has several years management experience and had updated her knowledge through training in the past year. People living in the home, and visitors we spoke to described the manager as excellent. In their completed pre-inspection survey, one visiting professional wrote I think it is a well run facility, staff are courteous and helpful. Patients appear happy and well cared for. The manager completed a pre-inspection self-assessment for us when we asked for one. This contained enough information for us to make an accurate assessment about the service. The manager knew what areas she needed to improve and was able to tell us what she was doing about it. Satisfaction surveys were sent out annually. The Care Homes for Older People Page 19 of 24 Evidence: outcome of the last one showed that people were satisfied with all aspects of the care and services. The owner of the home visited regularly and produced a brief summary of his findings. People living in the home, and their visitors told us that the owner asked for their opinions on the service during his visits, as part of his quality assurance. However, these were not always documented. Money held by the home, on behalf of people, was stored securely and transactions were well documented to provide safeguards for people. There was a health and safety policy, which had been signed by the owner in May 2009. Within the environment, two areas had not been subject to full risk assessment. Some first floor window restrictors had broken and were not tamper-proof, so there was potential for people to fall from a height. Also, the external walkways were uneven in places causing a potential trip hazard. The manager said that the walkways were being re-laid within the next month. There were service records in place to support that equipment used by the home was safely maintained. Care Homes for Older People Page 20 of 24 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 21 of 24 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 7 15 2b) New problems and 31/10/2009 needs arising must be added into the plan of care. This is to ensure that no care need is overlooked. 2 38 13 4) Windows and external walkways must be risk assessed and any remedial action identified must be taken. This is to ensure people are kept safe. 31/10/2009 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 3 A standardised pre-admission assessment form should be used to maintain consistency in the recording of preadmission assessments, and to ensure that they are dated and signed by the assessor. This will help to further demonstrate that people are only admitted following a comprehensive assessment of their needs. Care Homes for Older People Page 22 of 24 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 2 3 Admission profile sheets should record the persons marital status and any known allergies to ensure their safety and individualised care practices. A medication storage Fridge should be purchased to ensure peoples medications can be safely stored. Action should be taken to ensure peoples bedrooms are kept odour free in order to maintain peoples dignity. Staff should have their foundation training recorded in line with TOPSS specifications. This is to support people receive care from suitably inducted workers. The registered provider should record the outcome of any consultation with people living in the home and their relatives as part of the monthly monitoring reports. 3 4 5 9 19 30 6 33 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!