Care Home: Beech Street Home

What the care home does well Beech Street provides a caring homely environment in a pleasant setting on the edge of Jarrow Town Centre. Everyone spoken to enjoys living in this home and many positive comments were received about the good support received from the staff team There is a varied range of activities for residents to enjoy. All complaints are taken seriously and addressed. Staff are well trained to enable them to support residents appropriately. What has improved since the last inspection? What the care home could do better: Residents should be included in the preparation of their plan of care and they should also be involved in the regular monitoring of the care provided. Maintenance items that detract from the quality of life in the home should be done in a timely way and not left to be identified by an outside inspection. CARE HOMES FOR OLDER PEOPLE Beech Street Home Jarrow Tyne and Wear NE32 5LD Lead Inspector Allan Helmrich Key Unannounced Inspection 29th and 30th July 2008 09:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Street Home Address Jarrow Tyne and Wear NE32 5LD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0191 483 5284 0191 489 8549 South Tyneside MBC Angela Weedy (not registered) Care Home 35 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (18), Learning disability over 65 years of age of places (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (3), Old age, not falling within any other category (35), Physical disability (1), Physical disability over 65 years of age (5) Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service may from time to time admit persons between the ages of 60 and 65 years of age. 1st August 2007 Date of last inspection Brief Description of the Service: Beech Street Elderly Persons home is a Local Authority purpose built home which is situated in Jarrow. The home is registered for up to 35 residents, some of whom have a dementia type illness. Nursing care is not provided but district nursing services are accessed as required. Accommodation is over one floor, with level access throughout, and consists of a number of communal lounge areas, a smoking room and a dining area. Residents have access to a well-equipped reminiscence room and a separate hairdressing facility. There is spacious garden and car parking is available to the front of the home. The home is situated on Beech Street which is located close to the busy town centre of Jarrow where facilities such as shops, pubs, GP surgerys and places of worship can be easily accessed. Information about the home, including recent inspection reports is readily available. The weekly fees for this home range from £103 to £438. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Visit: The inspection was unannounced and was undertaken by the link inspector for the service. Information was collected over two days as the first day was shortened to enable the home manager to attend an organised event for residents and their visitors. During the visit we: • • • • • • • Talked with people who use the service. Talked with the area manager, home manager and staff on duty. Looked at information about the people who use the service and how well their needs are met, Looked at case records for three residents and other records which must be kept, including medication. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to assess if it was clean, safe and comfortable. Checked what improvements had been made since the last visit. What the service does well: What has improved since the last inspection? Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 6 The décor has been improved and the use of pictures has brightened the corridors. Information for people considering at place in Beech Street has been reviewed and improved. The complaints brochure has been produced in large print and is available in several languages to make it more readable for older people and those whose English is not their first language. A quality monitoring system has been introduced to identify any areas for improvement to better the lifestyle of residents in the home. Action has been taken to address the majority of requirements made at the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. People who use the service experience good quality outcomes in this area. Pre admission assessments are carried out and the manager reviews these before accepting a referral to ensure staff can provide appropriate care. Each referral is provided with the information they need about the care home. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Everyone is given the opportunity to spend time in the home prior to admission. The manager has recently improved the information available to prospective service users, which gives people information about the home and the service it provides. There is a statement of purpose that encourages new residents to identify any individual needs they may have and a brochure Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 9 entitled ‘What you need to know’ that has been recently amended to identify the way care is provided to anyone with a dementia. The home receives an assessment from the persons care manager prior to admission. This information is looked at by the manager to ensure the home can meet the person’s needs. Each of the case records reviewed contained an assessment of the person’s needs and other appropriate supporting information. Within a short time of admission each resident has a plan of care constructed by senior staff in the home. These plans identify any special needs the individual may have such as religious or cultural requirements as well as personal care needs. Although these plans are described in the information provided to each resident, there was no evidence of any involvement of the resident in the construction of these plans. The manager stated the home does not provide a rehabilitation service but short-term respite beds are available. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience good quality outcomes in this area. The information in case records ensure the healthcare of residents is well managed, however some regular reviews done by staff could be improved. Residents seen were in good health and treat with respect by the staff team. Medication procedures used in the home ensure residents are safe. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Shortly after admission a range of assessments to determine the physical and mental needs of the resident are conducted and following these any identified needs are included in a plan of care. Care plans are produced and although these are improving, some contained insufficient information to demonstrate a person centred approach is used. The Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 11 care plans are reviewed by key staff each month but the reviews are of varying quality. Some staff provide an overall assessment of the individuals health, wellbeing, involvement in activities and other factors of daily living, This ensures that staff are considering the individuals needs are wishes on a regular basis. However, some records only stated ‘no change to care plan’. Records demonstrated that residents regularly see healthcare professionals to promote their good health with details of health checks, visits to their GP and hospital appointments being recorded in the individual files Five residents spoken to all stated the home provides a good standard of support and staff were observed throughout the inspection talking to residents and involving them in ad-hoc activities. The manager is concerned that all residents are treat individually and has provided training for the staff team in equality and diversity. Seven staff have done this training in the past year to ensure residents are well supported to live a life of their choosing. All senior staff that dispense medicines and some care staff have had training in the safe handling of medication. The medication records were up to date, storage and handling of medicines was appropriate and procedures to ensure that residents are safe are in place. Some handwritten entries in the records had not been double signed to make sure they were accurate. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use the service experience good quality outcomes in this area. Residents take part in regular activities of their choice. Visitors are made welcome. A good standard of healthy food is provided. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home is designed with four wings each with a lounge and small kitchen area. One of the wings is used mainly to provide respite care and the manager has made an area for people to use a computer. There is also a main focus area with dining, sitting and reminiscence areas. The manager has made a wall of pictures showing film stars and famous faces of the fifties to stimulate residents. The reminiscence room is filled with age appropriate items that staff use to stimulate conversation about bygone days. And another area of the main corridor has a table set for afternoon tea with a bookcase and seating nearby. A room near the entrance contains a payphone to enable anyone to make calls in comfort and with privacy. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 13 On the afternoon of the first day of the inspection that was unannounced, there was a summer fete/barbeque with an entertainer brought into the home. Separately a resident was entertaining her extended family in another lounge on the occasion of her birthday. Many visitors were seen attending these events, they all appeared comfortable in the home and were seen talking to management and staff. People spoken to stated they enjoy living at Beech Street. One lady particularly likes to use the reminiscence room to colour drawings. Another resident stated there is a lot goes on that she enjoys but she misses the opportunity to go out on trips. Two different entertainers visit the home each month, there is a Karaoke machine used at social events and a coffee morning is held in the home monthly. All activities are recorded and this showed that recently many residents have been involved in a range of activities including; nail care, bingo, dominoes and quizzes. One resident stated she loves the quizzes. Each week there is a church service where those who choose can have a communion. The manager stated that currently no one in the home has a religious need that is not met but that anyone coming into the home with an assessed religious need would be catered for in the local community. Residents and their families are consulted regularly to ensure the home meets their needs. Currently all residents are supported by close family, but if needed the local authority can provide an advocacy service and the manager can also contact Age Concern. Contact details are available in the home. An information brochure is produced each month and twice yearly a comment card is attached to give any supporters who cannot visit the home regularly the opportunity to tell management about any concerns, although the results of the returns are not published. The manager agreed to include the number of returns and any comments in future newsletters. The manager stated the homes email address is on the councils Internet site should anyone want to contact them in this way. At lunchtime residents were well supported where appropriate by the staff team. Tables were pleasantly decorated and everyone spoken to said they enjoyed the meal they had. The cook stated she had prepared two choices and also provided one resident who was unwell with a light meal of scrambled egg. No one currently in the home has any dietary or cultural needs that can not be met. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People who use the service experience excellent quality outcomes in this area. The home takes complaints seriously and staff are well trained to ensure everyone is protected from abuse. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Several people spoken to stated they felt safe in the home and would feel comfortable taking a complaint to the manager or staff. One resident said that if she is dissatisfied with anything she always tells staff because this is her home. There is a complaints information notice at the entrance to the home for the benefit of visitors. Leaflets detailing the complaints process are also available at the home’s entrance, a copy is provided in an information pack given to each new resident and a new corporate complaints booklet that is available in large print and in several languages has recently been made available. To promote comments a card is available in the home and a copy is sent to next of kin twice yearly. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 15 Five complaints made to the home since the last inspection were recorded in a log by the manager and addressed in an appropriate manner. No complaints were made directly to the Commission. A staff training programme is in place to ensure all staff are aware of how to ensure residents are maintained in a safe environment. The manager and senior staff are to be re-trained later in the year. Information to support staff is available in the home and those staff spoken to were aware of the issues that affect vulnerable people and of the home’s whistle-blowing policy. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. People who use the service experience adequate quality outcomes in this area. The home provides a clean pleasant environment to live. Some repairs that may affect the wellbeing of residents are needed. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: There is a programme of ongoing maintenance in the home and the manager and staff have tried to brighten some areas with pictures and ornaments. All areas of the home were clean and tidy. The laundry contains appropriate equipment to clean clothes and the manager attends infection control meetings Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 17 arranged by the local Primary Care Trust, ensuring that latest best practice is applied in the home. The entrance area of the home contains a small indoor garden with seating and there are two reminiscence areas that residents can use themselves or staff can take people to, to stimulate conversation. There are sufficient well-equipped bathrooms in the home, although these are generally bare and in two bathrooms tiles have fallen off and not been replaced. In another bathroom the wallpaper was torn by wheelchairs just above the skirting. Bedrooms were individual in character with many containing small items of personal furniture and memorabilia. Those residents spoken to in their bedrooms stated they were very happy with them. Other residents spoken to in lounges and dining areas also stated the home meets their needs. One resident who uses a wheelchair stated that staff have no problems giving her access to all areas of the home. Throughout the home corridor doors are held back with a magnet attached to the fire alarm system and the front door is automatic with a sensor. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People who use the service experience good quality outcomes in this area. There are sufficient staff to meet the needs of each resident and recruitment procedures ensure people who live in the home are safe. Staff get regular training and supervision to ensure the necessary skills are available to provide the people who live at the home with good care. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Information provided by the home manager showed that over 85 of the staff have an appropriate vocational qualification. The records showed that a regular training programme is in place to ensure staff receive the training they need to care for older people and people with a dementia. The range of training provided this year includes; first aid, fire, infection control, falls prevention, equality and diversity, caring for people with a dementia and alerter training dealing with the protection of vulnerable people. During the inspection sufficient staff were on duty to meet the needs of the residents and the staff rota demonstrated that the normal care staffing levels in addition to the manager who normally works Monday to Friday and a senior Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 19 care on duty at all times is four care staff on both am and pm shifts with two care staff on duty through the night. The home has had recent staffing problems, however following recent recruitment the home is now fully staffed. The files of recent recruits were reviewed and found to contain appropriate information in the form of application forms, references and Criminal Record Bureau (CRB) checks to ensure residents can live in a safe environment. One new recruit had not started work yet as the manager had not received her CRB clearance. A system is in place to ensure all new staff receive an induction that demonstrates they are able to care for people living in the home. Initially a corporate induction is followed by a full induction into care and care principles. Details of this is recorded in a workbook and signed by a senior staff member on completion of a demonstration of competency. Also each new staff member is provided with a handbook providing information regarding codes of practice for care workers. Each resident who expressed an opinion complemented the staff team on the quality of support they provide. Staff spoken to stated that morale is low at the moment because of uncertainty about their jobs but they also stated this does not affect the way they care for people living at Beech Street. Staff confirmed that training is available and that management provide regular support for them in their work. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. People who use the service experience good quality outcomes in this area. Beech Street is a safe home that is well run for the benefit of the people who live there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The manager, who is not yet registered by The Commission, has worked in a senior capacity for several years and is aware of the needs of older people. She has made improvements to the home since being promoted and is also Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 21 reviewing systems and improving them to provide better standards of care for the people who live in the home. There is a quality monitoring system being introduced that is being supported by a senior manager. To date the manager has done an initial review of the care systems and this is to be expanded to ensure people living in the home receive an appropriate standard of care in line with their expectations. The home has procedures in place that make sure resident’s finances are safeguarded. A fire risk assessment has been produced. Staff have received fire instruction and fire drills take place to ensure residents are maintained in a safe environment. The manager demonstrated that regular servicing of equipment takes place, that staff, through training, promote safe working practices to ensure the safety and welfare of people who live in the home. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement The manager must make sure that staff sign the medication records when any changes are made and that these changes are checked and countersigned by another staff member. The manager must ensure these maintenance issues are addressed: • Tiling in bathrooms should be repaired and action taken to ensure residents can bathe in safety. • Wallpaper damaged by wheelchairs should be repaired and action taken to limit the re-occurrence. Timescale for action 30/09/08 2. OP19 23 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 24 1. 2. 3. OP3 OP7 OP14 The manager should ensure that whenever possible, each new resident is consulted about and agrees with their individual plan of care. The manager should ensure that monthly assessments done by key staff are holistic and include a discussion with the resident. The manager should publish the results of any returns from the home’s comment cards in the monthly newsletter. Beech Street Home DS0000037970.V369322.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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