Care Home: Beechcliffe Residential Home

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What the care home does well The management team continue to have a positive approach to the inspection process and show a willingness to work with us to maintain and improve standards. Staff are approachable, have a caring attitude and try hard to create a homely atmosphere. The home has established a close working relationship with other health care professionals, which makes sure people`s health care needs are met in line with their care plan. People told us that the food is good, they said there is always a choice and alternatives are available if they don`t like what is on the menu. The home has been awarded a 5* rating (5 is the highest) by Environmental Health for its standard of food safety and hygiene. What has improved since the last inspection? The management team are now more proactive and identify shortfalls in the service quickly instead of them being brought to their attention through the inspection process. There are now clearer lines of communication and accountability both within the home and external management, which means that the home is being managed more effectively and in the best interest of people living there. Staff morale has improved since the last inspection and staff now have a more positive attitude, are better motivated and want to move the service forward. Improvements have been made to the admission process and people will now not be admitted to the home unless the manager is sure that staff are able to meet their needs. Improvements have been made in the care planning system and care plans are now more person centred and provide staff with clearer guidance on how to meet people`s needs. Improvements have been made to the environment including completing outstanding fire safety work and internally the home is more welcoming, bright and airy. Externally the grounds have been made more attractive and there are now pleasant areas for people to sit out and enjoy the summer months. What the care home could do better: Nutritional screening should be routinely completed for all admissions to the home so that any significant weight loss or gain can be monitored and appropriate action taken. The home could provide more opportunities for people to participate in a wider range of appropriate social and leisure activities both within the home and the wider community.Staff should not stand over people when assisting them to eat their meals but sit next to them and help them in a discreet and sensitive manner. The home needs a period of stability and clear leadership so that it can move forward and improve outcomes for people. Key inspection report Care homes for older people Name: Address: Beechcliffe Residential Home 16 Park Drive Heaton Bradford West Yorkshire BD9 4DR     The quality rating for this care home is:   one star adequate 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: Stephen Marsh     Date: 1 0 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Beechcliffe Residential Home 16 Park Drive Heaton Bradford West Yorkshire BD9 4DR 01274487207 01274497352 satnam@pcslimited.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Jarnail Singh Bassan Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 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: 25 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 25 Dementia Code DE, aged 55 years and above on admission, maximum number of places 25 Date of last inspection Brief description of the care home Beechcliffe Residential Home is a large detached Victorian building standing in its own grounds in the Heaton area of Bradford. The home provides accommodate for twentyfive people in a mixture of single and double rooms. The home does not provide Care Homes for Older People Page 4 of 26 Over 65 0 25 25 0 2 5 0 2 2 0 1 0 Brief description of the care home nursing care. There is good disabled access into the premises and a large garden available for people to enjoy during the summer months. Car parking is available to the front of the building. The home is fairly close to a number of amenities within the local area including shops, public houses and a large park. The weekly fees range from GBP356.00 to GBP542.00 and do not include costs for hairdressing, chiropody, toiletries and personal transport. Care Homes for Older People Page 5 of 26 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: one star adequate 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 last key inspection of this service was carried out on 4 December 2009. The overall quality rating for the service at that time was was poor and we made ten requirements relating to the environment, pre-admission assessments, care plans, medication, staffing and the need to implement effective quality assurance monitoring systems. Five requirements were outstanding from a previous inspection. On the 25 February 2010 we carried out a random inspection visit and found that the home had taken action to address all but three requirements. Outstanding requirements related to pre-admission assessments and care planning. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. Care Homes for Older People Page 6 of 26 In future, if a requirement is repeated, it is likely enforcement action will be taken The purpose of this inspection was to assess what further progress the home had made and the impact of any changes made on the quality of life experienced by people using the service. On this occasion we did not ask the home to complete an Annual Quality Assurance Assessment form and we did not send surveys questionnaires to people living at the home, their relatives or other health care professionals. The visit was unannounced and was carried out by two inspectors between the hours of 09:30 and 17:00. During the visit we talked to people using the service, visitors, staff and management. We also spent time observing care practices. At the end of the visit we gave feedback to the general manager about our findings. The manager was on annual leave on the day of the visit. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Nutritional screening should be routinely completed for all admissions to the home so that any significant weight loss or gain can be monitored and appropriate action taken. The home could provide more opportunities for people to participate in a wider range of appropriate social and leisure activities both within the home and the wider community. Care Homes for Older People Page 8 of 26 Staff should not stand over people when assisting them to eat their meals but sit next to them and help them in a discreet and sensitive manner. The home needs a period of stability and clear leadership so that it can move forward and improve outcomes for people. 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 26 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 26 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. Improvements have been made to the admission procedure and people will now not be admitted to the home unless the manager is sure that staff are able to meet their needs. Evidence: The home has produced a statement of purpose and service user guide which are made available to all people considering using the service. A power point presentation with information about the home is also displayed on a screen in the entrance hall. Since the last key inspection the home has introduced a new pre-admission assessment form and people are now not admitted unless the manager is confident that staff can meet their needs. We looked at the pre-admission assessment for the last admission to the home and found that it provided staff with good information about the persons health, personal and social care needs. However, it did not clearly indicate who had been involved in the assessment process and provided the Care Homes for Older People Page 11 of 26 Evidence: information. Since the inspection we have received written confirmation from the general manager that the form as been revised and now includes all relevant information. The general manager confirmed that pre-admission assessment visits are always made to see people either in their own homes or temporary place of residence. Before admission people are encouraged to visit the home to meet the people who already live there and the staff. This means that staff can get to know the persons needs and the individual can see see at first hand the accommodation and facilities provided. People are also able to move into the home for a trial period if they are still undecided about living in a residential setting. The general manager confirmed that people offered a place at the home are supported through the admission process and care is taken to make sure they settle into their new environment. Care Homes for Older People Page 12 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the care plans. However, further work is still required to make sure that all supporting documentation is completed and updated so the the home can clearly evidence that they can meet peoples needs. Evidence: A new care planning system has recently been introduced at the home which covers all aspects of peoples health, personal and social care needs. The care and support plans we looked at showed that improvements have been made since the last key inspection visit and generally provide staff with clear guidance on how to meet peoples needs. However, in some instances they did not contain sufficient detail and in one instance contradicted information provided by other health care professionals. This matter was discussed with the general manager who confirmed that immediate action would be taken to make sure that all care plans reflected peoples current health, personal and social care needs. There was evidence to show that wherever possible people are involved in the care planning process. This means that they are consulted about how they want their care and support to be provided. Care Homes for Older People Page 13 of 26 Evidence: Risk assessments are in place where areas of potential risk relating to peoples general health or well-being have been identified including falls, tissue viability and moving and handling. However, nutritional screening is not routinely carried out for new admissions to the home and there were no nutritional assessments on any of the files we looked at. This matter was discussed with the general manager who acknowledged that some documentation still required updating or completing and this was very much work in progress. All people living at the home are registered with a general practitioner and are supported in having access to the full range of NHS services. The input of other health care professionals is clearly recorded in the documentation available, which shows that staff are seeking advice if they have any concerns about an individuals health care. We reviewed the medication system in place and found that medicines are managed safely. Policies and procedures are in place relating to the receipt, safe storage, administration and disposal of medication and all staff receive appropriate training. This means that people can be confident that their medication is being given as prescribed. Care Homes for Older People Page 14 of 26 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. The home could provide more opportunities for people to participate in a wider range of appropriate social and leisure activities both within the home and the wider community. Evidence: On the day of the visit the atmosphere within the home was calm and relaxed and staff were observed to interact well with the people in their care. The general manager confirmed that the daily routines of the home are flexible and people are encouraged to be as independent as possible and wherever possible consulted about how they want to spend their time. The home does not employ an activities co-ordinator therefore in house activities are organised by the care staff. Staff told us that they encourage people to participate in social and leisure activities and one hour every afternoon is set aside for this purpose. For people that dont like to join in group activities time is made to engage with them on a one-to one basis. Staff told us that entertainers visit the home on a regular basis and a motivation session is held once a month to encourage people to do some physical activity. Care Homes for Older People Page 15 of 26 Evidence: Some people said that they enjoyed the activities arranged for them and confirmed that special occasions throughout the year including birthdays and anniversaries are always celebrated with a party tea or entertainment. However, one person recently admitted to the home said that other than watching the visiting entertainers there was nothing else really to do. This matter was discussed with the general manager who acknowledged that more could be done to provide people with a stimulating environment and would discuss this with the manager on her return from leave. Feedback from people shows that they are able to see visitors in their own room if they wish to do so and family and friends are always made to feel welcome and offered refreshments. During the visit we observed the lunchtime meal being served in the dining room. The tables were nicely set and people were given the time they required to eat their meal in comfort without being hurried. However, we did observe some staff standing over people when assisting them to eat instead of sitting with them and helping in a discreet and sensitive manner. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are now suitable systems in place to make sure that complaints are taken seriously and people are protected from abuse. Evidence: There is a clear complaints procedure in place and one relative visiting on the day of the inspection told us that she would have no problem at all in approaching the manager if she had any concerns about the standard of care being provided. Adult protection (safeguarding) policies and procedures are in place and the general manager said that all staff receive training in the recognition and reporting of allegations of abuse. Staff spoken to had a good understanding of the different types of possible abuse and were able to give examples of how poor working practices could be abusive. Staff also said that they were aware of the homes policy on whistle blowing and knew how to report incidents of possible abuse both to the manager and other external agencies. At the last key inspection we were concerned that the manager had failed to inform us of an adult protection issue that had occurred at the home as required under regulation 37 of the Care Standards Regulations 2001. Since that visit we have received confirmation that the manager is now fully aware of her roles and responsibilities in this area of work and she now keeps us fully informed of any incidents at the home. Care Homes for Older People Page 17 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been significant improvements made to the environment since the last inspection and there an ongoing programme of refurbishment and renewal in place to make sure the standard of accommodation at the home in maintained and improved. Evidence: Some parts of the home are still in need or upgrading however there have been significant improvements to the environment since the last key inspection and there continues to be an ongoing programme of refurbishment and renewal. At the last key inspection we had concerns that work had not started to comply with the enforcement notice served by the Fire Service. However, on this visit the general manager confirmed that the majority of this work had now been completed and would be finished by the end of June 2010.This means that people living and working at the home can be confident that the building meets current fire safety legislation. All the communal areas including lounges and the dining room are situated on the ground floor of the home, conveniently close to toilet facilities. Since the last key inspection the lounge area as been decorated and generally made a more pleasant and comfortable place for people to relax. Bedrooms are situated on three floors of the building and there is a passenger lift Care Homes for Older People Page 18 of 26 Evidence: available to enable people with mobility problems reach the accommodation on the upper floors. The rooms we looked at were decorated and furnished to a satisfactory standard although some rooms would benefit from decorating and old tired furniture replacing. Bathroom and toilet facilities are located throughout the home. At the last key inspection we found the bathroom on the ground floor was in urgent need of refurbishing to bring the facility up to an acceptable standard. It was therefore pleasing on this visit to find that the room and been refurbished to a good standard. On the day of the visit the home was clean,tidy and free from offensive odours. Externally a lot of work as been done in the grounds of the home to make them more accessible and attractive and there are now pleasant areas for people to sit out and enjoy the summer months. Care Homes for Older People Page 19 of 26 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. More emphasis has recently been placed on staff training and development and therefore people can be confident that their care and support is being provided by a skilled and experienced staff team. Evidence: Since the last inspection we have received confirmation from the general manager that staff recruitment and selection procedures are now being followed and no staff are employed until all relevant checks have been completed. The staff files we looked at during this visit confirmed that. At the last key inspection we had concerns about the lack of cleaning hours available at the home resulting in care staff having to undertake some cleaning tasks in addition to their normal duties. Since the inspection we have received confirmation that the cleaning hours have been increased, which should make sure the home is kept clean and tidy and care staff have more time to spend with people. The staff files showed that new staff receive induction training to help them gain the knowledge and skills they need to meet peoples needs and staff spoken to during the visit confirmed that there has been an improvement in the amount of training they receive. They told us they have regular staff meetings and one to one supervision where they can discuss their training needs. Care Homes for Older People Page 20 of 26 Evidence: Since the last key inspection we have received a training programme for 2010 and confirmation from the manager that more emphasis is now being placed on staff training. We have also received confirmation from the general manager that the home now intends to put all staff training on to a training matrix, which will help to identify training needs and help to plan future training programmes. Care Homes for Older People Page 21 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are now clearer lines of communication and accountability both within the home and with external management which means the home is in a position to move forward and continue to improve quality outcomes for people using the service. Evidence: The manager has now been in post about eighteen months although she has still to complete the registration process. The manager is a qualified nurse, has a positive attitude to the inspection process and has always shown a willingness to work with us to maintain and improve standards at the home. Feedback from staff show that they feel well supported by the manager and found her to be approachable and caring. Comments included the manager is very good and supports staff in all aspects of their work and the manager is trying hard to improve the service and make sure that people receive good quality care. Staff confirmed that they have one to one supervision meetings with their line Care Homes for Older People Page 22 of 26 Evidence: manager on a regular basis and this is evidenced by the supervision records we looked at on individual files. Supervision meetings support staff to plan their personal and professional development and give them the opportunity to discuss any areas of concern in a confidential setting. The home has started to introduce quality assurance monitoring systems and survey questionnaires were recently sent out to people who live at the home and their relatives as part of this process. The questionnaires give people the opportunity to express their views and opinions of the service and provide valuable information on what improvements they would like to see. The general manager employed by the company also visits the home on at least a monthly basis and completes a written report on the conduct of the service as required under Regulation 26 of the Care Standards Act 2001. The home holds money in safekeeping for a number of people. Only senior staff deal with peoples personal finances and receipts are obtained for any items purchased on their behalf. At the last key inspection we checked the systems in place for dealing with financial transactions and no concerns were raised. Information provided in the self-assessment form completed by the home for the key inspection in December 2009 shows that policies and procedures are in place to make sure staff follow safe working practices and all equipment is serviced in line with manufacturers guidelines. People can therefore be sure that their health and safety is not being compromised. Care Homes for Older People Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Nutritional screening should be routinely completed for all admissions to the home so that any significant weight loss or gain can be monitored and appropriate action taken. The home should provide more opportunities for people to participate in a wider range of appropriate social and leisure activities both within the home and the wider community. Staff should not stand over people when assisting them to eat their meals but sit next to them and help them in a discreet and sensitive manner. 2 12 3 15 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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