Care Home: Beechcroft Care Centre

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What the care home does well Residents` needs have been assessed before they are admitted to ensure Beechcroft Care Centre is able to meet them. Care plans have been drawn up for each resident to ensure care staff have the necessary information to enable them to meet identified needs. Residents are provided with a range of internal and external activities to ensure their social and recreational needs have been met. The environment has been well designed and equipped to meet the complex physical needs of residents accommodated. All staff have received a programme of training, including induction training, to ensure they have the necessary knowledge and skills to provide care to residents. They have also been well supported and supervised by the manager and senior staff. What has improved since the last inspection? No requirements or recommendations were made after the last inspection. What the care home could do better: The manager needs to ensure that, when care plans are reviewed, information is updated so that it reflects the current needs of residents. Some improvements are needed to care records to ensure they include information about all medication which has been prescribed on an as required basis. This will mean trained staff have appropriate information to ensure residents medical needs are met safely. Key inspection report Care homes for adults (18-65 years) Name: Address: Beechcroft Care Centre West Hoathly Road East Grinstead West Sussex RH19 4ND     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Bannier     Date: 2 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Beechcroft Care Centre West Hoathly Road East Grinstead West Sussex RH19 4ND 01342300499 01342300795 ivy.dann@sussexhealthcare.org sussexhealthcare.org Dr Shafik Hussien Sachedina,Mr Shiraz Boghani care home 20 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following categories of service only: Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) Physical Disabilities (PD) Date of last inspection Brief description of the care home Beechcroft Care Centre is registered to provide residential and nursing care for up to twenty adults with learning and physical disabilities. The home is divided into two units known as Beechcroft House and Chestnut House each accommodating ten people. Beechcroft House is an older building which is partly adapted and partly purpose built. Chestnut House has been completely purpose built. Each unit provides ten single bedrooms, each with ensuite toilet, wash basin and shower facilities. Communal areas comprise of a lounge, activities room, sensory room, Care Homes for Adults (18-65 years) Page 4 of 30 2 2 1 0 2 0 0 8 20 20 Over 65 0 0 Brief description of the care home and a fully adapted bathroom. The home is equipped with the latest technological aids including an audio loop system, hydrotherapy bath and overhead tracking hoists. A passenger lift provides level access to all parts of the home. The site also offers a specialist swimming pool. The main kitchen is located in Beechcroft House. Current fee levels range from £2,100.00 to 3,000 per week. More detailed information about the services provided at Beechcroft Care Centre, can be found in the homes Statement of Purpose and Service User Guide. Copies of both documents can be obtained directly from the Provider. The service is owned by Dr Shafik Sachadina and Mr Shiraz Boghani. The registered manager, who is responsible for the day to day running of the care home, is Mrs Ivy McEwan. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. The inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. This inspection will also determine the frequency of inspections hereafter. We asked the registered provider to return an Annual Quality Assessment Form known as an AQAA prior to the inspection. The information received from this document helps us to form an opinion about how well the service is being run and is a legal requirement. Information provided in this form will be referred to throughout this report. A visit to the care home was made on Friday 22nd January 2010. This was an Care Homes for Adults (18-65 years) Page 6 of 30 unannounced inspection. This means the registered provider had no prior warning of our visit. We met and spoke with a resident and two relatives in order to form an opinion of how it is to live at the care home. We spoke to some of the staff on duty in order to gain a sense of how it was to work at the care home. We also observed care practices and interactions between residents and staff. We were accompanied by an expert by experience during part of our visit. An expert by experience is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Their observations are featured within this report. We viewed some of the private and communal accommodation and examined some records. The visit lasted approximately eight and a half hours. We gave Mrs McEwan, the registered manager, feedback of our findings on its completion. Prior to our visit we were made aware that the local authority has received a number of safeguarding adult alerts. As a result the local authority has conducted an investigation into the allegations made. We have been informed that the outcome of the investigation is that some of the allegations have been substantiated. We found evidence during our visit of improvements that have been made to ensure residents are protected. Care Homes for Adults (18-65 years) Page 7 of 30 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 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 Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. The needs and aspirations of prospective residents have been assessed before admission. Evidence: We looked at the care records of three residents who are currently living at Beechcroft Care Centre, one of whom had recently been admitted. Care records sampled indicated that peoples needs were fully assessed before they are admitted to the home. We spoke to the relative of one resident who confirmed they were able to visit the care home before they decided to move in. They also confirmed they were involved in the needs assessment of the resident. They told us, I remember someone coming to our home and to the respite centre where my daughter was living to assess and find out about what she needed. Staff on duty were clearly able to discuss the needs of each resident and how they Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: should be met. We spoke to the manager who was able to explain how new residents needs are assessed. Information supplied in the AQAA confirmed that, We carry out a comprehensive assessment to ascertain whether the home can meet the service users needs with relatives and multi disciplinary team input. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents assessed needs are reflected in their individual care plan. Some work is needed to ensure information about how residents needs are to be met is clear and up to date. Residents can make decisions about their lives with assistance as needed. Residents are enabled to take risks as part of an independent lifestyle. Evidence: We looked through a selection of care records and care plans. We found that information about each residents needs together with guidance for staff to follow had been drawn up. We found that there were instances when the guidance was not as detailed as it could be to ensure identified needs have been met on a consistent basis. For example guidance instructed staff to carry out a task regularly. We discussed this with the manager who agreed that this should be more specific with regard to the frequency the identified action should be carried out, that is either hourly or three Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: times a day depending upon the needs of the individual resident. We also saw that risk assessments have been carried out when necessary to determine the level of risk an identified activity would present to a resident and the action staff should take to reduce it. We noted instances when a year had elapsed without their being reviewed and updated. In addition records seen demonstrated that care plans had carried out on a monthly basis. However, there was no evidence that care plans have been routinely updated as part of this process. We spoke to the manager who agreed to take the necessary steps to ensure care plans are up to date. We observed staff working with residents. They demonstrated that care practices and support given to residents were in line with the guidance provided. Discussions with staff on duty confirmed they had been made fully aware of the needs of each resident and how they should be met. The expert by experience observed staff working with residents and noted, Staff are friendly and gave the residents undivided attention. Staff have worked with the residents who have high communication needs and are able to tell what the residents want through body language and gestures. During the visit, I noticed one of the residents being transferred from a standing up frame onto a wheelchair in the presence of other residents. I felt that this persons dignity was not respected. We discussed this observation with the manager who agreed to consider how this may be improved to ensure the residents dignity has been maintained. Staff on duty informed us residents are encouraged to make choices on a daily basis. This includes making decisions about what to eat, how to spend leisure time, when to get up and when to go to bed and what clothes to wear. Care plans examined include the choices and individual wishes, likes and dislikes of each residents. Records we saw included significant people in their life, how each resident communicates, what is important to each resident, their gifts and qualities, and their dreams and aspirations. We spoke to a relative who informed us they are confident that care staff and nursing staff are able to look after their daughter. The staff are interested in my daughter. They are constantly asking us what she likes and what she wants to do. We know she is safe and she is well cared for. She appears to be happy and relaxed. This person also confirmed they have read their daughters care plan and are aware of its contents. The AQAA confirmed that, Staff, with the service user, devise individual care plans. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Service users needs are met to the full. Confidentiality is maintained at all times. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to take part in appropriate activities. Residents have been encouraged to become part of the community. Residents have been supported in maintaining family relationships. Residents have been provided with a healthy, varied and appropriate diet. Residents rights have been respected whilst ensuring their safety is maintained. Evidence: Care records we examined demonstrated the interests and hobbies have also been taken into account. We also saw that each resident has an individual activity Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: programme for each day. This included a range of activities, including free time, in which they wish to participate. From records and documents seen, and meeting with residents, we concluded that each programme has been drawn up with the interests and hobbies of individual residents in mind. In house activities include art and crafts, cooking, games, discussion groups, sessions in the spa bath and in the sensory room, music, relaxation and DVD movie afternoons. Residents who want to, have been allocated placements at a local college. Other activities outside of the home include going horse riding, trips to the shops, to the theatre, to the pub and to the cinema. Some residents also attend the local church. During our visit we observed a group of residents attending an art session. Afterward a group of residents took part in a game of scrabble. A relative informed us, The facilities which are available are very good. My daughter loves swimming and she enjoys the sessions in the hydrotherapy pool. When I visit I have never seen her sitting doing nothing. Today she is enjoying the art and craft session. She also takes part in cooking, gardening, swimming, and physiotherapy sessions. She has been able to continue the interests, hobbies and activities she developed when she was in the sixth form at school. The expert by experience observed, On the board in Beechcroft House, there was a list of residents allergies and on another board, there were pictures of activities for the week, which included horse riding, cookery, karaoke and painting. Though there are two houses, residents do get together for activities, as I witnessed, residents from Beechcroft House had gone to Chestnut House to play scrabble. The activities in the home are done in a group. Though there are many staff on duty, some of the residents looked bored and could have had one to one activities of their choice with the staff. We discussed this with the manager who agreed to consider how improvements can be made when group activities are provided. We spoke to the chef during this visit who told us about the main meal of the day that was being prepared. This consisted of a choice of sausages in onion gravy or egg and bacon flan with either chips or creamed potatoes, sweet corn and peas followed by rhubarb. Alternatives such as jacket potatoes and omelettes, salad, ravioli on toast and sandwiches are also available each day for those residents who required a lighter meal. The cook also informed us of the special diets that were currently being catered for. This included diets for residents who have allergies and intolerances, are diabetic and also those who required liquidised meals. We were given copies of recent menus to look through. They demonstrated that a varied, wholesome, nutritious and appropriate diet has been provided. We were informed that, due to the allergy of one Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: resident fish does not appear on the menu. However, we were informed that residents are taken out to have a fish and chip meal if they wish. We also saw evidence that a dietician visits every two weeks to provide advice and guidance to ensure residents nutritional needs have been met. We also saw evidence that residents have been consulted about meals and type of food they want included on menus. Whilst we did not observe the main meal of the day being served, we were informed that the meal is prepared and cooked in the main kitchen located in Beechcroft House, and transported to Chestnut House in heated trolleys. The expert by experience observed, Residents have a choice of what they eat. During the visit I was shown a menu book which had clear photographs of different kinds of food that is offered to them. A relative informed us, My daughter eats well. They have a list of her dietary needs, including her likes and dislikes. Information provided in the AQAA confirmed that, We have specialist trained nurses and therapists. Food is available 24 hours a day. We welcome relatives, friends and advocates to visit. Activities within the home and in the community are accessed by all. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Support and personal care provided takes into account the wishes and personal preferences of each resident. The physical and emotional health care needs of residents have been met. Staff deal with medicines in a way that protects and supports residents. Evidence: We examined a selection of care records. The care planning system includes risk assessments where necessary. It also records visits by each resident to doctors and other health care professionals such as dentists and chiropody. We have already noted that reviews take place on a monthly basis but care plans have not been routinely updated to ensure they reflect the current care needs of residents. The manager has agreed to make the necessary improvements to this. Clear guidance for staff and up to date information in care plans underpin good care practices and ensure residents needs are met consistently and continuously. A relative told us, We know our daughter is safe and well cared for. They also Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: informed us they are confident that care staff know how to meet their daughters nursing and social care needs. We noted that medication has been appropriately and securely stored. Records seen had been well maintained and kept up to date. We noted that only trained nurses are responsible for administering medication to residents. Medication records and care plans also include clear directions to staff with regard to the administration of medication given on an as required basis as part of agreed procedures for managing epileptic seizures. Care records include guidelines with regard to the circumstances when medication should be administered. Once medication has been given, the circumstances and the outcome of administering medication has also been routinely recorded. However, we noted that this is not the case with regard to medication given to provide pain relief. Following discussion with the manager, we recommended that the same practices are followed for the management of epileptic seizures and for pain relief. From records seen we noted that only trained nurses are responsible for administering medication to residents. We also observed the nurse on duty in Beechcroft House administering medication during the evening meal. Information provided in the AQAA confirmed that, All service users are given privacy and respect at all times. Personal and intimate care is discussed with each service user and their wishes documented in their care plans. All physical and emotional support is given at all times. Medicines are given appropriately at correct times and administered with their consent. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has set up a system for ensuring residents, relatives and visitors views are listened to. Residents are protected from abuse, neglect and self-harm. Evidence: A complaint procedure has been drawn up so that residents and their families know how to make a complaint if they wish to do so. A procedure which is in picture form has also been drawn up. We saw that they were on display in the front hallway of the care home. Residents and relatives we spoke to confirmed they knew who to speak to if they wished to make a formal complaint. Information provided in the AQAA confirmed that two complaints had been received in the last 12 months. It also confirmed that they had been resolved within 28 days. We examined the record of complaints that has been kept by the manager. We noted that not all the information we would expect to see was available. The manager informed us that some records are also kept at the providers head office. We looked at minutes of resident meetings. They demonstrated that residents are Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: supported by staff and encouraged to discuss any issues that can be sorted out before they become major concerns. We spoke to some staff, who confirmed they know how to identify different types of abuse and also know what to do if they witness a resident being abused. Training records confirmed that staff are provided with training about adult protection and the accompanying procedures. We have been made aware of recent allegations related to care practices that have been investigated by the local authority under safeguarding vulnerable adult procedures. The manager showed us evidence of the action she has taken to ensure improvements have been made to care practices and that residents are safe. Following observations of interactions between staff and residents, discussions with residents, their relatives and staff on duty, we found no evidence of poor practices during our visit. Information provided in the AQAA stated that, Any concerns or complaints are dealt with immediately. Service users, relatives and visitors are able to express concerns and choose who they like to talk to. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have been provided with a homely, comfortable and safe environment in which to live. The home has been kept to a good standard of cleanliness and hygiene. Residents continue to benefit from living in an environment that has been specifically designed and built to meet their complex needs in a safe and comfortable way. Evidence: We visited both houses during our visit. We noted that each of the bedrooms currently occupied have been decorated to reflect the individual tastes and preferences of the individual. The decoration and furnishings provided ensured residents live in a comfortable and homely environment. Communal areas comprise of a lounge, dining room, sensory room, and a fully adapted bathroom. The home is equipped with the latest technological aids including an audio loop system, hydrotherapy bath and overhead tracking hoists. We also viewed the kitchen, sluice rooms, bathrooms and toilets. We noted that these areas of the premises were fresh, clean and hygienic. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Residents and relatives we spoke to confirmed they were very satisfied with the accommodation. The expert by experience observed, The home is a large, comfortable, clean and purpose built to suit the needs of the people who live in it. The bedrooms are large with ensuite wet rooms and overhead tracking for safety and ease of transfer on to and off the beds and wheelchairs. There is a sensory room for residents who need to be in a quiet place. The home has a relaxed atmosphere. The garden and patios are all wheelchair accessible. Information provided in the AQAA stated that, We have a well maintained spacious purpose built home. free from offensive odours. There is access to local amenities and integration into the local community is encouraged. Environmental health and safety regulations and fire regulations are adhered to. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by competent and qualified staff. The homes recruitment practices and procedures protects vulnerable residents. Residents needs have been met by the staff team. Evidence: We examined the recruitment records of two members of staff who had been appointed since our last visit. We found that all appropriate information and checks had been obtained to ensure vulnerable residents have been protected. This included two written references, proof of identity and criminal record checks. We spoke to three members of staff who were on duty. They demonstrated they were knowledgeable about their role and were able to explain the needs of individual residents and how they are to be met. We looked at staff training records. They demonstrated that newly appointed staff undertake structured induction training. This includes providing an understanding of the principles of good care practices and covers the promoting of residents rights, independence, choice and dignity. We were shown a copy of the induction booklet Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: which is given to new members of staff. We examined a completed induction record which demonstrated staff are expected to complete them within 6 weeks of appointment. Training records we examined confirmed staff have been provided with mandatory training such as identifying and reporting abuse, fire safety, health and safety, first aid, infection control and food hygiene. Staff spoken to confirmed the training and induction training they had received. Records seen also demonstrated senior staff have received specialised training in chewing and swallowing, epilepsy and staff supervision. We observed staff on duty interacting with residents. This showed us that staff treat residents with respect and ensure their dignity is upheld. We were given copies of staff rotas to examine. They demonstrated that between 8am and 8pm each day there are at least two trained nurses on duty supported by a team of at least nine care assistants. From 8pm to 8am two trained nurses and two care assistants are awake and on duty to provide care and support to residents through the night. In addition there is a team of domestic and catering staff who are responsible for keeping the home clean and providing food for residents. Following discussions with the manager, with residents and relatives, observations of care provided and examining a selection of care records we concluded there were sufficient staff on duty to provide for the current needs of residents accommodated. Information provided in the AQAA confirmed that, We follow the homes recruitment procedure which is based on on equal opportunities. Service users are involved with the recruitment of staff. Support, training, supervisions are all carried out. Information provided also confirmed that of the 22 permanent care workers employed nine have the National Vocational Qualification (NVQ) in Care or Health and Social Care at Level 2 or above. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 care home is well run and in the best interests of residents. The views of residents and their families are sought as part of any self monitoring, review and development of the care home. The health, safety and welfare of residents and staff have been promoted. Evidence: Mrs Ivy McEwan is the registered manager and is responsible for the day to day running of Beechcroft Care Centre. She has been in post since the care home was first registered in April 2008. We were informed that representatives of the registered provider visit Beechcroft Care Centre each month. When we examined reports of such visits we could not find evidence that visits had been made in October and December. The manager confirmed that the visits have been carried out and that she has not received these reports. The manager agreed to ensure a copy of reports are kept in the home and available for Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: inspection. The manager informed us that the provider has an appropriate quality assurance system which is used to to monitor and evaluate the quality of care provided in each of their homes. We were also informed that the manager is expecting that the home will have its first evaluation in March 2010. We were shown records of staff supervision and staff meetings. They demonstrated that such meetings are held regularly and are used by the registered manager to communicate with staff and to ensure staff are appropriately supported. Staff we spoke to confirmed that such meetings do take place and that, as a result they felt well supported in their work. There is an internal system for staff to use to record and report any issues related to the maintenance of the premises to ensure any defects or repairs are dealt with in a timely manner. Residents and relatives we spoke to confirmed that the home has been well run and in the best interests of residents. We were also informed that meetings regularly take place between the manager, residents and their relatives to obtain their views and opinions regarding the running of the care home. Information provided in the AQAA confirmed that, Internal and external quality assurance audits are in place. Individual care plans are implemented and regularly updated and evaluated. Risk assessments are maintained. Service users are given access to speak with inspectors and social workers. Information in the AQAA also confirmed appropriate action has been taken to ensure the premises and equipment within the care home is safe for use. Gas and electrical appliances have been checked and maintained regularly. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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