Care Home: Beechcroft Retirement Home

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What the care home does well The people who live at the home remain cared for by staff team who are friendly, supportive and who understand their care needs. A core group of staff have worked at the home for quite lengthy periods of time and were clearly dedicated to ensuring that the peoples` care and social needs were met as best as they were able to. The people benefit from a "community spirit" within the home and are encouraged and enabled to socialise with each other as desired. The result of this is that people can benefit from companionship with each other as desired but can choose to "keep themselves to themselves" if they so wish. Beechcroft provides a clean, comfortable and spacious home for the people living there. Visitors to the home are encouraged and made welcome. What has improved since the last inspection? What the care home could do better: The care plan for each person, detailing the care to be given, should also contain a personal profile in relation to their personal social history prior to coming to live at Beechcroft. This is to ensure that staff, delivering care have a better understanding of the person prior to their admission. Advice sought from outside professionals, as well as agreement obtained from the person themselves and/or their family/advocate as to the use of any form of restraint i.e. the use of a cot side, should be recorded. This is to evidence that any form of restraint used is considered be all concerned to be in the best interests of the individual person in fully meeting their individual care needs, whilst at the same time respecting their right to freedom and choice. The home`s medication system should provide a photograph of each person on their medication administration record, which will help ensure that all the people, who live at the home, remain protected regarding the administration of their medication. The owners must ensure that the temperature of the hot water delivered to peoples` wash hand basins is risk assessed and subsequently regulated as deemed necessary to a safe temperature (approximately 43degrees Centigrade). The owners must also risk assess the shared bathing facilities, which also have unregulated hot water and provide water regulation as required. This is to ensure all people, who live at the home, deemed at risk, will be protected against sustaining a scald. General upgrading of the building should continue to ensure that the home provides an attractive well maintained, safe environment for the people to live in. To ensure that the people who live at the home are always protected, any care staff including staff from overseas awaiting the return of their Criminal Record Check, should work under supervision having a named supervisor recorded on their staff file until the required Criminal Record Check is returned and is deemed to be satisfactory. Training, specific to the needs of the people currently being cared for at the home, should continue to be provided.Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 8This refers to staff receiving training in dementia, and in providing appropriate care for those who are now very physically dependent so that staff are fully aware of how care should be delivered to all the people who currently live at the home. The owners should also continue to make national staff training available to allow the home to achieve its target of having 50 percent of the staff working at the home trained to NVQ level 2 in care. The owners should act on the information received, via their quality assurance systems, by producing an annual development plan for the home taking into account this information. The owners should then ensure those involved in providing this information are made aware of how their feedback has informed the owners and how any noted strengths can be built on or how any improvements needed could best be made. This is to ensure the home is always run in the best interests of the people who live there. The peoples` finances should be maintained in an appropriate manner. This means that each person`s monies, held by the home`s management, should be held individually and be available as required. This is to ensure that the people who live at the home can be sure that their monies are protected when held within the home. All record keeping should be maintained in accordance with the Data Protection Act 1998 requirements in ensuring peoples` right to confidentiality is maintained. In particular an individual record should be maintained, regarding any complaint/concern that is received, in respect of any individual person who lives at the home. The management of the home must inform the Commission of any serious illness or untoward incident affecting any person living at the home. This is so that the Commission can be aware of and monitor any such incident and therefore be aware how the organisation/home responds. This will help ensure the well being of the people is upheld. It should be noted that the owners made the Commission aware that they addressed these identified shortfalls immediately or shortly after this inspection informing the Commission of the actions taken to rectify them. CARE HOMES FOR OLDER PEOPLE Beechcroft Care Home Palermo Road Babbacombe Torquay Devon TQ1 3NW Lead Inspector Judy Cooper Unannounced Inspection 16th January 2008 9:45 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 Beechcroft Care Home DS0000071497.V360156.R03.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. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechcroft Care Home Address Palermo Road Babbacombe Torquay Devon TQ1 3NW 01803 327360 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) Beechcroft Retirement Home Ltd Vacancy Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places 360156 Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for max 24 (OP) service users. Date of last inspection 3rd August 2006 Brief Description of the Service: Beechcroft residential care home is a large Victorian building with a modern extension that was built several years ago. It is in the Babbacombe area of Torquay on Devons southwest coast. There is a large car park close to the home and a shopping area that is just a short walk away. This has all the usual amenities as well as tourist attractions such as a ‘model village’ and Babbacombe Downs. The home is registered to provide personal care for up to 24 people who fall into the ‘older people’ only category. The home benefits from a large level garden to the side of the premises, which is easily accessible from the home. The first floor of the home is serviced by a passenger lift and a chairlift. There is a staircase to the lower ground floor where the office, three additional bedrooms, a further lounge and bathroom can be found. There are 18 single bedrooms and two double rooms (19 with en suite) although only one of these is used as a double room. The management aim to accommodate the people for the rest of their lives, and deal with developing physical and mental health conditions as they occur. The current fee range is £338 to £385; with the actual fee dependent on care needs and the room occupied. The inspection report will be made available within the home’s entrance hall. Beechcroft Care Home DS0000071497.V360156.R03.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 stars. This means the people who use this service experience good quality outcomes. This site visit took place on Wednesday between 9.45 a.m. and 4.00 p.m. and two inspectors were involved in the inspection. Opportunity was taken to observe the general overall care given to the people who live at the home. The care provided for four of these people was also inspected in specific detail, from the time they were admitted to the home, which involved checking that all elements of their identified care needs were both assessed prior to admission and were then being met appropriately once the person came to live at the home. A tour the premises, discussions with both of the owners of the home, as well as discussions with the newly appointed manager for the home, other staff and some people living at the home were undertaken during this inspection. Staff generally were also observed, in the course of undertaking their daily duties. Surveys from 8 relatives, 4 service users and one visiting professional were returned to the CSCI and comments from these questionnaires have been incorporated within this report. Likewise information collected from all other sources has been used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well: Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 6 The people who live at the home remain cared for by staff team who are friendly, supportive and who understand their care needs. A core group of staff have worked at the home for quite lengthy periods of time and were clearly dedicated to ensuring that the peoples’ care and social needs were met as best as they were able to. The people benefit from a “community spirit” within the home and are encouraged and enabled to socialise with each other as desired. The result of this is that people can benefit from companionship with each other as desired but can choose to “keep themselves to themselves” if they so wish. Beechcroft provides a clean, comfortable and spacious home for the people living there. Visitors to the home are encouraged and made welcome. What has improved since the last inspection? The home’s statement of purpose is now available within the entrance hall, which ensures that anyone can have an understanding of what services and facilities are made available for the people who choose to live at the home. Some parts of the home’s environment have been improved since the last inspection in August 2006. For example the laundry area has been upgraded and a new bathroom has been installed since the last inspection. This was the major capital project for the home in 2007. Further upgrading continues to be undertaken and has been planned to help ensure that the people will benefit from an attractive and pleasant home setting (at the time of the inspection the home’s dining room was being redecorated). The people who live at the home have noted the improvements with one person stating that they had been here for eighteen years and: “It is better than ever now – more friendly.’ Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 7 What they could do better: The care plan for each person, detailing the care to be given, should also contain a personal profile in relation to their personal social history prior to coming to live at Beechcroft. This is to ensure that staff, delivering care have a better understanding of the person prior to their admission. Advice sought from outside professionals, as well as agreement obtained from the person themselves and/or their family/advocate as to the use of any form of restraint i.e. the use of a cot side, should be recorded. This is to evidence that any form of restraint used is considered be all concerned to be in the best interests of the individual person in fully meeting their individual care needs, whilst at the same time respecting their right to freedom and choice. The home’s medication system should provide a photograph of each person on their medication administration record, which will help ensure that all the people, who live at the home, remain protected regarding the administration of their medication. The owners must ensure that the temperature of the hot water delivered to peoples’ wash hand basins is risk assessed and subsequently regulated as deemed necessary to a safe temperature (approximately 43degrees Centigrade). The owners must also risk assess the shared bathing facilities, which also have unregulated hot water and provide water regulation as required. This is to ensure all people, who live at the home, deemed at risk, will be protected against sustaining a scald. General upgrading of the building should continue to ensure that the home provides an attractive well maintained, safe environment for the people to live in. To ensure that the people who live at the home are always protected, any care staff including staff from overseas awaiting the return of their Criminal Record Check, should work under supervision having a named supervisor recorded on their staff file until the required Criminal Record Check is returned and is deemed to be satisfactory. Training, specific to the needs of the people currently being cared for at the home, should continue to be provided. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 8 This refers to staff receiving training in dementia, and in providing appropriate care for those who are now very physically dependent so that staff are fully aware of how care should be delivered to all the people who currently live at the home. The owners should also continue to make national staff training available to allow the home to achieve its target of having 50 percent of the staff working at the home trained to NVQ level 2 in care. The owners should act on the information received, via their quality assurance systems, by producing an annual development plan for the home taking into account this information. The owners should then ensure those involved in providing this information are made aware of how their feedback has informed the owners and how any noted strengths can be built on or how any improvements needed could best be made. This is to ensure the home is always run in the best interests of the people who live there. The peoples’ finances should be maintained in an appropriate manner. This means that each person’s monies, held by the home’s management, should be held individually and be available as required. This is to ensure that the people who live at the home can be sure that their monies are protected when held within the home. All record keeping should be maintained in accordance with the Data Protection Act 1998 requirements in ensuring peoples’ right to confidentiality is maintained. In particular an individual record should be maintained, regarding any complaint/concern that is received, in respect of any individual person who lives at the home. The management of the home must inform the Commission of any serious illness or untoward incident affecting any person living at the home. This is so that the Commission can be aware of and monitor any such incident and therefore be aware how the organisation/home responds. This will help ensure the well being of the people is upheld. It should be noted that the owners made the Commission aware that they addressed these identified shortfalls immediately or shortly after this inspection informing the Commission of the actions taken to rectify them. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 9 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. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 10 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 Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 11 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): Standard 3 (standard 6 is not applicable as the home does not provide intermediate care) The quality in this outcome area is adequate. The home’s pre-admission assessment processes do not always provide enough information to ensure that all staff would be aware of a new person’s needs/past history. The home’s admission criteria needs to be clear as to what categories of people the home will provide care for so that the appropriate category (ies) of people are cared for at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s statement of purpose and service user guide was now available within the entrance hall. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 12 The owners stated that they had recently completed these documents, which were sited within the home’s entrance hall lobby. One person had only just been admitted to the home and their admission process was looked at. The person stated that they had not chosen this home, but had been helped by a social worker. The assessment of the person had been carried out over the telephone with the help of an advocate. The management had not visited this person prior to admission. The assessment was noted as not having been signed as being agreed by the person to receive the care. The person’s pre-assessment details were fairly informative however, there were little details regarding the person’s past history prior to admission. (This was also the case for several other people whose care was looked at in detail). Another person stated that they had been helped by their relatives to choose Beechcroft, and had visited before moving in. People either had a Social Services contract or a private contract. Since the last inspection it was also noted that the management of the home has admitted one person with diagnosed mild dementia and another through the involvement of the older person’s mental health team. Other established peoples’ needs had also increased significantly, for example three people are now completely physically dependent and need help both in and out of bed, being unable to weight bear. With the level of providing care to people in these different categories increasing, additions to the categories of registration should be considered as some people being cared for no longer just fall into the “older person’s” category which is the only category the home currently is registered to provide care for. This was discussed with the owners at this inspection. Prior to any application being made, in respect of the home being registered to provide care to different client groups, the registered owners would need to provide appropriate, specialist training, ensure the environment is suitable and that staffing levels are adequate to meet the needs of the different client groups to be cared for. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 13 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 The quality in this outcome area is good. People are looked after well in respect of their health and personal care needs and their privacy and dignity upheld whilst their life style choices are respected. A few small additional measures need to be put in place to fully ensure peoples’ medication is administered as safely as possible and risk assessments in relation to the use of cot sides also support the use of a cot side. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for the people whose care was looked at in detail were inspected. They were seen to be up to date with reviews regular carried out. It was noted that the person and/or their advocate was only involved in the review every six months whilst, on a monthly basis, it was the carers that undertook the review. A comment received from a relative of a resident: Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 14 It would help if each care plan had a list of all the resident’s requirements on a daily basis (i.e. help getting dressed, washing, taking of medicine etc). The staff could then tick or initial a box to show that the task had been done. Then visiting family could look at the chart and see everything is being done on a daily basis. However, there were detailed professional daily records available, which were used to inform the care plans with any changes required noted down. There were risk assessments in place in relation to moving and handling and pressure area care as well as the use of cot sides where used. However it was noted that, although the risk assessments in relation to the use of cot sides (where used) were detailed, the owner had completed these without documenting the involvement of a District Nurse or an Occupational Therapist etc who the owner stated had been originally involved in the decision to use such measures. A visiting G.P. stated: The service communicates well with myself and on behalf of the people and their families. A good service is provided. The home’s medication systems were inspected. Medication administration records were noted as in order with medications administered signed for appropriately. The newly appointed manager stated that trained staff only administer medication. A photograph of the person was seen to be on some peoples’ individual medication records, although in some instances some of these were missing. Having a photograph of each person does help ensure that all staff are fully aware of which person corresponds to which name, this is particularly important as the new manger informed the inspector that it was the management’s intention to have as many staff as possible be able to administer medications in the future. There was a copy of all current staffs’ signatures, who are deemed qualified to dispense medication. Therefore it would always possible to quickly independently identify which staff member had administered medication at any one time. One person is on a medication that needs continual monitoring and it was noted that up-dates about the dosage of the medication were displayed on a white board in the staff room so that all staff remain informed which helps protect the person in respect of this. Self administration of medication is encouraged where possible and it was pleasing to note the detailed risk assessment in place in respect of one person whose self medication record was checked. This should ensure the person remains protected whilst self administering and with the assessment being regularly reviewed it should alert staff if there were Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 15 any changes that may affect the person’ ability to continue with the practice safely. The people spoken with during the inspection felt that they were treated with respect and that their dignity was preserved and it was noted that staff interacted in a professional and relaxed manner, which helped foster good communications within the home. It was noted that individual preferred terms of address were being used by the staff, for example one person was referred to by her chosen name. The dependency levels within the home vary greatly with some people who live at the home being relatively independent whilst others are very dependent (as detailed within the previous section entitled: CHOICE OF HOME. For example, one person is very dependent with severe physical disabilities and is wheelchair bound. However the person is unable to get to the home’s communal shower because they cannot use the stair lift to the lower ground floor, and is unable to use the bath on the top floor because they are too heavy for the hoist. Therefore the person is washed in their room. However it pleasing to note that the person is encouraged to have as much independence with this task as able, to help maintain their independence and dignity. The room allocated to the person, which they like because they see people coming and going, unfortunately has no en suite facility and as the communal toilets near their bedroom room are too small for a wheelchair user, the person has to be hoisted on to a commode in their own room. Another person is too anxious to leave her bed since falling and suffering a broken leg. This person was also noted as having some mental health needs. It was noted that the care plans referred to these needs and staff were aware of them and how to provide for the person’s needs. A relative of a person stated: Not able to keep in touch as X is now senile however the owners of the home keep me well-informed. Another comment received stated: I find Beechcroft excellent and feel confident that X is well cared for. This means I can relax and not have to worry about X’s day-to-day needs. I am very grateful to the owners for their professionalism”. Another comment stated: Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 16 In the short time X has been at Beechcroft all X’s needs have been fully understood and met. They are very caring. They contacted me immediately regarding an issue with X ‘s care needs ”. A resident stated: They are very keen on medical issues. Another person who was also noted as having mental health problems was receiving support from the Mental Health Team. Peoples’ personal preferences were being maintained for example, one lady at the home would prefer not to have a male carer to help with her bath, and this had been agreed. There was a weight chart in a communal bathroom, where weights of 7 people were recorded, however this information was all on one page and as such compromises a person’s right to their personal details being held individually, thus maintaining confidentiality, in accordance with the Data Protection Act 1989. The home was noted as having suitable pressure relieving equipment including pressure relieving mattresses and cushions. One person was noted as being in a reclining chair, with soft light and music playing and they stated they were comfortable like this and it was their choice. Food and fluid charts were also seen in bedrooms, with entries for the morning of the inspection signed and timed which evidences that adequate attention is paid to the peoples’ day to day care needs. Also it was noted that a member of staff always accompanies a person for any appointment such as a visit to the hospital etc. This is good practice and helps people feel confident of support. Another example of good care practice involves a person with sight loss living at the home. The staff maintain her bedroom in such manner as to ensure the person always knows where their belongings are and as the person prefers to have their bedroom door open, a device to allow this to happen safely has been provided whilst staff know to always leave the outside corridor light on at night time as it allows the person to feel more secure. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 17 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 The quality in this outcome area is good. People who live at the home stated that they enjoy living at the home, with visitors encouraged and welcomed. The home’s activity programme meets the needs of the current group of people. Staff respect peoples’ personal choices and the home provides good nutritious and varied meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several people at Beechcroft retain a relatively high degree of independence. During the inspection, some chose to remain in their rooms while others joined groups in the lounge. Very independent people who live at the home were noted as going for walks etc from the home. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 18 Many of the people were able to express themselves adequately and could exercise choices in their daily routine. People were seen relaxing, reading etc as they wished. One person said that they do not go to the lounge because so few of the other people who live at the home have any conversation. They also said that there used to be a person who would be constantly on the move and would go into other peoples’ bedrooms although this is not the case at the moment. This does suggest that some peoples’ behaviour is such that it has encroached on the pleasure of others. This may be due to the home providing care to people who have some identified mental health needs. The hairdresser was visiting at the time of this inspection and indeed it was noted that many of the ladies presented very well and were obviously keen to have their hair done regularly. The hairdresser had been a regular visitor for several years and was full of admiration for the service provided at Beechcroft stating: “Nothing’s too much trouble, they put on a fantastic pantomime at Christmas”. A person having their hair done stated: “It’s very good – I enjoyed my first Christmas here”. People said that they enjoy hearing the piano player who comes every month, and the harpist who was playing during this inspection. Brixham Activities have been engaged to provide a monthly outing, and people said they had enjoyed a cream tea outing at Babbacombe. They also said they enjoyed the garden in good weather, and that staff had time to take them out there. Feedback received from a resident stated: We have a lady playing the piano, we have a man playing the harp. Activities from a Brixham lady, bingo one or two afternoons a week. Cream teas on Babbacombe seafront (a speciality). A feedback comment received from a relative stated that they felt the following would be beneficial: If possible to provide more outside trips to give residents a change of scenery and some much-needed fresh air. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 19 Visitors are welcomed into the home and although none were noted to be visiting during this inspection, the visitors book evidenced that there were many visitors to the home at different times and people who live at the home said that they were free to have visitors as they wanted to. Menus were examined and a meal was taken with the people who live at the home. This was a relaxed, congenial and unhurried occasion and comments received about meals provided were favourable. The menus seen were based on a four week cycle with alternatives based on peoples’ needs and preferences. They appeared to reflect a varied and wholesome diet. At the time of inspection, there were some specific dietary needs such as providing for a someone who needed a low potassium diet. Their needs were fully understood by the home’s cook who has worked at the home for approximately seven months. There is always a cook on duty to cook the main meal of the day (lunch) and the home also employs a breakfast cook. People who live at the home stated that breakfasts are mostly taken in their own rooms, which they were happy with. Teas are prepared and given out by the evening care staff, with the lunchtime cook often pre-preparing the main supper dish. The menu of the day is displayed on a white board outside the dining room. There is usually the main dish displayed but people may request an alternative if they wish. From a feedback comment received from a relative it would appear not everyone is aware that choice is available as the comment stated: I feel strongly that there should be a choice with the main meal”. However, on the day of this inspection a choice was noted as being offered. Spaghetti bolognaise was the main course, but the cook was aware that as several people may not like it, savoury mince was also on the menu. Crème caramel or fresh fruit were offered for dessert. A feedback comment received from a person living at the home stated: That they would like more fresh food. However it was noted that both fresh fruit and vegetables are regularly provided, and the cook said that she also liked to provide home made puddings and cakes. Another feedback comment from a relative stated: The food at Beechcroft is always of a good standard with adequate portions. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 20 Some people need to have puréed meals. The cook stated that she does not currently puree the components of the meal individually but after a discussion with the inspector, during the inspection, she stated that she would try this as she agreed that this would be visually more appetising and allow the person concerned to be able to taste the individual components of the meal, therefore possibly increasing their enjoyment of their food. People generally are encouraged to come to the dining room, but six currently choose to take meals in their room. Staff were noted as speaking to the people, and recording their choices for tea, which was soup and a variety of sandwiches. Most people said that they enjoyed the food at the home. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 21 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 and 18. The quality in this outcome area is good. Arrangements for protecting people and responding to their concerns are such that they should be protected. Staff have an awareness of adult protection issues, which will allow them to maintain the peoples’ welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaint procedure is displayed communally on a notice board within the home’s hallway and within the home’s newly produced statement of purpose. Some feedback comments, however suggested that not everybody knew how to complain, for example one person stated, when asked: “Do you know how to make a complaint about the care provided by the home if you need to”? stated: “That presumably they would approach social services” whilst another ticked the box to say they did not know how to make a complaint. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 22 Staff stated that they had recently undertaken the protection of vulnerable adult training, and they were familiar with the principles of what constituted abuse and what they would do in the event of an allegation being made. The senior staff were due to undertake further training next week, which consisted of a foundation course in the protection of vulnerable people. The home’s adult protection policies and procedures were easily available and contained enough detail to ensure staff members were familiar with what to do if they suspected any abuse taking place. The home maintains a record of any complaints received and of what action has been taken to resolve the problem and it was to the home’s credit that this information was clear, concise and detailed. A feedback comment received from the family of a person at the home stated that they would appreciate a suggestion box to allow clients and families to make suggestions that they feel could improve the service. Each individual complaint/concern should however be recorded separately to protect each person’s right to confidentiality under the Data Protection Act 1989. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 23 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 and 26. Quality in this outcome area is adequate. Some ongoing general improvements/upgrading measures have allowed Beechcroft to provide a pleasant environment to live in. Further upgrading continues to be undertaken to ensure that the whole home is of a good environmental standard throughout. Lack of hot water regulation to a safe temperature may put people at risk of sustaining a scald. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On inspection the home was generally clean, comfortably furnished and well decorated and seen mostly to be in a good state of repair and decoration. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 24 There is level access around the ground floor, where the lounge and dining room are, and a lift to the first floor, a stair lift to the lower part of the first floor, and another stair lift to the lower ground floor. There is one step at the front door but a steel folding ramp is available in the porch. There is a level path with a good surface from the front of the house round the garden. There is only one communal lounge, but it is large enough for separate activities to take place at the far end where there is a table and chairs, piano and large flat screen television. Four ladies regularly sit here for lunch, which is their personal choice. This is also very suitable for people who do not like to eat in a large group, including one person who has breathing difficulties. The home’s dining room was in the process of being redecorated at the time of this inspection. There is solid wooden furniture, with some carver chairs provided to help maintain peoples’ independence. The lounge windows face south on to the pleasant and accessible garden. People also enjoyed being able to see across Cary Park, to see the public out and about and playing sports. The owners are currently upgrading the two communal toilets on the ground floor, close to the lounge and dining room. The owners also stated that they are currently seeking planning permission for an extension, which would include the installation of an accessible bathroom on the ground floor. (An accessible communal toilet, close to the lounge and dining room would also be an asset for the people who live at the home). There is a communal bathroom on the top floor with a hoist, and an accessible communal shower on the lower ground floor. The water in the hot tap of the bath was not regulated to a safe temperature being noted as running at 58 degrees centigrade as measured at the inspection with the digital thermometer left for staff to record bath temperatures. The bathing record showed that the temperature is recorded each time someone takes a bath, and that this is usually around 38 degrees. However this safe temperature is solely reliant on staff members running the water and testing it prior to someone having a bath. It could prove a danger for a person to run a bath unsupervised and not test the water before submersion. Water in all bedroom hand basins that were inspected again had water that was a similar hot temperature (around 58 degrees). Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 25 Risk assessments for all these hot water outlets and subsequent regulation to a safe temperature, have not been completed, which means that the people are not fully protected from the risk of sustaining a scald. As the owners are now accepting/maintaining more people who have some diagnosed mental health/dementia/increased physical needs it is important that this work is undertaken s soon as possible to ensure all people who live at the home are protected as required. However it should be stated that immediately following this inspection the owners undertook risk assessments and have already provided some additional water regulators. Accessibility around the home is provided by stair lifts and a shaft lift. Rooms 20 and 21 have four steps to reach the level of the lift. One of these was being used for staff accommodation at the time of this inspection. The other was occupied by a person who needed help from staff to get up or down these stairs, so her independence was restricted. However, the owners stated that they planned to keep this person in this room for as long as possible, because they can smoke there without inconveniencing other people. The bedrooms visited were light and warm, with suitable furniture. The radiators, in bedrooms, were covered to protect people from potential harm, and the temperature could be regulated in each room. Radiator guards were provided throughout the rest of the house, except in the top bathroom. The owners said that this radiator was not working, and as the room is warm enough without further heating there is no need for a cover to be fitted. Rooms had views across the park, street or gardens. Family photos were seen in many. Privacy locks were fitted to bedroom doors, with a small knob on the inside so that people might lock them with no danger of losing the key, and a keyhole on the outside for if they wished to secure their belongings while they are away. However when inspected they were not seen to be easy to operate and as such may not be fully effective in helping people who live at the home maintain privacy. There is a lobby on the lower ground floor, beside the lockable medication room, used by staff to sit and write care notes which is sufficiently private for confidential discussions. There is also a small bedroom on the top floor used by staff for sleeping in. The laundry has had a good flooring surface laid since the last inspection. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 26 There are two deep sinks, one for soaking soiled items, the other for hand washing and flower vases. There are adequate laundry facilities to undertake the personal items of laundry that the home undertakes for the people who live at the home. The owners maintain a contract with a local laundry for the laundering of sheets and towels. Towels and bedding are stored on open shelves, but there is plenty of space. Each person had a labelled plastic box, but these were all empty with nothing left lying around or waiting to be delivered. No person complained of any problem with the laundry service. Disposable gloves and aprons were seen being used where personal care was given. Liquid soap was available in some bedrooms and bathrooms, but was temporarily unavailable in the communal toilets. Generally good housekeeping meant there were few items left out, but in the lower ground floor shower it was noted that there were three bars of old soap and a toilet cleaner, which was not put away. This could be a risk for someone with mental health needs who may not recognise the danger of chemicals. However people overall seemed happy with the cleanliness of the home with two peoples’ feedback comments stating that the home: Provided excellent cleanliness”. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 27 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. The quality in this outcome area is adequate. Staff at the home are employed in adequate numbers to meet the peoples’ personal care and social needs. However, the home’s recruitment programme was not always fully protecting people who live at the home. EVIDENCE: At the commencement of the inspection one of the owners, Mr Gow-Smith was on site. The deputy manager was in charge of care (8.00a.m. until 2.00p.m), supported by two carers, a cook and a cleaner. The rota showed that there are normally two cleaners, but one had been asked to work at the owners newly acquired second home on the morning of the inspection. There were mixed comments received regarding the staffing of the home from relatives and residents. The following are a few examples of comments received: One relative’s comment received stated: “There is not enough staff to enable a good rapport with each client, and allow staff to have the time to chat. If someone wants to get out they can, but only Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 28 on their own as there isn’t enough staff to take people out if they need a hand”. Another relative comment stated: Very caring people. However the same person stated that sometimes staff, being extremely busy, did not always have the time to keep an eye on little things such as checking personal bedrooms to ensure that food, taken by relatives, does not go off and that flowers are kept in fresh water. An example was given of flowers being kept in the same water for three weeks, which then caused the water to become stagnant. A residents comments stated: A shortage of staff means I do not get the support as I would like at times. However other comments from relatives stated: Overall the staff have the necessary skills and experience to look after people properly. It seems a very friendly and homely place and X sees to be very happy living at Beechcroft ” They all always act in a very professional, caring and friendly way. They care for X in a relaxed friendly way. X has improved since being here, putting on weight and looking so much healthier and well groomed. “There has been increases in turnover of personnel but all would appear to be caring and put service users’ needs to the forefront”. People, spoken to, stated that they did not wait long if they call for help and that staff overall were kind and helpful. One said that there are sometimes difficulties understanding what is being said in respect of some of the overseas staff and a feedback comment received from a persons family stated that: I often hear them say what did she/he say in respect of overseas staff, as “Some have poor English”. The home owners said that they do try to ensure that an overseas person, with poor language skills, is always on duty with someone who can interpret if necessary, but they agreed that there had been a recent incident where this had not happened and it had caused a communication problem for the person concerned. There was an induction programme in place and completed records were seen. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 29 The deputy manger stated that she had two appraisals last year with the home owner. She stated that she had prepared for it beforehand, and was given feedback on her performance as well as consideration of her training needs. Some supervision records referred to actual observation of staff carrying out their work. A record of training was kept on behalf of each staff member, as well as a chart, which summarised the training undertaken. This showed that care staff had received moving and handling training in August 2007 and most staff had attended the fire training in November 2007 whilst other training provided had included the protection of vulnerable adults, first aid, control of infection and health and safety. Three senior staff had attended a training event on mental health awareness, however further training, to meet the other specialised needs of the people who currently live at the home, would be advisable to ensure that the care staff have the skills needed to meet the needs of the all the people who live at the home cared for. Recruitment records were looked at for the staff employed at the home since the last inspection. They were mostly in order, however British Criminal Record Bureau checks had not been undertaken for those staff employed from overseas and a check was outstanding for another employed member of staff. Neither was there a named supervisor for these staff, of whom who were already working within the home, providing personal care. A new overseas staff member had just arrived on the day of the inspection. The home uses the services of an employment agency to help in the recruitment of overseas staff and although relevant details are obtained from the agency a British Criminal Record Bureau check is not undertaken by the agency and had not been undertaken by the owners. This means that the owners would not be aware of any convictions of any overseas person if a person had been in this country prior to commencing work at the home. This could compromise peoples’ safety. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 30 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): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is good. The management of the service has recently changed significantly. The previously registered manager (who is also the registered provider for the home) is however currently supporting the newly appointed manager for the service to ensure that the home continues to be run in a professional manner and in the best interests of the people. Adjustments to the way peoples’ monies are held, within the home, need to be made to ensure that they can always be individually available on demand. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 31 Since the last inspection the owners have made some major management changes. One of the owners previously undertook the management of the home, following the resignation of the previously registered manager shortly after the owners took over the running of the home in 2006. This worked well and the owner was liked and respected by the people and the staff at the home. A feedback comment received from a relative stated: X is very happy at Beechcroft and overall I think it is very well-run. I feel that this is mainly due to the fact that is run by the owners, (Mr. and Mrs. Gow-Smith). I and my family are very happy with the way Beechcroft is run and would not wish for X to be anywhere else”. However, due to the acquisition of a second residential establishment the owner has now had to manage that establishment with the sudden departure of the registered manager designated for the second home. This has meant that Beechcroft was without a registered manager. Consequently the owners appointed a new manager who was previously the deputy manager at the home and who has had several years working at a senior level in care. The appointment is very new, having only been made two days before this inspection took place. The new manager, although very professional in approach, has yet to become familiar in her new role of manager. She has an NVQ level 3 award in care and although does not already possess the qualification is committed to undertake the Registered Manager’s Award, necessary for this post. The owners have also commenced the registration process to allow the new manager to register with this Commission and undergo the necessary vetting process required to establish her fitness to become the registered manager for the service. However until this has occurred the owners will remain accountable for the running of the home. The owners stated that “service users” meetings are held, and staff also confirmed that staff meetings are also held so that they can address any issues raised. Those spoken to stated that they found the owners and the newly appointed manager approachable. Accident reporting was noted as in order, within the home, and the home had let the Commission know of any deaths that had occurred. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 32 However, it was noted in the accident reporting that there had been a fall, which had resulted in a serious injury (fracture) in respect of one person, whose care was inspected, with the person being in hospital for about six weeks, and since discharge, the person has become bedfast. The management must ensure that the full details regarding the circumstances of any serious incident or accident such as this, appertaining to any person living at the home, are forwarded to the Commission to allow the Commission to be able to monitor the situation and ensure correct action has been taken, which will help to protect the people at the home. The home’s Annual Quality Assurance Assessment had also referred to nine admissions to the local accident and emergency unit. The owners had commenced quality auditing within the home and had requested and received some feedback from the people who live at the home and from their families/advocates. However this information has not yet been collated into a formal quality auditing system, which when undertaken will allow the management to see what strengths and weaknesses the home has and then use this information to better the service provided. The people involved in providing this feedback, have not yet been made aware of how their views will be acted upon or taken into account in the future planning for the home. The owner stated that the home’s health and safety procedures were being maintained as required and the home’s fire log book was seen to be in order. Monies held on behalf of the people were checked. The current system in place is such that it is classed as a collective system, which means the owner balances all the peoples’ monies together. This should be changed to allow each person’s monies to be held individually and accounted for separately. Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 33 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 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 x x 2 Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? NO (none issued) 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 OP25 Regulation 13(4)(c) Requirement The registered owner must ensure that unnecessary risks to the health or safety of the people are identified and so far as possible eliminated. This refers specifically to completing individual risk assessments in relation to: unregulated hot water throughout the home. This so that the people who live at the home can live in a safe, risk free environment 2 OP37 37 1(d) The management must ensure that the full details regarding the circumstances of any serious illness, appertaining to any person living at the home, are forwarded to the Commission. This is so the Commission can monitor any such events and ensure correct action has been taken which will help to protect the people at the home. 16/02/08 Timescale for action 16/03/08 Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP7 Good Practice Recommendations The consultation process regarding the use of restraint measures such as cot sides should always be fully documented. The care plan for each person, detailing the care to be given, should also contain a personal profile in relation to their past history prior to coming to live at Beechcroft. The home’s medication system should provide a photograph of each person on each medication administration record General upgrading of the building should continue to ensure that the home provides an attractive well maintained, safe environment for the people to live in. Any care staff, including staff from overseas, awaiting the return of their Criminal Record Check, should work under supervision, having a named supervisor recorded on their staff file until the required Criminal Record Check is returned and is deemed to be satisfactory. The owners should also continue to make national staff training available to allow the home to achieve its target of having 50 percent of the staff working at the home trained to NVQ level 2 in care. The owners should ensure that the staff, working at the home, receive appropriate training for the work they do. The newly appointed manager should continue her registration with the Commission. The owners should act on the information received, via their quality assurance systems, by producing an annual development plan for the home taking into account this information. DS0000071497.V360156.R03.S.doc Version 5.2 Page 36 3 4 OP9 OP19 5 OP29 6 OP27 7 8 9 OP30 OP31 OP33 Beechcroft Care Home They should also ensure those involved in providing the information are made aware of how their feedback has informed the owners as to how they feel the home operates and if any improvements could be made. 10 OP35 The peoples’ finances should be maintained in an appropriate manner. This means that each person’s monies held by the home’s management should be held individually to be immediately available as required. The owners should ensure that confidential information regarding the people at the home is protected by the systems and practices in the home. 11 OP37 Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 37 Commission for Social Care Inspection South West Regional Contact Team Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI Beechcroft Care Home DS0000071497.V360156.R03.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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