Care Home: Beechdale House Care Home

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What the care home does well The home provides a warm and friendly environment. The staff team have many years experience and they are supervised closely by the manager who has been in post for many years. The manager ensures that staff receive regular training to keep their skills up to date. Residents and relatives tell us that the staff are very friendly and helpful and work well as a team. What has improved since the last inspection? The manager has improved on the systems in place for controlling the safety of the environment to ensure that any risks to the safety of residents is reduced or eliminated. What the care home could do better: The manager is ensuring that the National Minimum Standards are met and continues to improve the services in line with changes in legislation. We have made recommendations only as part of this inspection, mainly to ensure that care plans are dated and signed to show who is involved and to monitor the staff files to ensure they are kept up to date and compliant with regulations. The manager should also ensure that the staff team understand new ways of working with the implementation of the Mental Capacity Act training and associated safeguards around best interest decisions. Key inspection report Care homes for older people Name: Address: Beechdale House Care Home Beechdale Rd Aspley Nottingham NG8 3EZ     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: Mary OLoughlin     Date: 0 7 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 Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Older People Page 3 of 24 Information about the care home Name of care home: Address: Beechdale House Care Home Beechdale Rd Aspley Nottingham NG8 3EZ 01159292792 01159426094 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: B L Premier Care Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category terminally ill Additional conditions: Within the total number of beds two beds may be used for the category of TI. Within the total number of beds ten may be used for category of DE(E) Date of last inspection Brief description of the care home Beechdale House is registered to provide 40 places for older people. The home is accessible to wheelchair users and has a passenger lift to the first floor. Set in its own grounds with an enclosed rear garden it is situated on a bus route and is close to shops. There is information on the services and facilities available within the homes statement of purpose which is available on request. The most recent inspection report is also Care Homes for Older People Page 4 of 24 Over 65 0 40 0 10 0 2 1 8 0 3 2 0 0 9 Brief description of the care home available at the home. The weekly fees range from £356-£380 extra charges are made for chiropody and hairdressing. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission(CQC) is upon outcomes for the people using the service and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of the service that need further development. Prior to our visit an analysis of all the information we have received about the home since our last inspection was undertaken. We looked at what the responses we received from our Have Your Say surveys which we sent to residents and staff at the home told us. The main method of inspection used was called case tracking, which involves looking Care Homes for Older People Page 6 of 24 at the quality of care received by a number of people living at the home.We use evidence from our observations, from speaking to people about their experience of living at the home, talk to staff about their understanding of peoples needs and the training they receive to support them in their role. Care Homes for Older People Page 7 of 24 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 Older People Page 8 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures that people receive a full assessment before admission is planned and that they are provided with information about the home, its facilities and services. The home does not provide intermediate care services. Evidence: We saw records of a recently admitted person that showed the staff had obtained lots of information about the person before they were admitted to ensure that they were able to provide suitable facilities and services for them. The manager and senior staff have been trained in new ways of working which ensure that residents are supported to make decisions about their care. The care plans we looked at showed that external professionals were involved in supporting people with no relatives of their own and who were unable to make their own decisions. Care Homes for Older People Page 10 of 24 Evidence: 3 residents responding to our surveys told us they had received enough information to help them decide if the home was right for them. Staff told us in our surveys they had received training relevant to their role which helped them understand and meet the individual needs of people, it kept them up to date and gave them knowledge about health care and medication. A relative said, my relative had respite stays at the home and then came to stay 18 months ago, I have been very satisfied with the care provided. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health monitored and receive their medicines safely. Evidence: 3 Residents responding to our surveys told us they always got the medical care they needed. One relative told us, They look after the people very well by keeping them clean, happy and entertained. My wife has dementia and I cannot praise the staff highly enough, all the staff. Another told us, My impression is that the manager and staff act speedily to any medical care needs and all the staff establish a caring relationship with each resident. The 5 staff surveys told us they always or sometimes felt they had enough support and experience to meet the different needs of people at the home and always or sometimes had enough staff. Comments were, I enjoy working here, all staff are helpful to each other We work well together making sure residents are safe Care Homes for Older People Page 12 of 24 Evidence: We looked at 3 care plans and saw that each person was regularly assessed for any risks to their health. Where required a plan of care was developed to advise staff on how to monitor and support the identified needs of the person. Not all identified risks had a suitable care plan that described the necessary actions to manage the risks, staff explained to us that they knew people well and felt it was not always necessary but recognised that people who may not be familiar with residents needed to know. They agreed to ensure that all risks had a care plan in place as part of the person centred planning improvements. The staff are receiving training on person centered planning and we saw how they had started to complete a record of each persons individual needs and preferences, the manager agreed to ensure these would be dated and signed to make sure they were kept up to date and relevant. We saw that staff store and administer medicines safely and in accordance with the prescribed times. Only trained nurses administer medicines. The residents we spoke with told us they felt well cared for and found the staff to be very good with them. We observed staff maintaining peoples dignity throughout the inspection. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are arranged and people receive appropriate nutrition. Evidence: The 3 responses we received from residents at the home told us that they usually have opportunities to take part in activities and a relative told us, The home is so friendly and there are many activities that the staff put on such as singalongs, visiting markets outside and river trips as well as parties for special occasions. Residents we spoke with during the inspection told us they were happy with the daily activities and events. The manager told us she is working to improve the way activities are organised and is planning on training staff in the provision of suitable activities for people who suffer from Dementia. Although we saw that there were opportunities for religious observance in the home,the care plans we looked at did not have sufficient information on the spiritual needs of each resident and it was unclear if staff had discussed this with residents. The manager agreed to use this information as part of person centred planning in Care Homes for Older People Page 14 of 24 Evidence: future. We saw that staff understand the importance of suitable nutrition, they have received training on how to feed people safely and to support people who are unable to eat a normal diet. They regularly weigh residents and assess them for any nutritional risks to ensure that they are receiving appropriate nutrition. We observed the lunchtime meal and found that staff supported people properly, they took time and maintained dignity when assisting people to eat. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a suitable complaint procedure and staff are trained to recognise and respond to any abuse. Evidence: The information we received from residents both within our surveys and from speaking to them during the inspection was that they felt safe at the home, thought staff listened to them and acted on what they said. We saw that residents and relatives have access to a suitable complaint procedure and that the manager holds records of all complaints and the outcomes to them. The manager also ensures people can have their say during monthly meetings, both residents and relatives are invited to attend at the home. The Commission have not received any complaints about the service and no safeguarding investigations have been alerted to us. The training planned for staff during 2010 includes how to manage people who may exhibit challenging behaviour which will ensure that they know how to maintain people safely if this occurs. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and people tell us they find it homely and comfortable. Evidence: The home was found to be clean and warm. Residents told us they liked the environment and felt it was always kept fresh and clean. Improvements have been made to the management of hot water since our last inspection. The hot water is now regulated to ensure that there are no excessive hot water temperatures that could harm people. The manager told us that they are in the process of reviewing a policy for the control of Legionella and we saw that they had undertaken testing to the water systems to ensure they were safe. The manager confirmed that window restrictors have been fitted to the first floor windows for safety. The home have received a full infection control audit from the primary health care infection control teams and a further visit is planned by them to assist the manager with any required improvements. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team are safely recruited and trained in the needs of the people they care for. Evidence: Residents and relatives who responded to our surveys told us that there was always enough staff on duty to care for them. Each response gave us very positive information about the staff team, examples of the comments from relatives are; All the staff try to establish a caring relationship with the residents I cannot praise the whole staff team enough, there is a home closer to me but the staff at Beechdale House are so friendly I prefer to travel further to visit Residents we spoke to during our inspection said the staff were very good to them and especially the manager We looked at 3 staff recruitment files and found that some information was missing for staff who had been working at the home over many years, the manager took immediate action to ensure all staff files were audited and confirmed to us after the inspection that all appropriate documentation was now in place. Care Homes for Older People Page 18 of 24 Evidence: All 5 staff returning our surveys told us they found their induction covered everything they needed to know when they started and all 5 confirmed the employer had carried out checks before they started. We saw records of induction training during our inspection and ongoing training for staff which ensures that people are in safe hands. The 5 staff returning our surveys said they had training relevant to their role which kept them up to date with new ways of working and helped them understand the needs of people. They also said they received training in medication. The training records we viewed showed that the manager ensures staff receive regular updates in training to make sure the care practice is up to date. Staff comments included, I have been working here for 5yrs and its a pleasure to come to work in the morning management and nurses are very helpful we work well as a team and provide good quality care Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of the people who live there. Evidence: 3 Responses to our resident surveys all told us that the home was managed well, people commented, Beechdale house is very well managed, the manager has the ability to motivate the staff in the day to day running and decision making. On entering the home it is bright, clean and relaxed, with all the staff working as a team. The manager has been in post for many years and has extensive experience in the nursing care of older people. The records we looked at showed that she continues to attend training to update her skills. We found the home was organised and record keeping was up to date. The staff team were supporting residents in a timely way. The manager told us that they continue to monitor the quality of the services provided Care Homes for Older People Page 20 of 24 Evidence: through regular consultation with residents and their families. They also send out quality questionnaires each year to all residents. The management of personal finances has improved, the manager now ensures that anyone who is unable to manage their own finances has access to legal representation to protect their interests. The management of health and safety has improved and the requirements we made at our last inspection have been addressed. The hot water is now properly monitored and window restrictors are in place on the first floor. The handyman has responsibilities for the management of regular testing to comply with health and safety legislation. We saw that the manager has recently completed fire risk assessments and ensures that the fire detection system is regularly tested. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 8 Always sign and date care records and record the involvement of the resident or their representative. Always write up a care plan when risks are identified through assessment so that anyone not familiar with the person knows how to manage the risks safely. Sign and witness hand written medicines. Develop a written programme of activities that is provided to residents in a suitable format. Care plans should reflect how the spiritual needs of each person are being supported. A regular recorded audit of staff files should be undertaken to ensure they contain all the required information and renewal PIN numbers for trained nurses. Training for staff in The Mental Capacity Act should be completed. 3 4 5 6 9 12 12 29 7 30 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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