Care Home: Beeches Care Home (Arnold)

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What the care home does well People that live in the home are given the opportunity to participate in a variety of recreational activities and go on trips outside the home. The home has robust recruitment procedures in place. A health professional told us, `Staff are very informative and responsive` and `staff always seek advice and act upon it to manage and improve health care needs`. On the day of the inspection we found the management to be accessible and available for people to approach. Discussions with people living and working in the home supported this. What has improved since the last inspection? The home has the current local safeguarding referral procedures in place and staff have a good understanding of how to safeguard people from abuse. The home now has a registered manager with the required qualifications in place. More activities and trips out have been introduced to the home. What the care home could do better: Each service user must be issued with a copy of the service user`s guide on admission and have access to the homes statement of purpose. Nutritional charts in care plans must be completed and information given on what action staff should take if a person is deemed, `at risk`. If people go to bed before the evening drink and snack is served then it must be recorded in their care plan that they must be offered this in their bedroom and a record made to say if they have received it each day. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beeches Care Home (Arnold) 55 Furlong Street Arnold Nottingham NG5 7AJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynda Dyer     Date: 1 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 27 Information about the care home Name of care home: Address: Beeches Care Home (Arnold) 55 Furlong Street Arnold Nottingham NG5 7AJ 01159262838 01159204397 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Healthcare Services Ltd care home 54 Number of places (if applicable): Under 65 Over 65 45 0 0 old age, not falling within any other category physical disability terminally ill Additional conditions: 0 4 5 Within the total number of beds a maximum of 4 beds maybe used for the category PD, where service users will be aged between 50 and 65 years. Within the total number of beds a maximum of 5 beds maybe used for the category TI Date of last inspection Brief description of the care home The Beeches was opened in 1995 and is situated close to the centre of Arnold in Nottingham. It is a two-storey building, with one large lounge, incorporating a designated dining area. There are four bathrooms, of which two are fitted with an assisted, bathing hoist and one with a Parker bath and two separate shower rooms. All of the homes bedrooms are single with the exception of one, and twenty-eight of the bedrooms have an en-suite facility. Four adjoining rooms are available. There is a passenger lift. The home has a compact garden that is well maintained and easily accessible. Care Homes for Older People Page 4 of 27 Brief description of the care home Fees for The Beeches range from £355 - £652 per week. Care Homes for Older People Page 5 of 27 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 is upon outcomes for people who live at the home 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 service provision that need further development. The last time we visited this service was April 10th 2007. We, as it appears throughout the Inspection Report refers to The Care Quality Commission. One inspector carried out an unannounced site visit to the agency, which took place Care Homes for Older People Page 6 of 27 over 6 hours. The Registered Manager and operational manager assisted us during the site visit to the home. We found the management and staff to be very helpful and friendly during the inspection. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service, this is called an AQAA (Annual quality assurance assessment). We received the AQAA back from the manager in good time. The form was completed well and gave us all the information we asked for. We also sent out surveys called, have your say, to people who use the service, staff that work there and relatives. This meant we could get an idea of what people thought about the way the agency was run. We had 16 completed surveys back and we have included some of the comments in this report. We have not included comments that could identify the writer as we want people to feel they can be open about the way they feel the service is run. We also reviewed all of the information we have received about the agency since we last made a visit to them and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing three people who use the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with the manager, three members of staff, five people who live in the home and three visitors to help us to form an opinion about the quality of the service being provided to people. We read documents as part of this visit and looked at the environment to form an opinion about the health and safety of people who live in the home. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. 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 set out 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 27 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 27 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. Peoples needs are assessed before they move into the home so that staff know how to care for them. Evidence: The manager told us in the Annual Quality Assurance Assessment that all new service users receive a comprehensive needs assessment prior to admission. This is carried out by a suitably qualified member of staff in either their own home, in hospital or other establishments. We viewed three care plans as part of our case tracking methodology and all three contained the required pre admission assessment. We spoke with people living in the home and they told us that they had plenty of chance to visit the home before deciding to live there. Care Homes for Older People Page 10 of 27 Evidence: Information we received from surveys and from speaking with people on the day of the inspection told us that generally people receive the required information before they move into the home. However there was occasion when this information was not given. The home does not offer intermediate care. Care Homes for Older People Page 11 of 27 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 living in the home have their healthcare needs met and the homes medication systems are safe. Evidence: The manager told us in the Annual Quality Assurance Assessment (AQAA) that service users care files identify the individual needs that enable the staff to care for them in a personal and individual manner. These are reviewed monthly or more often if necessary. Service users have access to all areas of health care such as hospitals and community medical services, chiropody and pharmacy. We have named linked nurses for tissue viability, continence and have a key worker system in place within the Home. Medication is administered by the nurses and all staff who administer medication have had all of their medication training. Surveys received back from people living in the home told us that people felt they received medical support and received the required care from staff. Care Homes for Older People Page 12 of 27 Evidence: Surveys received back from staff told us that they felt they received up to date information about the people they supported. I spoke with two members of staff about the care needs of two people living in the home and the staff demonstrated a good range of knowledge of the care they needed to deliver to those people. A health professional told us, Staff are very informative and responsive and staff always seek advice and act upon it to manage and improve health care needs. We viewed the care plans of three people living in the home. They all contained assessments around various risks and gave a clear account of what staff should do to manage those risks. Staff are weighing people living in the home on a regular basis but are not completing the full assessment including the risk rating and what action to take if a person is deemed at risk. However, one of the care plans showed evidence of a person being referred to a nutritionist. All care plans are being reviewed regularly but there is no evidence of individual people living at the home or their representative being involved in the review of their care plan. We observed a nurse administering medication and we looked at the medication systems in the home. There is an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. We spoke with staff about privacy and dignity and they gave a good account of how they would respect this when delivering personal care. I observed staff talking to people living in the home respectfully and knocking on bedroom doors before entering. Care Homes for Older People Page 13 of 27 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. People that live in the home are given the opportunity to participate in recreational activities and maintain social contacts. People receive a nutritious and appetising diet. However, individual needs around nutrition is not recorded and could lead to people not having their specialist needs met. Evidence: The manager told us in the Annual Quality Assurance Assessment that the activities Co-ordinator provides a large variety of events and entertainment. Some in house and some professional entertainment. They also said that they hold birthday parties and celebrate wedding anniversaries and go on day trips and that they provide some form of outside entertainment and church services monthly. The manager told us, we discuss menus and planning with our service users and encourage them to choose their own meals and preferences. We have private rooms for private visits and functions. We have open and free visiting in the Home. We observed and spoke with visitors in the home and saw that they were welcomed by staff and able to visit freely. One person who visits the home told us, The Beeches feels welcoming when you enter and there is a family atmosphere. Care Homes for Older People Page 14 of 27 Evidence: The activities co-ordinator works in the home for 30 hours per week and has a work store that has supplies of arts and craft materials which are used to provide stimulation to people living in the home. One person living in the home told us in a completed survey, I like painting, watching TV and the physical activities that we do. People living in the home told us of the Easter party they had recently and of other parties that were held in the home. They also told us that there were entertainers that came to the home and one said, The entertainment is fantastic. We saw a photograph album in the reception area full of photographs of recent trips out. There was also an activity schedule on display. One health professional told us in a survey, People seem happy living here and the activities and trips out are done well and are enjoyable. The home uses the Nutmeg system for assessing the nutritional value of the meals. We observed lunch and this was mainly served in an attractive dining area, although some people chose to eat their lunch in the lounge area. The meal looked appetising and nutritious and the people we spoke with in the dining room told us that there was always plenty of choice available and that the food was absolutely lovely. One or two people said that there was sometimes a long wait from sitting in the dining room to receiving the meal and we observed this on the day. If people living in the home have special requirements around their meals, this is passed on to the cook through word of mouth. One person in the home regularly goes to bed before the evening drink and snack is offered. The manager told us that this person, along with a few others, have a snack made up and delivered to their bedroom. This was not recorded in the persons care plan so that staff knew this was to happen and staff were not recording when this snack had been given. This could lead to people going for more than the recommended length of time without food and a drink. One person who visits the home told us in a survey, My relative needs softer, blended food and it is not always available due to what is on the menu. Care Homes for Older People Page 15 of 27 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 living in the home are safeguarded from abuse. However the home does not always act on concerns raised by them. Evidence: The manager told us in the Annual Quality Assurance Assessment (AQAA) that all complaints are recorded and responded to within 28 days. She told us that there is easy access to the complaints procedure and complaints are audited on a monthly basis and efforts are always made to improve this service. They also said that staff receive training in safeguarding and whistle blowing. The Commission has not received any complaints about the home in the last 12 months. The service has received 7 complaints in the last 12 months. We viewed the complaints records and all complaints had been dealt with, recorded and action taken where necessary. The complaints procedure was on display in the home and was up to date and easily accessible. The home has the current local safeguarding referral procedures in place. We viewed Care Homes for Older People Page 16 of 27 Evidence: three staff training files and they had all received or were due to attend safeguarding training. We spoke with two members of staff who gave clear accounts of how they would respond to concerns being made by people living in the home and about safeguarding procedures. People living in the home told us that they knew who to speak to if they had any concerns and that they knew how to make a complaint. However, at a recent meeting held for people living in the home, some people had expressed concerns about how long they had to wait for staff to assist them when they wanted to go to the toilet. There was no evidence that these concerns had been addressed and this issue was raised again in the surveys we received and by speaking with people living in the home. Care Homes for Older People Page 17 of 27 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. Good housekeeping procedures provide people with safe, clean and homely surroundings in which to live. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that they encourage service users to see the Home as their own. Their views are sought when redecoration or upgrading is needed. The Home is well organised, hygienic and well maintained and we have compliments about this. Service users are encouraged to personalise their own rooms. On the day of the inspection we found the home to be clean, homely and well maintained. Bedrooms viewed were clean and personalised with peoples own possessions. We spoke with three people and they all said they liked their bedroom. One person told us in a survey, More time could be given to decorate and renew bedrooms when people have been living there for more than 3 years so that rooms have a fresher look. We observed staff and viewed schedules and records and this showed that the home has effective infection control policies and systems in place. Care Homes for Older People Page 18 of 27 Evidence: Nine people living in the home completed surveys and they all said that the home was usually or always clean. Care Homes for Older People Page 19 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has robust recruitment and training procedures to protect people living there. Sometimes people living in the home have to wait a long time for staff to assist them with personal care. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home has a thorough recruitment policy in place and that they obtain two references and the required checks prior to staff commencing employment. . They also told us that all staff attend induction training, continue training within the Home environment and there is a training matrix and training plans in place. We viewed the files of three staff members and they all held the required documentation and records of checks being made prior to them commencing work in the home. We spoke with staff working in the home, received completed surveys from them and looked at their training records. This showed us evidence that the home recognises the importance of having a well trained workforce. One person who visits the home said, They do everything well, they could not look Care Homes for Older People Page 20 of 27 Evidence: after my relative any better if they were family. One health professional that visits the home told us, Staff show professional attitude while still considering person centred needs and choices of service users. We received completed surveys from people living in the home and one person said, I need assistance with going to the bathroom but sometimes I am asked to wait. I understand this but sometimes I cannot wait The minutes of the meetings attended by people living in the home made reference to some people not being happy with the amount of time they had to wait for staff to assist them with going to the toilet. On the day of the inspection we spoke with 5 people living in the home and they all said that the staff were very good but sometimes, particularly in the evening, there were times when they had to wait for a long time for staff to be able to assist them to go to the toilet. One person who visits the home told us, Staff need to be more visible as chair bound people are not able to walk to find assistance. Staff we spoke with and information we received back from staff in the surveys said that there was usually enough staff on duty. We spoke with the manager on the day of the inspection about the concerns people had with how long they had to wait for staff. The manager told us that as a result of what people had said, she planned to address this through training and supervision. We have addressed this issue with a requirement made in outcome 2 of this report. Care Homes for Older People Page 21 of 27 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 Beeches is run in the best interest of the people living there and there are effective health and safety systems in place. Evidence: The manager told us in the Annual Quality Assurance Assessment that the Management of the Home is based on openness, honesty, respect and positive attitude. The Management aims to create a welcoming atmosphere to the Home. The manager also states that effective quality assurance and quality monitoring systems are in place which seek the views of service users, relatives and visiting professionals in order that success can be measured. The service users are encouraged where possible to manage their own money and valuables and if this is not possible the service users designated person or an advocate would be encouraged to assist them. On the day of the inspection we found the management to be accessible and available for people to approach. Discussions with people living and working in the home Care Homes for Older People Page 22 of 27 Evidence: supported this. The manager has the required qualifications and attends workshops to ensure she keeps up with new ways of working. One member of staff told us in a survey, The manager gives her best to support staff and will help in any way she can. One person living in the home told us, The manager is smashing. The home has recently sent out surveys to people living in the home, visitors and health professionals and is in the process of compiling the results so that they can be published to people involved in the home and the results acted on. We viewed a range of health and safety records and maintenance records and these were all up to date and are being maintained effectively. The operations manager from Southern Cross carries out regular internal audits and we saw the records of these visits. We viewed the training records of staff in the home and they are trained in safe working practices. Staff are receiving formal supervision with the manager but these are generally in groups and on an infrequent basis. One visitor told us, My relative has come on in leaps and bounds since moving into this home. Peoples personal spending money is managed safely in the home. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 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 1 1 5 Each service user must be issued with a copy of the service users guide on admission and have access to the homes statement of purpose. This will ensure people have enough information about the home. 26/06/2009 2 7 15 People living in the home and their representative, if appropriate, must be involved in the review of their care plan and there must be evidence that this has been offered. This will ensure people are receiving care the way they wish to. 21/07/2009 3 8 17 Nutritional charts in care 21/07/2009 plans must be completed and information given on what action staff should take if a person is deemed, at risk. Care Homes for Older People Page 25 of 27 This will ensure risks around nutrition are met. 4 10 18 There must be sufficient staff on duty at all times to meet the needs of service users. To ensure peoples needs are met in a timely manner. 5 31 18 There must be sufficient staff on duty at all times to meet the needs of service users. To ensure peoples needs are met in a timely manner. 6 36 18 Staff must receive individual 23/07/2009 formal supervision 6 times a year. This will ensure they are working safely. 25/06/2009 25/06/2009 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 9 There should be a procedure in place for staff to follow in the event of the medication fridge or storage area temperature breeching the recommended levels. Peoples likes, dislikes, allergies and special requirements with regard to food should be recorded and kept in the kitchen for the cook to refer to. If people go to bed before the evening drink and snack is served then it must be recorded in their care plan that they must be offered this in their bedroom and a record made to say if they have received it each day. 2 15 3 15 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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