Care Home: Beechfield Lodge

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What the care home does well Care plans are informative and give staff good background information about each resident. This is helpful for staff in assisting residents to maintain their personal preferred lifestyle. There was evidence to show that residents and relatives were supported to participate in care planning and reviews and demonstrated that they were consulted on all aspects of care and support where possible. The staff team and management of the home have worked hard in creating a relaxed, welcoming and positive atmosphere for residents and their families to enjoy. During this visit there was a calm atmosphere and residents were moving about the home with a sense of purpose. Staff were seen supporting residents in a positive and meaningful way. Throughout the whole day there was a buzz of activity and many residents joined in the range of activities on offer. All residents who were spoken to were complimentary about the way the home was run and managed. One resident said, "It`s very good here, it`s free and easy, there are no laws or rules". This comment reflected the sense of well being expressed by all the residents who were spoken to. There was a lot of evidence during this visit show that the staff team promoted the rights of individuals to live an ordinary and meaningful life. One relative who was visiting the home said, " I think they treat each resident as an individual". A number of residents were spoken to in private and some of their comments are included below: "It`s lovely here, everything is perfect and I love my bedroom. There`s always entertainment and we are going on a trip to Southport this year". "This place is wonderful. You can go to a lot of places, but none as good as here, otherwise I wouldn`t be here". "It`s lovely here. You get the help you need, they (the staff) help you tremendously and they listen to what you say". "The staff are lovely, all of them". There was an excellent activities programme available to residents in the home. The home employs a full time activities co-ordinator who is responsible for arranging group and one to one activities throughout the day. One resident said, "I have lived here four years and the activities have got better. I enjoy the activities, we had a man playing the banjo and the other day people came from the church". A rehabilitation officer is in post and has the responsibility of helping new residents to settle in. Her role also includes liaising with external professional agencies such as occupational therapists and physiotherapists, and making referrals to them as appropriate. She is actively involved in care planning and communicates well between agencies and the staff team.Mealtimes were a pleasant social occasion. Table settings were of a high standard and meals were nutritionally well balanced and well presented. All comments about the meals were positive and residents were offered a wide choice of menus`. One person said, "The meals here are fantastic". Residents are supported by an enthusiastic and well-motivated team. One relative said that the staff always had time to talk and discuss any concerns, and said they were always friendly and smiling. The home continues to prioritise training and development programmes for staff so that residents and their relatives can feel confident that they receive care and support from a well-trained team with a good skill mix. Staffing levels in the home support the smooth running of the service and ensure that individual needs are met in a timely and appropriate way. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. There is a high standard of cleanliness throughout the home. The manager has demonstrated that she is able to manage her budget and has continually managed the maintenance of the building in a way that has resulted in positive improvements in the physical layout. The manager has used a creative approach in developing the facilities in the home in a manner that ensures that the changing needs of residents and any specialist care needs are appropriately met. The recent improvements in the garden mean that residents and their visitors can enjoy a pleasant external environment in the better weather. What has improved since the last inspection? The requirement from the previous inspection visit has been fully addressed. Medication procedures had been improved so that residents receive medication in a safe way. New systems have been put into place to regularly monitor the receipt, disposal, storage and administration of medication in the home. Financial investment has been made in the home to promote health and safety and comfort in the home. A new boiler has been fitted, a new fire alarm system has been installed, and new emergency lights have been fitted throughout the building. Bathrooms have been upgraded to provide up to date modern facilities, and the manager has arranged for work to be completed in such a way to promote a homely and domestic feel. New carpets have been ordered for corridors and all corridor areas are scheduled for painting in the next month or so. Improvements have been made to dining and kitchen areas in a creative way. This means that residents and staff benefit from an environment that is practical and homely. What the care home could do better: One requirement has been made for the storage arrangements for controlled drugs to be reviewed to meet the requirements of recently introduced legislation. CARE HOMES FOR OLDER PEOPLE Beechfield Lodge 232 Eccles Old Road Salford Manchester M6 8AG Lead Inspector Ann Connolly Unannounced Inspection 26th June 2008 10:45 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 Beechfield Lodge DS0000067821.V365493.R01.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. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechfield Lodge Address 232 Eccles Old Road Salford Manchester M6 8AG 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) 0161 707 6747 Margaret.thomas@anchor.org.uk keri.sherwood@anchor.org.uk Anchor Trust Ms Margaret Thomas Care Home 59 Category(ies) of Old age, not falling within any other category registration, with number (59), Physical disability (1), Physical disability of places over 65 years of age (59), Sensory Impairment over 65 years of age (59) Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of fifty nine (59) service users may be accommodated who are aged 60 years and over and require care by reason of old age (OP) and who may also have a sensory impairment (SI(E)) and/or a physical disability (PD(E)). One (person maybe accommodated who is under the age of 60 years in the category of Physical Disability (PD). 29th June 2007 2. Date of last inspection Brief Description of the Service: Beechfield Lodge consists of 44 self-contained flats, which have a bedroom area, lounge, small kitchen, en-suite shower and toilet facilities. There are 12 en-suite residential bedrooms and the facility for 1 respite care place in a room, which is not en-suite. The home has a range of communal facilities, including a cinema room, courtyard and barbeque area with a patio and shrubs. The premises are specifically designed for people with visual and physical impairment and include a talking lift, textured floor coverings, tactile signs, entrance lighting and colour contrasting decoration to aid residents. Fees for accommodation at the home range from £373.52 to £420.00 per week. Fees do not include charges for hairdressing services, private chiropody and holidays. Beechfield Lodge DS0000067821.V365493.R01.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 3 stars. This means the people who use this service experience excellent quality outcomes This was a key inspection that included a site visit to the home. The manager was not told beforehand that we were coming to inspect, this is called an unannounced inspection. This inspection looked at all the key standards and included a review of all available information received by the Commission for Social Care (CSCI) about the service provided at the home since the last inspection. During the site visit a selection of records, care plans, policies and procedures were examined. Discussions took place with the manager, staff working in the home, and some relatives who were visiting. Several residents living in the home were spoken to in private during the visit, and discussions took place with them to find out what they thought about the home and what they felt about how the staff supported them. A tour of the home was undertaken and residents were asked for their comments and views about the environment. Before the inspection, we also asked the manager of the service to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This is one of the ways that we get information from the manager of the service, about how they are meeting outcomes for people using their service. Information that was provided in the (AQAA) for this service, was detailed and provided evidence of a service that was committed to focusing on positive outcomes for the people who use the service. Since the last inspection visit, which took place on 29th June 2007, the Commission for Social Care Inspection has not received any concerns about this service. There was evidence during this visit that the manager was managing complaints well, and that procedures were followed appropriately. Over the last twelve months the home’s manager has received 20 complaints, and information in the AQAA states that these were investigated within 28 days. Fourteen of these complaints were upheld. A number of these complaints were minor in nature, and the response made by the home shows that no matter how small the complaint, the home takes all concerns seriously. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 6 What the service does well: Care plans are informative and give staff good background information about each resident. This is helpful for staff in assisting residents to maintain their personal preferred lifestyle. There was evidence to show that residents and relatives were supported to participate in care planning and reviews and demonstrated that they were consulted on all aspects of care and support where possible. The staff team and management of the home have worked hard in creating a relaxed, welcoming and positive atmosphere for residents and their families to enjoy. During this visit there was a calm atmosphere and residents were moving about the home with a sense of purpose. Staff were seen supporting residents in a positive and meaningful way. Throughout the whole day there was a buzz of activity and many residents joined in the range of activities on offer. All residents who were spoken to were complimentary about the way the home was run and managed. One resident said, “It’s very good here, it’s free and easy, there are no laws or rules”. This comment reflected the sense of well being expressed by all the residents who were spoken to. There was a lot of evidence during this visit show that the staff team promoted the rights of individuals to live an ordinary and meaningful life. One relative who was visiting the home said, “ I think they treat each resident as an individual”. A number of residents were spoken to in private and some of their comments are included below: “It’s lovely here, everything is perfect and I love my bedroom. There’s always entertainment and we are going on a trip to Southport this year”. “This place is wonderful. You can go to a lot of places, but none as good as here, otherwise I wouldn’t be here”. “It’s lovely here. You get the help you need, they (the staff) help you tremendously and they listen to what you say”. “The staff are lovely, all of them”. There was an excellent activities programme available to residents in the home. The home employs a full time activities co-ordinator who is responsible for arranging group and one to one activities throughout the day. One resident said, “I have lived here four years and the activities have got better. I enjoy the activities, we had a man playing the banjo and the other day people came from the church”. A rehabilitation officer is in post and has the responsibility of helping new residents to settle in. Her role also includes liaising with external professional agencies such as occupational therapists and physiotherapists, and making referrals to them as appropriate. She is actively involved in care planning and communicates well between agencies and the staff team. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 7 Mealtimes were a pleasant social occasion. Table settings were of a high standard and meals were nutritionally well balanced and well presented. All comments about the meals were positive and residents were offered a wide choice of menus’. One person said, “The meals here are fantastic”. Residents are supported by an enthusiastic and well-motivated team. One relative said that the staff always had time to talk and discuss any concerns, and said they were always friendly and smiling. The home continues to prioritise training and development programmes for staff so that residents and their relatives can feel confident that they receive care and support from a well-trained team with a good skill mix. Staffing levels in the home support the smooth running of the service and ensure that individual needs are met in a timely and appropriate way. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. There is a high standard of cleanliness throughout the home. The manager has demonstrated that she is able to manage her budget and has continually managed the maintenance of the building in a way that has resulted in positive improvements in the physical layout. The manager has used a creative approach in developing the facilities in the home in a manner that ensures that the changing needs of residents and any specialist care needs are appropriately met. The recent improvements in the garden mean that residents and their visitors can enjoy a pleasant external environment in the better weather. What has improved since the last inspection? The requirement from the previous inspection visit has been fully addressed. Medication procedures had been improved so that residents receive medication in a safe way. New systems have been put into place to regularly monitor the receipt, disposal, storage and administration of medication in the home. Financial investment has been made in the home to promote health and safety and comfort in the home. A new boiler has been fitted, a new fire alarm system has been installed, and new emergency lights have been fitted throughout the building. Bathrooms have been upgraded to provide up to date modern facilities, and the manager has arranged for work to be completed in such a way to promote a homely and domestic feel. New carpets have been ordered for corridors and all corridor areas are scheduled for painting in the next month or so. Improvements have been made to dining and kitchen areas in a creative way. This means that residents and staff benefit from an environment that is practical and homely. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 8 What they could do better: 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. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 9 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 Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 10 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): 3 (Standard 6- Intermediate care is not provided). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed prior to admission to the home so they are confident their needs will be met, and the home is sure it can meet their personal needs. EVIDENCE: A comprehensive admission policy was in place, which included information about opportunities for people to visit the home on a trial basis, stay for a meal and talk to existing residents and staff. Information provided by the manager before this visit in the AQAA, stated that all existing and prospective residents were provided with the statement of purpose and service user guide. These documents are useful in helping prospective residents to make an informed choice about their future care arrangements. The care plans were examined and they contained assessments carried out by the care manager from the placing authority. In addition, an assessment of care needs was carried out by the manager or representative from the home, Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 11 and the information obtained was used to develop a detailed care plan for each resident. From discussion with staff, there was evidence of a person centred approach in carrying out assessments. The pre admission assessment included personal details and information on personal care, past history, continence issues, mobility difficulties and medical history. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 12 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 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans provided staff with the information they need to meet and monitor the residents’ needs. Medication practices have improved and the audit of the medication ensures that all staff comply with good practice. EVIDENCE: Three care plans were looked at during this visit. The care plans were person centred and focused on individual needs. Each plan included a personal profile, a life history and risk assessments. There was evidence that nutritional screening formed part of the care plan. A progress and evaluation sheet was linked to the care plans so that staff kept a record of care needs and documented any changes when required. There was evidence of important information about the resident’s lifestyle, and instructions for staff on how to support the resident in maintaining this lifestyle. There was a good system in place for carrying out regular reviews of care plans. The care plan of one resident, who was registered blind, contained detailed instruction for staff to support this resident to become orientated in the home. Staff were given guidance on the support needed to enable the resident to maintain Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 13 independence. Discussions with the rehabilitation officer shows that the staff in the home take the admission and settling in process seriously. There is recognition that the event of moving into the home can be quite traumatic for some individuals. The role of the rehabilitation officer is to support residents to become orientated and to liaise with external support agencies such as physiotherapists, occupational therapists etc as required. The role also provides a link between staff to ensure that communication about residents care needs is transferred appropriately and well documented. The manager said that this role was invaluable as it supported new residents to settle in quickly, and allowed initial problems to be resolved in a timely manner. Medication systems had improved so that residents receive medication in a safe way. New systems have been introduced to regularly monitor the receipt, disposal, storage and administration of medication in the home. All medication was appropriately stored in a locked room. The medication file contained all relevant documentation, for example, a photograph of each resident on the Medication Administration Records (MAR) for identification purposes, a copy of specimen signatures of staff responsible for the administration records, and a copy of the company policy and procedures for the safe handling of medication. One of the staff who was spoken to confirmed that all staff with the responsibility of administering medication receive training. Controlled drugs and associated records were examined and found to be in order. The current storage arrangement for controlled drugs does not meet the requirements of recently introduced legislation. Appropriate safe storage for controlled medication must be in place and must meet current legislation. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 14 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 and15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about their life style and they are supported to maintain independence. Residents are able to enjoy a fulfilled lifestyle and have a variety of options to choose from. EVIDENCE: The home’s aims and objectives are to promote the individual’s right to live a meaningful life in the community. There is evidence that the home use care plans which identify individual interests and preferences to provide a meaningful activity programme. The information in the AQAA states that there are no set routines, and that the activity programme is set by the care planning process and on an individual needs basis. This was reflected in comments made by residents in the home. One person said that the lifestyle in the home was ‘free and easy with no set rules’. Residents who were spoken to confirmed that they were encouraged to have visitors and supported to pursue their interest in activities. There was an excellent activities programme available to residents in the home. During the morning there were three activities taking place, these included hairdressing, a group card game (play your cards right), and a newspaper reading session. In the afternoon, one to one activities were taking Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 15 place including nail care and hand massage. The activities organiser showed a creative approach to the role. She said that she was involved at the admission point in order to get to know the individual resident and find out their interests. She said the activity programme was structured into the day, but recognised that within the structured programme it was important to respond to the needs and preferences of the residents on a day-to-day basis. Residents were very positive about the activities available in the home. One resident said, “I usually go into the quiet lounge, but today I’m in here because I like this activity”. One resident said, “ I enjoy the activities, especially the quizzes”. “They have a lot of entertainment and we have an organiser- she is very good, a very nice person”. The lunchtime meal was a relaxed social occasion. Table settings were pleasantly presented in small group settings. Residents said they were offered a choice of menu and were very complimentary about the quality of food in the home. The meal choice during this visit was lamb chops with vegetables, scampi and salad and a choice of several desserts. Meals were well presented, looked appetising and were nutritionally well balanced. At the end of the meal staff took the orders for the evening meals, which was varied with several choices. Breakfast offers a buffet style menu. The menu for the week is displayed on the dining room wall, and there is an all day menu, which offers further choices that are available at all mealtimes, this consisted of jacket potatoes with various fillings, omelettes, salad and sandwiches. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to ensure that the health and welfare of residents is protected. EVIDENCE: There is a complaints procedure in place, which is displayed prominently around the home. This gives details and timescales by which a complainant can expect a response and also provides the contact details of the Commission for Social Care Inspection. There is a complaints record, which logs all complaints which are brought to the attention of the manager. It details the nature of the complaint, the action taken and the outcome for the complainant. From discussion with staff, there was evidence that they had a good understanding of issues around adult abuse and the safeguarding procedures to follow in the event of an allegation of abuse in the home. Since the last inspection visit, there had been four safeguarding issues, and there was evidence to demonstrate that procedures had been followed correctly. The manager had forwarded the details of the incident and the investigations that followed to the offices of the Commission for Social Care Inspection. All appropriate action had been taken, and other professional bodies had been involved as appropriate. Three allegations were unfounded and one was referred to POVA. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 17 Residents who were spoken to during this visit indicated that they felt confident in approaching the staff and the manager with any concerns. Relatives spoken to said that they found staff very responsive if a concern was raised, and all of them said that they had never found it necessary to raise a formal complaint. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 18 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 excellent. This judgement has been made using available evidence including a visit to this service. The physical layout of the home enables residents to live in a safe, wellmaintained and comfortable environment which encourages independence. EVIDENCE: The environment is warm and welcoming and throughout the building there are homely touches to the décor which gives it a ‘home from home’ domestic feel. Forty-four of the bedrooms are spacious and set out in a bed-sit arrangement which provides a bedroom area, a lounge, small kitchen and bathroom with shower facilities. The remaining bedrooms are well laid out with generous space. There was evidence that residents had been encouraged to personalise their private space. Details provided in the AQAA showed that the manager had carried out the necessary health and safety checks in the building in order to provide a safe environment for residents, staff and visitors. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 19 Evidence from the site visit and information in the AQAA show that this is an organisation with a management structure that is committed to improving the environment. As a result residents and their relatives enjoy positive outcomes from living there. The manager has shown a creative and innovative approach to improving the physical environment. By listening to residents and staff, and being aware of care needs, changes have been made to parts of the building to improve the day-to-day living arrangements. One example of this is in the dining room, where an open plan arrangement has been created. This enable staff and residents to enjoy better communication at mealtimes. A number of improvements have been made and are planned for the forthcoming year. Some examples of improvement are refurbishment of dining rooms, replacement of corridor lighting and emergency lighting, new fire alarm system, new boiler and refurbished bathroom with new bath. Plans for the future include the decoration of corridor communal areas and new carpets, new hairdressing room and new staff training room. One further improvement is the improved garden facility, which is both creative and imaginative. It provides a multi sensory environment by using appropriate planting and the use of tactile furnishing. Planting was in raised flower beds, and furnishings were sturdy with imaginative pieces to create interest in the garden. Residents commented on how much they liked this new facility, and how they were looking forward to sitting out in the warmer weather. It was evident that residents were encouraged to see the home as their own. Quiet lounge areas, a cinema area, large lounge areas and a choice of dining rooms mean that residents can find a choice of places to sit and chat with people. During this visit it was noted that cleaning and hygiene in the home was of a high standard. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The needs of residents are met by a well-trained and motivated staff team. EVIDENCE: Policies and procedures are in place for the recruitment of staff. Staff files were examined and contained all the documentation required by legislation including a Criminal Record Bureau (CRB) check. The home experiences a low staff turnover, which provides continuity in care and support arrangements for residents living in the home. The manager is supported by head office to carry out the recruitment process. There was a good staff presence in the home, and sufficient staff were on duty to meet the needs of the residents in the home. The deployment of staff in the home ensured that there was staff support where needed and ensured that residents’ needs were met in an appropriate and timely manner. Training needs were identified thorough the staff supervision process. All staff spoken to confirmed that they received regular supervision and that they felt well supported by the management team. The staff training matrix provided evidence that training was prioritised by the home. During this visit, it was noted that staff were very enthusiastic about their role and extremely motivated in supporting the manager and the rest of the staff team to provide good quality outcomes for residents in the home. One Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 21 member of staff told us about a five day dementia training course that all staff were expected to attend. She said that the three members of staff currently on the course would be giving a presentation on its completion. It was noted that residents had well established relationships with staff and they were seen engaging in meaningful conversations. It was evident that the residents knew the staff, and referred to them by their names. The residents spoke highly of the staff team. Comments included: “The staff are lovely, all of them. I would talk to the manager if I had a complaint, they have been very good to me”. “Staff are fabulous, She (pointing to a member of staff), is one of the best”. “The staff listen to what you say”. One relative said, “The staff are wonderful and I have no complaints. The staff are lovely, very friendly and helpful and they keep me informed”. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 22 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): 31,33 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This service is run in the best interests of the residents, and the management ensure that the safety and welfare of residents and staff is promoted. EVIDENCE: The registered manager has completed the Registered Manager’s Award and is appropriately qualified to carry out her role. Staff who were spoken to showed confidence in the manager, saying that they found her approachable and that they could talk to her about any concerns. There is a well-established supervision process in place. The residents in the home benefit from a committed staff team who are in turn supported by the manager. At the heart of the management style is a commitment to a person centred approach where Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 23 the focus is on how the individual person who uses the service wants their care needs to be met. All residents and their relatives spoken to during the course of this visit expressed satisfaction on how the home was run and the quality of services in the home. One of the relatives spoken to during this visit said that she had found the manager very responsive to any problems and that the manager was approachable and quick to respond to any concerns. Some of the residents have been supported to maintain contact with a local church and the community activities. There was documentary evidence of regular staff and residents’ meetings. The meetings were used as a forum to exchange views, and to seek the views of residents about how the service could be developed. Information in the AQAA provided evidence that good standards were maintained for the maintenance of equipment for health and safety including fire prevention equipment. Information provided by the manager in the AQAA, provided evidence of a manager who was committed to developing the service so that residents had positive outcomes. The manager shows a clear vision of how the service needs to be developed for the benefit of residents. There is evidence of a creative and innovative approach to all aspects of the management of the home, for example creativity in developing the physical environment and the provision of support and guidance to staff to develop their skills and promote good working practices. Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 24 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 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X X X X 4 Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13 Requirement Appropriate safe storage that meets current legislation must be in place for controlled drugs. This will ensure that medication is managed safely by the home. Timescale for action 02/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Beechfield Lodge DS0000067821.V365493.R01.S.doc Version 5.2 Page 27 - 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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