Care Home: Beechfields

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Key inspection report CARE HOMES FOR OLDER PEOPLE Beechfields Conyer Road Teynham Sittingbourne Kent ME9 9ET Lead Inspector Sandra Crosby Unannounced Inspection 8th April 2009 10:00 08/04/09 10:00 DS0000023905.V374800.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 2 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 Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechfields Address Conyer Road Teynham Sittingbourne Kent ME9 9ET 01795 520580 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) Mr Clifford Lewis Saffrey Mrs Dorothy Elizabeth Saffrey Mr Clifford Lewis Saffrey Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 9. Date of last inspection 12th April 2007 Brief Description of the Service: Beechfields is a privately owned residential home. It has registration for up to nine adults over the age of 65. There are seven single bedrooms and one shared bedroom. The premises have been designed and built with reference to the National Minimum Standards for Care Homes for Older People. The home is set on one level in a rural location with views of the countryside from most windows. There are several seating areas set around the outside of the building for Residents to use in the good weather. The weekly fees range from £395 to £450. Beechfields DS0000023905.V374800.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 star. This means that people who use this service experience excellent quality outcomes. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last Key Inspection of 12 April 2007, an Annual Service Review dated 03 April 2008 and a visit to the service. The key inspection visit was unannounced and carried out on Wednesday 08 April 2009 between 10.00 and 15.00 hours. During the inspection the inspector spoke with the Registered Providers, two care staff, residents and one visitor. Various records were seen during the visit, together with an accompanied tour of some areas of the premises. Some judgements have been made through observation only. Information contained in the completed Annual Quality Assurance Assessment (AQAA), was clear and informative and has been used together with information gained and observations made at the time of the inspection visit all of which has been used when completing this report. The aim of the visit was to carry out an inspection against the key standards of the National Minimum Standards for Older Persons in accordance with the Inspecting for Better Lives (IBL) process. Judgements have been made for each outcome area in this report and these have been made using the Key Lines of Regulatory Assessment (KLORA), which is guidance used to ensure that a fair and proportionate judgement is made in each outcome area. More information about KLORAs can be found on the Care Quality Commissions (CQC) website. The findings of this inspection were discussed with the Registered Provider at the end of the visit, and overall indicate that this service provides good quality outcomes provision for the service users and in line with CQC ratings agenda this service has achieved an excellent 3* rating. What the service does well: The service provides a home environment and one resident said it is home. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 6 Positive relationships have been formed between staff and residents and a relative spoken with confirmed this. Evidence was seen that the daily routines of the home were entirely focused on the choice and freedom of the residents. Person centred plans and medical notes evidenced good quality care being provided. A relatives spoken with confirmed that they were happy with the care provided by the home saying it is the best. Staff training is ongoing and on the day of the inspection visit two care staff were attending Mental Capacity Act training. This service has consistently provided good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. 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 Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 7 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. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 8 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 Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 were inspected at this visit. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. EVIDENCE: The completed AQAA documentation indicates that pre-assessments are carried out with the prospective resident and or their family or other professionals as appropriate. The registered provider confirmed that she arranges any admissions and visits the prospective resident prior to admission and discusses with them and/or their representative exactly what the home can offer. The registered provider said that she carries out a full assessment to Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 10 ensure the home can meet all of the persons needs. A completed Kent County Council assessment documentation was seen in one of the person centred plans as part of the care planning system. Prospective residents and their families are encouraged to visit the home prior to admission so that they can assess the facilities on offer for themselves. The home does not provide intermediate care. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were inspected at this visit. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having clear and in-depth person centred plans that identify their individual needs and give clear guidance to staff. Health needs are well met and residents benefit from having full access to all professional health care services as required. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 12 EVIDENCE: Two person centred plans were viewed. These contained all components as required by regulation for example regular reviews and daily records. The information contained was informative and written clearly. All appropriate individual risk assessments were seen as part of the care planning process, for example moving and handling. The residents had participated in making their individual care plans and how they wanted any personal care to be delivered. It was observed and discussed that the care plan when initially drawn up was dated but not signed and that the daily records were not always completed on a daily basis. The registered provider agreed to address these issues. Overall the information contained in the person centred care plans was clearly written and informative. Staff spoken with confirmed that all residents are registered with a local doctor, and other professionals for example dentist and optician. Information was seen in the person centred care plans in relation to doctor visits. The home administers from a single blister pack system provided by the local pharmacist and medications are stored appropriately, in sufficient quantities. The home uses Medicine Administration Record Sheets (MARS) system for recording the administration of medication. The medication records were seen and indicated that they were appropriately signed and up to date. It was observed during the day that staff treat all persons with respect and promote their rights to choices and privacy as appropriate. Residents were able to be as independent as possible and staff encouraged them to do as much for themselves as they were able with support available as required. One resident is able to walk their dog around the grounds several times a day as they wish. People feel their rights as citizens are recognised and promoted, including fairness, equality, dignity, respect, and autonomy over their chosen way of life. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were inspected at this visit. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they are able to maintain contact with friends and relatives and experience and choose a lifestyle of their choice. The residents benefit from the appetising meals and balanced diet offered by the home and those residents requiring specialist diets are catered for. EVIDENCE: Residents are able to live a lifestyle in their preferred manner. They are able to choose the activities they participate in and can access going to the library, shops, fetes, tea rooms, bazaars, theatre and shows. The completed AQAA documentation states that residents regularly go out to lunch with one of the venues being the local school catering college. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 14 On the day of the visit, a resident said that she was very happy living at the home. She was waiting to go to attend an Easter lunch arranged by Age Concern. As the Age concern transport had not arrived one of the registered providers took her to the Age Concern centre. It was observed that some residents have a small fridge, kettle and toaster in their rooms so that they have access to snacks and drinks at any time. These are all risk assessed. Friends and relatives can visit at any time and a relative spoken with confirmed this. It was previously reported that visitors to the home include monthly visits from a Reverend and a Priest to meet with individual residents who requested this. At the mealtime staff were heard to offer choices to residents for example asked whether they would like tomatoes, if everything was alright and were told more if anyone would like it. Residents spoken with said the food was good. The majority of the food is brought fresh from the local butchers and greengrocer. The food menus were seen and indicated that a varied and nutritious well-balanced good diet is maintained. There was no evidence of a daily record of the food provided by the home as required by regulation, and following discussion with the registered provider she agreed to address this issue. This service has consistently provided good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were inspected at this visit. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff are confident that their complaints will be listened to, taken seriously and acted upon. Staff have a good understanding of adult protection issues that protects residents from potential abuse. EVIDENCE: Staff and residents spoken with were very positive about the lifestyle and care that residents lead. Staff have attended Safeguarding of Vulnerable Adult training and are currently undertaking training in relation to the Mental Capacity Act. The homes complaint procedure is available to residents, relatives and friends. The completed AQAA documentation states that there has been one Safeguarding of Vulnerable Adults alert, and the registered provider confirmed that this had been investigated and was now closed. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were inspected at this visit. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a very well maintained homely environment. EVIDENCE: The home is registered for nine service users and there are seven single bedrooms and one double bedroom all with en-suite facilities. The rooms are well furnished with lots of personal belongings on display. The corridors are wide as are the doorways so that there is easy access for residents who need to use mobility aids. The communal areas are well presented and the dining room has recently been re-decorated and new dining furniture purchased. The Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 17 home is well set out with lots of natural light in all rooms and allows for good views of the countryside and local wildlife. There are seating areas around the outside of the home including a walled garden and several patio areas. The completed AQAA documentation confirms that all maintenance contracts are up to date and that the building complies with the fire safety requirements. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were inspected at this visit. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from have a stable, trained and skilled staff team. EVIDENCE: No new staff have started at the home since the last inspection, so the recruitment process could not be verified at this visit. At the last inspection there was not an issue with this area. The completed AQAA documentation states that 95 of staff have many years of experience in the care sector and the majority of staff are NVQ trained to Level 2 and 3. Mandatory training is ongoing, with two staff attending Mental Capacity Act training on the day of the inspection visit. A member of staff chatted with said that Moving and Handling training was booked in the near future. There was no staff training matrix for the home available, and the registered provider agreed following discussion to address this issue. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 19 Staff spoken with said that they received supervision on a regular basis, and that as the registered providers lived on site, support and advice was always available. Residents spoken with said that the staff were friendly, helpful and kind. People are well supported by a staff team that recognises and responds appropriately to their diverse needs and human rights. This service has consistently provided good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35,37 and 38 were inspected at this inspection. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home that is well managed and run in their best interest. Residents can be confident that their health, safety and welfare will be promoted and protected. EVIDENCE: Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 21 The registered providers are experienced, competent and qualified to manage a registered home. They continue to update and undertake additional training. They are aware of the national minimum standards and the regulations that underpin them and undertakes quality monitoring within the home, ensuring that residents and significant others are consulted. There is an open management style, which encourages the staff to play an active part in improving the service. The staff commented favourably on the positive impact that the registered providers have indicating that there is good consultation and open dialogue. Discussions with residents also indicated that management provides a positive open and inclusive atmosphere. The registered providers live on site and are able to react to any situation that may arise. Residents are able to choose to participate in shopping trips and outings and choose their own daily activities. The home is well run and done so in the best interests of the residents. Comments from residents included it was home happy at the home and staff are helpful and friendly. The registered provider confirmed that currently the registered providers do not handle any of the residents personal monies. A declaration has been made in the AQAA documentation that the service meets the requirements of the fire regulations and that maintenance of all equipment is up to date and all appropriate policies and procedures are implemented to ensure the health safety and welfare of residents and staff. The home has a quality assurance system in place and two Quality Assurance Providers Manuals were seen. The registered provider said that surveys are given out and completed anonymously. She said that all positive feedback was received and any suggestions made the registered providers try to implement. The registered providers need to complete the Quality Assurance process by producing a report available to residents and persons visiting the home and the registered provider agreed to do this. At the time of the visit there was no visitors book at the home, and the registered Provider agreed to address this issue. People enjoy as good a quality of life as possible because the home is managed in a way that takes into account and promotes their human rights and equality and diversity needs. This service has consistently provided good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 22 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 3 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 X 3 3 Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Ensure that care plan documentation is signed when initially completed. Staff to complete the daily record documentation on a daily basis. 2. 3. 4. OP15 OP30 OP33 Keep a daily record of the food provided at the home. Implement a staff training matrix. Standard OP33 Complete the Quality Assurance process used by the home by producing a report of findings. Beechfields DS0000023905.V374800.R01.S.doc Version 5.2 Page 24 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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