Care Home: Beechwood

What the care home does well Service users had a plan of care which provided good information for the care staff on how to provide the care and support required. Care plans on the Hunter Unit displayed evidence of input from the multidisciplinary healthcare team as needed. Evidence of relatives` and service users input varied but was encouraged. Relatives are always invited to medical reviews (three to six monthly). A relative was complimentary regarding the care. One said, "There have been a few issues but staff generally seem very caring. I have been to one review a few weeks following the admission of my relative." Other care plans evidenced personalised care around the management of aggression and agitation by including the recognition of trigger factors as well as individualised intervention for staff to help manage service users. Staffing levels remain good and provide a means so that social activity is not unduly reduced due to risk and service users receive the care they need. Where specific risks have been highlighted, staff provide one to one care to ensure their ongoing safety. This was seen at the time of the site visit and well managed. Service users observed appeared relaxed and supported by staff. Staff appeared to have a good rapport with them and the observations evidenced high levels of staff interaction and involvement by residents in their daily activity. We completed a two hour observation of the care on Beechwood unit using a specially devised observation tool for people with dementia. The overall findings were positive in that staff were seen to be supporting service users to make positive choices; for example about the type of activity they wanted. Service users on the Hunter Unit are involved with the community through a programme of leisure pursuits and activities that are supervised by good levels of staff. Trips out are arranged regularly and the social interests of residents on the Hunter unit were recorded in good detail. One resident spoken with was being accompanied out by a relative but also goes out daily with staff support. The routine appeared relaxed and residents were free to wander around the home with or without the supervision of staff. Staff were seen to be very enthusiastic regarding the social programme in the home and they said they Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 enjoyed the trips out. They also described how activities are arranged according to service users` wishes. On Beechwood we saw an activities organiser who attends the unit during the afternoon. This person was seen relating to service users positively and including them in the social activity. Service users were taking part in crafts and art during the afternoon. Service users receive their meals in the dining rooms on both units and we saw the chef meeting with them to discuss the menu. We saw staff going around each person individually and asking them what choice of meal they wanted. The kitchen was well stocked and plenty of fresh fruit and vegetables were available to ensure well balanced and nutritional meals. The menu seen offered a good variety with plenty of refreshments throughout the day. The cook said the menu is subject to regular change to reflect the seasons and what the service users would like. Staff were observed to be careful to protect the dignity of people by ensuring good standards of personal care so that people were clean and appropriately dressed. Staff interviewed had a good knowledge of individual care needs and how to promote person centred care. This ensures individuals are involved with their care. Staff were seen to be respectful in their approach and they gave examples of how they respected service users` wishes. For example, clothes, meal times, preferred foods, routine and social interests. Service users have access to equipment such as handrails and other moving and handling equipment including bath aids. One care staff was able to explain the care of an individual resident in great detail and although this person had a severe and progressively deteriorating medical condition they were being appropriately assessed and, in this case, would soon have a specially designed wheelchair so that they could be supported to move around better and go outside the home. This shows that the home considers a diversity of care need. Service users have access to health care professionals, for example, doctors, consultants, speech and language therapists and dieticians. This helps ensure their care needs are being met effectively. Evidence was seen of this in the care files and by speaking with staff. We spoke to a visiting health care professional who gave positive feedback regarding the care and how staff were knowledgeable on the daily care people needed. The health care professional also said the staff were prompt in seeking advice when needed and they followed her instructions. This ensures that people are receiving the right support to keep them well. A number of checks are undertaken to ensure the home is well managed. This includes the completion of regular audits for areas such as care plans and managing risks. Senior management also attend the home and produce formal reports of their findings. Those seen were detailed. The quality of the service is reviewed regularly to ensure it is run in the best interest of the people accommodated. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 9 What has improved since the last inspection? Over all we found that people in the home were monitored and that challenging behaviour and behaviour which presented as a risk factor is managed in a proactive manner. This is an improvement on the previous inspection. For example, service users reviewed had been involved in incidents of aggression. We found that these are recorded and monitored appropriately and that full reviews had been carried out which included both medical and [where necessary] input from the local safeguarding team. The carers` notes are now recorded in the main file and these related to the care provided and act as a useful way of monitoring care on a daily basis. Staff commented that they now attend full daily briefings which include the registered nursing staff. They also have hand over sheets to complete as part of evidencing the care given. Again this has been a development since the last inspection and helps to improve communication so that the people living in the home benefit from consistent care. A number of pharmacy inspections have taken place over the last year and medicine management has improved so that medicines are administered safely to the service users. The managers have responded to requirements made on previous inspection reports. This includes more clearly defined areas so that male and female bedrooms are in separate areas as well as improving single sex access to bathrooms and toilets. Staff commented that this has made it easier to maintain some residents` safety and privacy. This will also have helped to reduce incidents in the home and is evidence of better risk management for the people accommodated.BeechwoodDS0000059323.V376234.R01.S.docVersion 5.20 What the care home could do better: We were concerned that the assessments completed following admission to the home were not completed on one of the people we reviewed. These included basic assessments such as pressure sore risk, nutrition and dependency. The assessments help to develop a care plan and should be completed in all instances. The assessment process would also benefit from a more detailed cognitive assessment. This would record information such as reasoning, comprehension, awareness and understanding. This information helps to provide more person centred care and for staff to have a greater understanding of individual need. We were concerned that one person had been admitted for two months and still did not have a more in-depth care plan. Staff explained that the care plan is built up over an extended period as information is gathered. We would recommend that the manager looks at introducing a standard time for when a care plan should be drawn up. This will ensure that everybody involved in the care can be clear about the aims and objectives of the care and how this should be carried out. We did not see any evidence of people using the service or their relatives or advocates being asked to contribute to the evaluations of the care plans. This would be recommended occasionally as it is a formal way of including people in the care they are receiving. Whilst reviewing care documents we were concerned regarding management of weight loss. This has not been addressed in terms of appropriate medical referral or review. We spoke to the managers about this and would recommend this is reviewed more regularly as part of monitoring health needs. The moving and handling assessments to move people safely should also be completed in more detail with regards to the equipment used. On the Beechwood Unit we felt that evaluations could be developed further to show a clearer progress of the care rather than `continue as plan`. This would give a clearer outline of the progress of the care. We discussed this with the staff on the unit On the Hunter Unit some of the toilet areas were not as accessible as they could be. For example one toilet had been out of use for some time and other toilets are not signposted appropriately so that residents who may be disorientated can be assisted to find them. We looked at some of the toilets and bathrooms on the Hunter Unit. One was in a state of disrepair with tiles missing off the wall. Another bathroom was being upgraded but this was still in progress [we were advised] for a time approaching a year. We spoke to the managers about this and the need to ensure that facilities are maintained adequately and are fit for use.BeechwoodDS0000059323.V376234.R01.S.docVersion 5.21Other toilets and bathrooms are not easy to find, especially for people with dementia. There are no obvious signs or environmental prompts to help people orientate themselves and we would again recommend that this is addressed as the Hunter Unit develops. This is important as good environmental cues and aids are needed to help people with dementia to orientate them. The central patio area needs attention as there are lots of weeds and the surrounding plaster work to the walls is in need of repair due to general wear and tear. A number of service users were seen to sit out on the patio and the overall appearance of this area should be improved for them. The maintenance plan for the home should include replacement of a large window in the conservatory as the glass has `blown`. This was stated at the previous key inspection. A number of windows have been replaced in other areas. Staff training files were looked at and these showed that staff require training in food hygiene so that they have the skills and knowledge to hand food safely. No training dates were seen for this. The training organiser said a course would be arranged as soon as possible. The training plan should also evidence dates of future training courses available for staff. Reporting incidences and referring safeguarding concerns was seen to be more effectively managed. Staff however, still need guidance on the completion of Regulation 37 reports. These had not been submitted to us for all of the incidences discussed at the time of this inspection. There is still room for improvement in this area so that service users are protected. Staff induction should be in accordance with Skills for Care Induction Standards which provides formal learning for staff in the care setting. Key inspection report CARE HOME ADULTS 18-65 Beechwood Beechwood Road Liverpool Merseyside L19 0LD Lead Inspector Claire Lee and Mike Perry Key Unannounced Inspection 30th June and 1st July 2009 09:30 Beechwood DS0000059323.V376234.R01.S.doc 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 home adults 18-65 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. Beechwood DS0000059323.V376234.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 Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechwood Address Beechwood Road Liverpool Merseyside L19 0LD 0151 427 5963 0151 427 7352 beechwood@europeanwellcare.com 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) European Wellcare Homes Ltd Mrs Mary Regan Care Home 60 Category(ies) of Dementia (60) registration, with number of places Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 60 Date of last inspection 21st May 2008 Brief Description of the Service: Beechwood is made up of two units. The Beechwood Unit provides care and support for elderly mentally infirm residents, and the Hunter Unit provides nursing care for younger adults with early onset dementia. At the time of the inspection staff were providing care and support for forty younger adults and seventeen older people. A small number of day care places are also provided within the overall number accommodated. One to one care by a staff member is based on individual assessment and need. The home is located in the Aigburth area of Liverpool, directly overlooking the River Mersey at the Otterspool promenade. The home is set in it’s own grounds and has extensive grounds for the residents to enjoy. Car parking space is available. Most bedrooms are single and each unit has spacious communal areas for the residents to sit in comfort. Residents have a choice of bathing facilities with aids and adaptations to assist those less able. A call system with an alarm facility is operational throughout all the areas and this enables residents to call for assistance when needed. Residents have the use of small kitchens if they wish to make their own drinks and there is a designated activity/ craft room. There is a separate fee rate for Beechwood and Hunter Unit. The fees for Beechwood range from £377.00 to £415.50 and for Hunter Unit, £1228.42 to Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 5 £2192.53. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star which means that people who use this service experience good quality outcomes. A site visit took place as part of the inspection and this was carried out for a duration of two days for approximately fourteen hours by two inspectors. Information for this inspection was gathered in a number of different ways. This included the unannounced site visit where time was spent reading service records and looking at different areas of the building. All of the key standards and other standards were inspected and also previous requirements and recommendations from the last inspection were looked at. A pharmacy inspector conducted a pharmacy inspection on 24th June 2009 and the findings are recorded under the section, Personal Health Care of this report. The manager was present for the inspection and also managers of the different departments within the home. The Director attended the feedback with the managers at the end of the inspection. ‘Case tracking’ was used as part of the site visit. This involves looking at the support residents get from the manager and staff including their care plans, medication, money and accommodation. Five residents were case tracked, however this was not carried out to the detriment of other residents who also took part in the inspection process. Time was spent meeting with residents, visitors and staff to gain their opinions of the overall service. We also spoke with visitors to the home including relatives and a health care professional. We also contacted and spoke with social service safeguarding unit to seek their views as to the running of the home. Surveys were sent out to staff to ask them for their comments regarding the care home. None were received. During the inspection we carried out some specific observations on Beechwood unit. This involved a two hour observation of the care using a specially devised tool called ‘Short Observational Framework for Inspection [SOFI]. It involves looking at staff and residents interactions and how the care on the unit affects residents’ feelings of well being. Again some comments from this are included in the report. An AQAA (annual quality assurance assessment) was completed by the manager prior to the site visit. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 7 service, including staff numbers and training. The manager had completed the document in good detail and some information from the AQAA is recorded within the report. People accommodated at the home like to be addressed as service users and this term is used in the report to respect their wishes. What the service does well: Service users had a plan of care which provided good information for the care staff on how to provide the care and support required. Care plans on the Hunter Unit displayed evidence of input from the multidisciplinary healthcare team as needed. Evidence of relatives’ and service users input varied but was encouraged. Relatives are always invited to medical reviews (three to six monthly). A relative was complimentary regarding the care. One said, “There have been a few issues but staff generally seem very caring. I have been to one review a few weeks following the admission of my relative.” Other care plans evidenced personalised care around the management of aggression and agitation by including the recognition of trigger factors as well as individualised intervention for staff to help manage service users. Staffing levels remain good and provide a means so that social activity is not unduly reduced due to risk and service users receive the care they need. Where specific risks have been highlighted, staff provide one to one care to ensure their ongoing safety. This was seen at the time of the site visit and well managed. Service users observed appeared relaxed and supported by staff. Staff appeared to have a good rapport with them and the observations evidenced high levels of staff interaction and involvement by residents in their daily activity. We completed a two hour observation of the care on Beechwood unit using a specially devised observation tool for people with dementia. The overall findings were positive in that staff were seen to be supporting service users to make positive choices; for example about the type of activity they wanted. Service users on the Hunter Unit are involved with the community through a programme of leisure pursuits and activities that are supervised by good levels of staff. Trips out are arranged regularly and the social interests of residents on the Hunter unit were recorded in good detail. One resident spoken with was being accompanied out by a relative but also goes out daily with staff support. The routine appeared relaxed and residents were free to wander around the home with or without the supervision of staff. Staff were seen to be very enthusiastic regarding the social programme in the home and they said they Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 8 enjoyed the trips out. They also described how activities are arranged according to service users’ wishes. On Beechwood we saw an activities organiser who attends the unit during the afternoon. This person was seen relating to service users positively and including them in the social activity. Service users were taking part in crafts and art during the afternoon. Service users receive their meals in the dining rooms on both units and we saw the chef meeting with them to discuss the menu. We saw staff going around each person individually and asking them what choice of meal they wanted. The kitchen was well stocked and plenty of fresh fruit and vegetables were available to ensure well balanced and nutritional meals. The menu seen offered a good variety with plenty of refreshments throughout the day. The cook said the menu is subject to regular change to reflect the seasons and what the service users would like. Staff were observed to be careful to protect the dignity of people by ensuring good standards of personal care so that people were clean and appropriately dressed. Staff interviewed had a good knowledge of individual care needs and how to promote person centred care. This ensures individuals are involved with their care. Staff were seen to be respectful in their approach and they gave examples of how they respected service users’ wishes. For example, clothes, meal times, preferred foods, routine and social interests. Service users have access to equipment such as handrails and other moving and handling equipment including bath aids. One care staff was able to explain the care of an individual resident in great detail and although this person had a severe and progressively deteriorating medical condition they were being appropriately assessed and, in this case, would soon have a specially designed wheelchair so that they could be supported to move around better and go outside the home. This shows that the home considers a diversity of care need. Service users have access to health care professionals, for example, doctors, consultants, speech and language therapists and dieticians. This helps ensure their care needs are being met effectively. Evidence was seen of this in the care files and by speaking with staff. We spoke to a visiting health care professional who gave positive feedback regarding the care and how staff were knowledgeable on the daily care people needed. The health care professional also said the staff were prompt in seeking advice when needed and they followed her instructions. This ensures that people are receiving the right support to keep them well. A number of checks are undertaken to ensure the home is well managed. This includes the completion of regular audits for areas such as care plans and managing risks. Senior management also attend the home and produce formal reports of their findings. Those seen were detailed. The quality of the service is reviewed regularly to ensure it is run in the best interest of the people accommodated. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 9 What has improved since the last inspection? Over all we found that people in the home were monitored and that challenging behaviour and behaviour which presented as a risk factor is managed in a proactive manner. This is an improvement on the previous inspection. For example, service users reviewed had been involved in incidents of aggression. We found that these are recorded and monitored appropriately and that full reviews had been carried out which included both medical and [where necessary] input from the local safeguarding team. The carers’ notes are now recorded in the main file and these related to the care provided and act as a useful way of monitoring care on a daily basis. Staff commented that they now attend full daily briefings which include the registered nursing staff. They also have hand over sheets to complete as part of evidencing the care given. Again this has been a development since the last inspection and helps to improve communication so that the people living in the home benefit from consistent care. A number of pharmacy inspections have taken place over the last year and medicine management has improved so that medicines are administered safely to the service users. The managers have responded to requirements made on previous inspection reports. This includes more clearly defined areas so that male and female bedrooms are in separate areas as well as improving single sex access to bathrooms and toilets. Staff commented that this has made it easier to maintain some residents’ safety and privacy. This will also have helped to reduce incidents in the home and is evidence of better risk management for the people accommodated. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 10 What they could do better: We were concerned that the assessments completed following admission to the home were not completed on one of the people we reviewed. These included basic assessments such as pressure sore risk, nutrition and dependency. The assessments help to develop a care plan and should be completed in all instances. The assessment process would also benefit from a more detailed cognitive assessment. This would record information such as reasoning, comprehension, awareness and understanding. This information helps to provide more person centred care and for staff to have a greater understanding of individual need. We were concerned that one person had been admitted for two months and still did not have a more in-depth care plan. Staff explained that the care plan is built up over an extended period as information is gathered. We would recommend that the manager looks at introducing a standard time for when a care plan should be drawn up. This will ensure that everybody involved in the care can be clear about the aims and objectives of the care and how this should be carried out. We did not see any evidence of people using the service or their relatives or advocates being asked to contribute to the evaluations of the care plans. This would be recommended occasionally as it is a formal way of including people in the care they are receiving. Whilst reviewing care documents we were concerned regarding management of weight loss. This has not been addressed in terms of appropriate medical referral or review. We spoke to the managers about this and would recommend this is reviewed more regularly as part of monitoring health needs. The moving and handling assessments to move people safely should also be completed in more detail with regards to the equipment used. On the Beechwood Unit we felt that evaluations could be developed further to show a clearer progress of the care rather than ‘continue as plan’. This would give a clearer outline of the progress of the care. We discussed this with the staff on the unit On the Hunter Unit some of the toilet areas were not as accessible as they could be. For example one toilet had been out of use for some time and other toilets are not signposted appropriately so that residents who may be disorientated can be assisted to find them. We looked at some of the toilets and bathrooms on the Hunter Unit. One was in a state of disrepair with tiles missing off the wall. Another bathroom was being upgraded but this was still in progress [we were advised] for a time approaching a year. We spoke to the managers about this and the need to ensure that facilities are maintained adequately and are fit for use. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 11 Other toilets and bathrooms are not easy to find, especially for people with dementia. There are no obvious signs or environmental prompts to help people orientate themselves and we would again recommend that this is addressed as the Hunter Unit develops. This is important as good environmental cues and aids are needed to help people with dementia to orientate them. The central patio area needs attention as there are lots of weeds and the surrounding plaster work to the walls is in need of repair due to general wear and tear. A number of service users were seen to sit out on the patio and the overall appearance of this area should be improved for them. The maintenance plan for the home should include replacement of a large window in the conservatory as the glass has ‘blown’. This was stated at the previous key inspection. A number of windows have been replaced in other areas. Staff training files were looked at and these showed that staff require training in food hygiene so that they have the skills and knowledge to hand food safely. No training dates were seen for this. The training organiser said a course would be arranged as soon as possible. The training plan should also evidence dates of future training courses available for staff. Reporting incidences and referring safeguarding concerns was seen to be more effectively managed. Staff however, still need guidance on the completion of Regulation 37 reports. These had not been submitted to us for all of the incidences discussed at the time of this inspection. There is still room for improvement in this area so that service users are protected. Staff induction should be in accordance with Skills for Care Induction Standards which provides formal learning for staff in the care setting. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 12 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 13 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, and 3 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. Service users have information regarding the service and have their health and social care needs assessed. This helps to ensure staff can meet their needs. EVIDENCE: The pre inspection questionnaire [AQAA] for the service states: ‘We have an up to date Statement of Purpose and Service User Guide outlining facilities available and services provided.’ The Service User Guide [a brochure of the service] was displayed for residents and their families to see. Following the last key inspection, the wording used in the Service User Guide has been changed to reflect the service user group. The document now states that ‘Hunter’s Way caters for young people with dementia and organic brain injury.’ This better reflects the registration of the service. The pre inspection questionnaire [AQAA] for the service states: Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 14 ‘All prospective service users are personally assessed using comprehensive pre admission assessment documents based on a client centred approach.’ Two service user assessments were looked at and these showed details regarding health and social care needs. The assessments had been completed by the manager and there was evidence of assessment information from the multidisciplinary health team [MDT] to assist with collating information. Staff interviewed said the assessments provided good detail to assist with formulating a plan of care. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 15 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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): All Key Standards. Quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. All residents have a care plan, which is reviewed regularly so that care can be given according to need. EVIDENCE: The pre inspection information [AQAA] for the service states: ‘Examples of the types of care plans and risk assessments include medication as well as incorporating the deprivation of liberty [safeguards]. We have a good turnout for our Residents committee - which is resident led. We also have a good turnout for the relatives committee - which is relative led. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 16 We will continue to access external specialist members of the MDT [multidisciplinary team] to enable us to continue to give high quality specialist care; with the support from the Mossley Hill Hospital team, who have continued to support us throughout, contributing advise and assessment our service users for optimum health and well-being’. This shows that the managers and staff are keen to seek advice form people using the service and have also worked well with outside agencies to support people in the home. Hunter Unit Three care files were viewed for residents on Hunter Unit. Care plans are loosely based on activities of living model of nursing care which looks at how people perform daily care activities. They displayed evidence of input from the multidisciplinary healthcare team as needed. Evidence of relatives’ and service users’ input varied but was encouraged. Relatives are always invited to medical reviews (three to six monthly). A relative was complimentary regarding the care. One said, “There have been a few issues but staff generally seem very caring. I have been to one review a few weeks following the admission of my relative.” Monthly reviews and evaluations were evident on care plans seen and the plans were based on needs identified on the pre-admission assessments such as more immediate risk factors. Multidisciplinary healthcare team (MDT) input was evident in all necessary care plans. We were concerned that the assessments completed following admission to the home were not completed on one of the people we reviewed. These included basic assessments such as pressure sore risk, nutrition and dependency. The assessments help to develop a care plan and advise staff of how to manage risks that affect a service user’s welfare. They should be completed in all instances. The initial activities of living assessment is completed and acts as an initial care plan although this is brief. A more in depth care plan is developed over the following weeks. We were concerned that one person had been admitted for two months and still did not have a more in-depth care plan. Staff explained that the care plan is built up over an extended period as information is gathered. We would recommend that the manager looks at introducing a standard time for when a care plan should be drawn up. This will ensure that everybody involved in the care can be clear about the aims and objectives of the care and how this should be carried out. Other care plans seen had been completed in good detail and the staff interview were knowledgeable regarding the individual care and support service users needed. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 17 The monthly evaluations were clear in that they were a record of the progress over the proceeding time period and they were a good monitoring guide. We did not see any evidence of people using the service or their relatives or advocates being asked to contribute to these evaluations. This would be recommended occasionally as it is a formal way of including people in the care they are receiving. An example of the importance of this came from a relative spoken with. They commented that they had some input initially following admission to the home by completing a social history but had little feedback since and were not really aware of the key people [nursing and care staff] involved in their relative’s care. Overall we found that people in the home were monitored and that challenging behaviour and behaviour which presented as a risk factor is managed in a proactive manner. This is an improvement on the previous inspection. For example service users reviewed had been involved in incidents of aggression and we found that these are recorded and monitored appropriately. Full reviews had been carried out which included both medical and [where necessary] input from the local safeguarding team. Other care plans evidenced personalised care around the management of aggression and agitation by including the recognition of trigger factors as well as individualised intervention for staff to help manage. Staff spoken with were aware of these factors as they had got to know the service users well. The staffing levels remain good and provide a means so that social activity is not unduly reduced due to risk and a service user receives the care they need. There are daily-recorded notes from nursing staff and care staff. The carers’ notes are now recorded in the main file and these related to the care provided and act as a useful way of monitoring care on a daily basis. Staff commented that they had enough information about each person cared for and that all staff now attend full daily briefings, which include the registered nursing staff. Staff also complete a hand over sheet with details of the care given. Again this has been a development since the last inspection and helps to improve communication so that the people living in the home can have a consistency of care. Service users observed appeared relaxed and supported by staff. Staff appeared to have a good rapport with them and the observations evidenced high levels of staff interaction and involvement by service users in their daily activity. Service users spoken with generally lacked concentration but were able to express positive feelings about being on the unit. One person spoken with said that staff supported him when he went out. Another person had two to one staff support when going out for walks. Staff interviewed described the assessment for one to one care and how they supported the service user during their shift. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 18 Beechwood Two care files were viewed and these evidenced a plan of care, which was detailed and provided good information for the staff on the care delivery. This helps to ensure good outcomes for the service users. Risk management had been instigated with control measures to help keep the service users safe and also to encourage their independence. This was seen, for example, in relation to nutrition and falls. Evaluations of care gave a good summary of care needs over a ‘given’ period of time. Consent to the plan of care had also been obtained to ensure relative involvement. Care staff write up the daily care they give to each service user and records seen were current and made reference to the plan of care. As on the Hunter Unit we felt that more ongoing input from relatives could be evidenced as the care is evaluated as this provides a formal means of getting relatives [and service users] involved in the care. We also felt that evaluations could be developed further to show clearer progress of the care rather than ‘continue as plan’. This would give a clearer outline of the progress of the care. We discussed this with the staff on the unit The care files seen contained information relating to social care and family background to enable staff to get to know the service user in more depth thus providing person centred care. A ‘family tree’ had been completed for this purpose. As on the Hunter Unit, the service users appeared relaxed and comfortable with the staff. We completed a two hour observation of the care on the unit using a specially devised observation tool for people with dementia. The overall findings were positive in that staff were seen to be supporting service users to make positive choices; for example about the type of activity they wanted. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 19 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: All Key Standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to enjoy an active lifestyle, as there is a good range of individualised activities in the home. EVIDENCE: The pre inspection information [AQAA] for the service states: ‘We provide the service users with an opportunity to maintain and develop independent living skills. We provide an activity programme and staff ensure service users have access to a range of leisure activities both internal and external.’ Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 20 This enables service users to be as independent as they can be. They can continue with their chosen social interests and are also offered the opportunity to try out new ones and to take part in community based activities. Hunter Unit Service users on the Hunter Unit are involved with the community through a programme of leisure pursuits and activities that are supervised by good levels of staff. Trips out are arranged regularly and service users have the use of two minibuses. The social interests of service users on the Hunter Unit recorded in good detail the social interests and the completion of a ‘family tree’ with photographs and plenty of personal details. Service users had their own book for recording activities and for photographs. The staff appeared busy sorting out social arrangements and service users were going out at different times of the day. Service user care files reference activities and these are also recorded in daily records. One service user spoken with was being accompanied out by a relative but also goes out daily with staff support. Other service users enjoy getting involved in gardening and there are also some animals kept at the rear of the home. The issue of intimate relationships is particularly difficult given the nature of disability on the Hunter Unit. The brain damage caused by early inset dementia can result in residents becoming at risk from behaviours such as aggression and also disinhibited sexual behaviour. Such incidents are recorded in care files and some have resulted in safeguarding referrals and investigation in the past. The managers have responded to requirements made on previous inspection reports and have introduced more clearly defined areas so that male and female bedrooms are in separate areas as well as improving single sex access to bathrooms and toilets. Staff commented that this has made it easier to maintain some residents’ safety and privacy. This has also helped to reduce the incidences in the home. The routine appeared relaxed and residents were free to wander around the home with or without the supervision of staff. Residents were receiving a good choice of hot and cold food, served in all the dining areas. The service users can choose which room they wish to have their meal. The menu is based over four weeks and the chef meets with the residents to discuss preferred options. Beechwood With regard to social activities a weekly plan was available and although not extensive it is planned in accordance with service users’ needs. Walks on the Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 21 promenade are encouraged during the warm weather and service users now benefit from gentle arm exercises and ball games which we observed on the inspection. We also saw that each person on the unit is developing their own photograph album of time spent and activities they have been involved in. This is useful so that staff can reminisce with residents and also include their family. We saw an activities organiser who attends the unit during the afternoon. This person was seen relating to service users positively and including them in the activity. Service users receive their meals in a dining room and like the Hunter Unit the chef meets with them to discuss the meals served. We saw staff going around each person individually and asking them what choice of meal they wanted. The SOFI observation conducted on the unit showed that staff interact well with service users and that this helps to make them feel better and more active and involved. Staff were good at ensuring that care was conducted with a relaxed pace so that residents could keep up with and involve themselves with the routine of the day. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 22 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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): All Key Standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health care is assessed and supported through adequate liaison with external professionals so that service users’ needs are met. EVIDENCE: General observations of service users care evidenced good standards in relation to staff attitudes regarding the privacy and dignity of the service users. Staff were observed to be careful to protect the dignity of people by ensuring good standards of personal care so that people were clean and appropriately dressed. On the Hunter Unit some of the toilet areas were not as accessible as they could be. For example one toilet had been out of use for some time and other toilets are not signposted appropriately so that service users who may be disorientated can be assisted to find them [see ‘environment’]. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 23 Staff interviewed displayed an understanding of the need for patience and tact when carrying out care with more challenging residents. Staff spoke about having to return frequently to service users and not to ‘give up’ if initially they are not compliant in terms of self care. The pre inspection information [AQAA] for the service details the staffing structure which helps to provide good continuity of care as staff have a designated job role. Independence was being encouraged through the activities programmes and family involvement. Support for personal hygiene was also evidenced in care plans seen. The detail in the care plans was personalised so that it was relevant to the person. Service users have access to equipment such as handrails and other moving and handling equipment including bath aids. On the Hunter Unit staff have team leader roles and senior carer roles as part of their development and are assigned a number of service users to care for which encourages individualised care. For example one care staff was able to explain the care of an individual person in great detail and although this person had a severe and progressively deteriorating medical condition they were being appropriately assessed and, in this case, would soon have a specially designed wheelchair so that they could be supported to move around better and go outside the home. Service users have access to health care professionals outside the home and this helps ensure their care needs are being met effectively. Service users who cannot attend a surgery receive GP visits. These were clearly recorded in care notes. We spoke to a visiting health care professional who gave positive feedback regarding the care and how staff were knowledgeable on the daily care people needed. Care files seen evidenced referrals to other health professionals. This ensures that people are receiving the right support. We reviewed the care of two people who was generally receiving appropriate support. We were, however, concerned that there had been weight loss recorded and this has not been addressed in terms of appropriate medical referral or review. We spoke to the managers about this and would recommend this is reviewed to ensure their health needs are monitored in relation to nutrition. A pharmacy inspection was conducted on 24th June 2009. We checked how controlled drugs (medicines that can be misused) were handled. The cupboard used for storage was secure and a special register was used for record keeping. Stock levels were correct and all entries were properly witnessed. Secure storage and witnessed records help make sure controlled drugs are not mishandled or misused. We looked at a sample of care plans and records to check if medicines were properly reflected in them. We found good information about how medicines Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 24 should be safely used and we saw up to date directions about how to use specific medicines in each persons care plan. People that were prone to seizures had clear plans about how they were to be managed, a person that was regularly refusing their medicines had a detailed care plan about how this was to be managed and several people who were diabetic had good paperwork to support the use of insulin and the recording of their blood sugars. Paperwork and information about doctors and nurses visits to the home and the treatments they had given people had been improved and this was clearly presented in the care plans and medicines records. Having clear written care plans helps make sure peoples medicines are handled safely. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 25 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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): All Key Standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. We have made this judgement using a range of evidence, including a visit to this service. Staff need guidance on incidences that need to be reported to the Commission to ensure service users are protected. EVIDENCE: Hunter Unit/Beechwood The complaints’ procedure was displayed for service users and visitors to access should they wish to raise a concern. The pre inspection questionnaire [AQAA] states that no complaints have been received by the home over the last twelve months and that there have been seven safeguarding referrals to protect the service users. The Commission received two complaints and these have been investigated to the satisfaction of all parties. As previously stated the number of safeguarding referrals received by the safeguarding team has been reduced. This was confirmed by a member of this agency. The staff have received training and guidance on managing safeguarding referrals and those interviewed demonstrated a good understanding of the procedure to be followed should they witness an untoward incident. A staff member said, “I would have no hesitation in reporting something and I know the contact numbers to do this.” Staff have Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 26 access to policies regarding safeguarding adults and local guidelines to be followed. Protection of vulnerable adult training is also included in the staff training plan which was seen at the time of the inspection. Reporting incidences and referring safeguarding concerns was seen to be more effectively managed. Staff however, still need guidance on what should be reported to us with the Regulation 37 reports. These had not been submitted to us for all of the incidences discussed at the time of this inspection. There is still room for improvement in this area so that service users are protected. Reports we have received were completed in sufficient detail. The staff are attending Deprivation of Liberty training. This looks at a person who may lack capacity to make a decision and the assessment that is needed to support them. The Mental Capacity Act has been amended to include the Deprivation of Liberty safeguards that came into force in April 2009. A statement to safeguard service users’ individual health and social care needs has been introduced into the care files. The manager has made two referrals for assessment and has followed the correct procedures for this; this demonstrates further evidence of how service users are protected. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 27 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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): All Standards People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There needs to be further development of the dementia care environment so that people are enabled to find their way around more comfortably and facilities are easily accessed. EVIDENCE: We reviewed a requirement made on the previous inspection. This concerned the provision of more clearly identifiable areas for female and male service users. This was to ensure privacy could be improved and also the number of adverse incidents involving allegations of sexual abuse could be reduced and service users protected. Some improvements to the environment have been made to provide this protection. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 28 We found that the managers have acted on the good practice recommendations discussed and that male and female bedrooms are now more likely to be in separate areas. Women who need extra protection in terms of behaviour management are cared for on Hunter 2 which is a separate area of the home. The evidence from staff interviews and incident files show that the number if incidents has fallen [none recorded since the last inspection] and that women are both safer and experience better levels of privacy. Bedrooms seen varied in the level of personalisation and maintenance in terms of cleanliness. For example one bedroom seen was very well personalised with evidence of the person’s life style being supported [this was particularly so on the Beechwood unit] but we also saw a bedroom on Hunter Unit which was very basic and standards of cleanliness had not been maintained. There was cigarette ash on the floor, stains and cigarette burns on floor and furnishings. Discussions are ongoing with the service user and family. We would recommend this is reviewed and the room is more consistently cleaned. We saw some of the toilets and bathrooms on the Hunter Unit. One toilet had been out of use for some time and was in a state of disrepair with tiles missing off the wall. The toilet was not locked however was clearly still being used by service users. We spoke to the managers about this and the need to ensure that facilities are maintained adequately and are fit for use. Other toilets and bathrooms are not easy to find, especially for people with dementia. There are no obvious signs or environmental prompts to help people orientate themselves and we would again recommend that this is addressed as the unit develops. This is important as good environmental cues and aids are needed to help people with dementia to orientate them and are a marker of good standards in this area. The grounds of the home are spacious and provide plenty of open space for service users to take walks. The central patio area needs attention as there are lots of weeds and the surrounding plaster work to the walls is in need of repair due to general wear and tear. A number of service users were seen to sit out on the patio and the overall appearance of this area should be improved for them. The maintenance plan for the home should also include replacement of a large window in the conservatory as the glass has ‘blown’. This was stated at the previous key inspection. A number of windows have been replaced in other areas. The laundry room was found to be clean and organised. Staff had gloves and aprons as part of maintaining effective standards of hygiene. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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): All Standards 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. Staff require food hygiene training so that they have the skills and knowledge to handle food safely. EVIDENCE: The pre inspection information [AQAA] for the service states: ‘We maintain a high ratio of staff enabling us to support our service users to the full and support them to achieve maximum independence through a client centred approach.’ This was seen at the time of the key inspection. The staffing rota for the week of the inspection reflected good numbers of staff to provide the necessary care and support to the service users. On the Hunter Unit, four registered nurses were on duty with twenty two carers. At night, two registered nurses and six carer work on the unit. Two care coordinators work closely with the care staff when planning care duties. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 30 Two groups of staff work with two groups of service users. Staff interviewed commented on how well this works and continuity of care has improved. On Beechwood a deputy manager, team leader and senior carer were on duty. Staff interviewed were very knowledgeable regarding the needs of the service users they care for. They were enthusiastic regarding their job role and said they were supported by the manager. They described the importance of one to one care, triggers that affect service user’s behaviour and how to respond to incidences. They were seen to be attentive and polite in their approach and they displayed patience when assisting service users with various activities. Three staff files were looked at to evidence safe recruitment practices. The files seen showed the staff members had been recruited robustly. The staff had completed an application form and there were references and police checks. The references for one staff member could not be located and the details were sent to the inspector following the inspection. The staff files looked at showed that staff had received an induction when starting employment. This should be linked to the Skills for Care Induction Standards which provide formal learning in the care setting. A newly appointed member of staff said the induction included mentorship with an existing member of staff and a written induction which she was completing with the manager. The staff had received training in safe working practices and also areas such as challenging behaviour, crisis management and dementia care. Some certificates were in staff files and the training plan showed dates of attendance. The training organiser is new in post and is currently sorting dates for further training as some gaps were noted on the training plan. It was noted that food hygiene is needed for staff so that they have the skills and knowledge to handle food safely. The pre inspection questionnaire [AQAA] for the service states that of the fifty eight care staff, thirty six have achieved an NVQ (National Vocational Qualifications) in care. This indicates a good training programme for staff as over 50 have achieved a formal qualification as part of their learning and development. Staff interviewed said they had attended NVQ courses and that the manager was good at arranging training relevant to the work place. Arrangements were in place for staff to meet with senior staff as part of supervising their job role and discussing staff training. Supervision dates were available in some staff files and also provided following the inspection. Annual appraisals are also given to the staff. A staff member said, “I can always seek advice from any of the staff.” Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 31 Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 32 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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): All Standards 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. The management of the service has improved to protect the welfare of the service users and staff. EVIDENCE: The registered manager is Ms Mary Regan and she maintains her Registered Mental Nurse qualification. She has also completed an NVQ course in management and dementia care. Ms Regan is no longer responsible for assisting the management of other services with European Wellcare. This has helped the manager to meet the requirements from the last key inspection and subsequent random inspections. Staff interviewed said the home was better managed and that changes made were positive. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 33 The service has been subject to rigorous compliance checks and audits, both internally and externally. A number of agencies and external health care professionals have also assisted staff with their training needs, development of new care documents and policies and procedures for safeguarding service users. These checks have provided valuable information regarding the quality of the service, for example, what the home does well and where there is room for improvement. Those seen were detailed and included areas such as, care planning, medicine management, the environment, health and safety and staff training. Compliance checks seen had highlighted the need for improvements to the environment and this work should be actioned in light of findings at the time of the inspection. The views of the service users and their families had been sought and surveys seen reported favourably regarding the service. A formal committee meets called ‘Friends of Beechwood’, which service users can attend. Good communication was evident and staff were seen to ask service users how they wished to spend their day, for example, taking part in the trip out. Their views are taken into account when planning outings and record kept of places of interest they would like to see. Reporting incidences and referring safeguarding concerns was seen to be more effectively managed. As stated under Standard 23, management decisions need to be made regarding what is recorded on a Regulation 37 form for the Commission and this includes incidences that affect the welfare of service users. Staff interviewed said they received a number of policy documents to read and that they are advised of any changes made to these by the company. The pre inspection questionnaire [AQAA] detailed a number of policies and their review date. Records seen were securely stored, the office door was locked when not in use. This included service user financial records which were accurate to protect their interests. The pre inspection questionnaire [AQAA] gave details of contracts for equipment and services. A spot check of the gas, electric, hoists and fire prevention were found to be in date. Fire alarms had been tested weekly and staff had received fire prevention training. These measures help to protect the service users. There are good lines of accountability in the home. Senior management, the manager and staff have worked together to improve standards thus providing a more settled environment and atmosphere for the service users. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 34 Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 2 3 3 3 3 3 Version 5.2 Page 36 Beechwood DS0000059323.V376234.R01.S.doc NO Are there any outstanding requirements from the last inspection? 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 YA24 Regulation 23 Requirement All bathroom and toilet facilities’ must be maintained in a fit and suitable state so the people using the service can access and use them safely and consistently Staff require food hygiene training so that they have the skills and knowledge to handle food safely. Timescale for action 01/10/09 2. YA35 18 01/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations We recommend that all assessments should be completed appropriately so that a care plan based on full care needs can be developed. The assessment process would also benefit from a more detailed cognitive assessment. This would record information such as reasoning, comprehension, awareness and understanding. This information helps to provide more person centred care and for staff to have a greater understanding of individual need. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 37 We recommend that managers develop a standardised time limit for the development of the care plan from the day of admission and this can then be audited. We recommend the moving and handling assessments to move people safely should be completed in more detail with regards to the equipment used. We recommend that people using the service and or there relatives and supporters are included in the formal evaluation process of the care plans. On the Beechwood unit we would recommend that evaluations are written in more depth to provide a better commentary [review] of the care. 2. YA18 As part of maintaining the health care of the service users we strongly recommend that all toilets are immediately accessible and maintained. This includes appropriate signage to help with orientation. 3. YA19 We reviewed the care of two people and were concerned that there had been a weight loss recorded. We spoke to the managers and would recommend this is reviewed to ensure health care needs are monitored. We recommend staff receive guidance on what should be reported to us with the Regulation 37 reports. There is still room for improvement in this area so that service users are protected. We recommend that the ‘dementia care’ environment be developed on both the Hunter Unit with and Beechwood by the provision of suitable orientation aids so that people can be enabled to move about the home more freely. The central patio area needs attention as there are lots of weeds and the surrounding plaster work to the walls is in need of repair due to general wear and tear. A number of service users were seen to sit out on the patio and the overall appearance of this area should be improved for them. The maintenance plan for the home should also include replacement of a large window in the conservatory as the glass has ‘blown’. This was stated at the previous key Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 38 4. YA23 YA38 5. YA24 inspection and its replacement would improve the appearance of this room. 6 YA35 We recommend the induction be in accordance with Skills for Care Induction Standards which provide formal learning in the care setting. We recommend the staff training plan show future training dates. Beechwood DS0000059323.V376234.R01.S.doc Version 5.2 Page 39 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE1 4WH 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. 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