Care Home: Beechwood House Care Home

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What the care home does well People living at the home praised the staff, saying that they were always listened to and staff were sensitive to their needs. Staff observed were polite and interacted with service users in a kind respectful manner. There was also strong praise for the manager. She was described as open and approachable. Everyone said that they would be comfortable to approach her with any concern or worry that they had. The manager gives a clear sense of direction to the home and ensures that high standards are maintained. People living at the home continue to feel in control of their day to day lives and are treated with respect and dignity at all times. All prospective service users have their needs assessed before being offered a place at Beechwood House Care Home. Many service users stated that they, or their representative, had visited the home before they decided to move in. People felt that they received adequate information to help them make their decision. All areas of the home were furnished and decorated to a high standard and there is a variety of communal areas for service users to utilise. On the day of the inspection all areas were immaculately clean and fresh providing a pleasant atmosphere for service users. What has improved since the last inspection? The home has a commitment to ongoing improvement and since the last inspection many areas have been redecorated and refurbished. Excessive signage has been removed to ensure that a homely environment is maintained. What the care home could do better: Although staff appeared to be very aware of the needs of individuals, care plans did not give clear guidance. Care plans would benefit from being made comprehensive and the manager must ensure that there are clear up to date guidelines for staff to follow, this would lead to greater consistency especially when new staff are employed. Some errors in the recording of medication were noted by the inspector and discussed with the manager. Some staff working at the home have not received fire training for over twelve months and now require up dates to ensure that they are confident in fire safety and prevention issues and are able to respond appropriately in the event of a fire at the home. CARE HOMES FOR OLDER PEOPLE Beechwood House Care Home 60 West Coker Road Yeovil Somerset BA20 2JA Lead Inspector Jane Poole Unannounced Inspection 8th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechwood House Care Home Address 60 West Coker Road Yeovil Somerset BA20 2JA 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) 01935 472793 01935 425723 beechwood@homecall.co.uk Beechwood House Care Home Ltd Mrs Sandra Jean Barclay Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th January 2007 Brief Description of the Service: Beechwood House Care Home provides care and accommodation for up to 28 older people. The home is set back on a main road on the outskirts of Yeovil. Residents living accommodation is arranged on the ground floor with easy access throughout, including access to the formal and natural gardens. All bedrooms have toilet and hand basin en-suite facilities, and there are ample shared bathing and toilet facilities throughout the home. The home has two dining rooms, two lounges and two conservatories. The home has a No Smoking policy. There is ample dedicated parking at the front of the home. Fees at the home range from £373.00 to £525.00 per week. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. One inspector carried out this inspection over one day. Prior to this inspection the home completed an Annual Quality Assurance Assessment (AQAA). This gave clear details about the home and demonstrated a commitment to ongoing improvement. 8 service users completed questionnaires prior to the inspection and some of their comments have been incorporated into this report. What the service does well: People living at the home praised the staff, saying that they were always listened to and staff were sensitive to their needs. Staff observed were polite and interacted with service users in a kind respectful manner. There was also strong praise for the manager. She was described as open and approachable. Everyone said that they would be comfortable to approach her with any concern or worry that they had. The manager gives a clear sense of direction to the home and ensures that high standards are maintained. People living at the home continue to feel in control of their day to day lives and are treated with respect and dignity at all times. All prospective service users have their needs assessed before being offered a place at Beechwood House Care Home. Many service users stated that they, or their representative, had visited the home before they decided to move in. People felt that they received adequate information to help them make their decision. All areas of the home were furnished and decorated to a high standard and there is a variety of communal areas for service users to utilise. On the day of the inspection all areas were immaculately clean and fresh providing a pleasant atmosphere for service users. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 7 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 Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users receive adequate information about the home and are able to visit before deciding to move in. All prospective service users have their needs assessed to ensure that the home is able to meet their needs. Intermediate care is not provided. EVIDENCE: 7 of the 8 people who completed questionnaires prior to the inspection stated that they had received enough information about the home before they moved in. People spoken to stated that they, or their representative, had been about to visit Beechwood House Care Home before deciding to make it their home. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 9 The manager meets and assesses all prospective service users before offering a place to ensure that the home is able to meet their needs. The service user guide clearly states that the first month of any stay is a trial period for the service user to decide if Beechwood House Care Home is the right place for them. Those people who are privately funding their care receive a contract from the home. Those who are being assisted with their fees by the local authority have a letter from the home setting out how the fee is made up and a financial agreement with the local authority. Copies of both were seen by the inspector. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The outcomes for service users in this outcome group is good although documentation does not always support this. Service users are treated with respect and dignity at all times. Medication Administration Records would benefit from regular auditing to ensure that good practice guidelines are being observed. Care plans are very basic and do not always give clear guidelines to enable staff to support service users in a consistent manner. EVIDENCE: All service users living at the home have a care plan. The inspector viewed the care plans of three people. These plans of care were very basic but gave an Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 11 overall picture of the person including their likes and dislikes. It was apparent when observing care practices that staff had a good knowledge of service users including their behaviour and needs, however these were not always reflected in the care plan and so did not give clear information. Written daily records again were very basic and gave only information about the physical care provided to people. Service users spoken to were happy with the access to healthcare professionals from outside the home. People stated that they are able to see healthcare professionals in the privacy of their rooms. 7 people who completed questionnaires answered ALWAYS to the question “ Do you receive the medical support you need?” and 1 person answered USUALLY. Currently all medical appointments are recorded in the daily records and are therefore difficult to find. No one living at the home has pressure sores but preventative equipment is used when a risk is identified. Everyone spoken to felt that their privacy and dignity was respected. Many service users praised the staff for the sensitive way that they assisted with personal care. The inspector observed that staff interacted with service users in a polite and respectful manner and assistance was given in a sensitive manner, which did not draw attention to the individual. The home uses a Monitored Dosage System for medication and there is appropriate storage facilities including storage for controlled drugs and medication that requires refrigeration. Some service users self-administer their medication and the inspector saw assessments in care plans for this practice. The inspector viewed the Medication Administration Records (MARs.) All medication is checked and signed in on the MARs when it arrives in the home. There were some gaps in signing when medication was administered or refused and some hand written entries had not been signed and witnessed in line with good practice guidelines. This was discussed with the manager at the time of the inspection. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are respected as individuals and continue to control their day – to-day lives. The quality of food in the home is good and there is a wide variety of meals. Service users maintain contact with friends and family but also enjoy socialising with other people living at the home. EVIDENCE: Everyone spoken to on the day of the inspection stated that they continued to control their day-to-day lives. People said that there are no strict routines in the home and that they are able to carry on living in their own preferred ways although they acknowledged that there were some compromises to be made at times. People said that they got up and went to bed at their preferred times and were free to decide how they spent their day. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 13 Activities are arranged daily and all service users receive a programme of events on a monthly basis. Service users stated that they are free to join in activities that interest them but there is no pressure to do so. On the afternoon of the inspection a small group of people attended a flower arranging session with the activities worker. People stated that they enjoyed quizzes, games and music. There is a regular exercise class and a monthly church service. The service user guide states that the home is committed to ensuring that no one is excluded on the grounds of ethnicity, religion or culture. One person spoken to stated that the home respected the beliefs held by service users and were always ready to listen to suggestions. It was also said that the manager of the home shows a great interest in each service user as a person and is always keen to ensure that people are happy and comfortable with all aspects of the service. All service users confirmed that they are free to have visitors at anytime. Many said that they continue to enjoy going out with friends and relatives. The majority of service users have personal phones in their rooms and are able to keep in touch with people from the privacy of their rooms. The home are due to have a computer with internet access installed in one of the lounges and are hoping that service users will use this to stay in touch with people. Many of the service users asked stated that they were interested in learning how to use email facilities. There are two dining rooms in the home giving people a choice of where they have their meals. One person stated that they usually chose to have breakfast in bed but went to the dining room at lunch-time because they enjoyed the company. All service users who completed questionnaires answered ALWAYS or USUALLY to the question “Do you like the meals in the home?” one person commented that there was a good variety of food and the home were always happy to provide alternatives. During the inspection service users praised the food saying that it was well cooked and tasty. The inspector saw lunch being served. The dining room was nicely presented and the occasion was relaxed and social. Service users stated that they can ask for drinks and snacks at anytime. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate systems are in place to minimise the risk of abuse to service users. Service users would be comfortable to raise any concerns with the manager and are confident that they would be listened to. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. A complaints log is maintained and the inspector saw that one complaint had been made. The issue had been investigated in a timely fashion and appropriate action taken. Without exception all service users asked stated that if there was anything that they were not happy about they would be very comfortable to approach the manager. All were confident that they would be listened to and that action would be taken to resolve any issues. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 15 The inspector observed that all service users have unrestricted access to their personal rooms and to all communal areas. The inspector viewed the recruitment files of three newly employed members of staff. All had been checked against the Protection Of Vulnerable Adults (POVA) register before commencing work in the home and all had undergone an enhanced Criminal Records Bureau (CRB) check. Beechwood House Care Home DS0000064801.V353444.R03.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All areas of the home are furnished and decorated to a high standard giving service users a comfortable home. The standard of cleanliness in the home is very good. EVIDENCE: There is an ongoing refurbishment plan. Within the last 12 months the home have redecorated many bedrooms, some communal areas and purchased new chairs for the lounge and some other rooms. There are plans to refurbish a bathroom to make it more appropriate to the needs of the service users. Since the last inspection the home have removed some signage to enhance the homely environment. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 17 All resident accommodation is on the ground floor and accessible to people with all levels of mobility. There are two lounges, two dining rooms with conservatories attached and attractive safe gardens. Various aids and adaptations have been put in place to enable people living at the home to maintain their independence. These include hand rails, assisted bathing facilities and raised toilets. Service users are able to bring personal items with them when they move to the home, which gives bedrooms an individual homely feel. Everyone who completed a questionnaire said that the home was always clean and fresh. On the day of the inspection all areas seen by the inspector were immaculately clean. All areas are well maintained and furnished and decorated to a high standard. Beechwood House Care Home DS0000064801.V353444.R03.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a robust recruitment procedure that minimises the risks of abuse to service users. Staff working at the home are respectful and sensitive to the needs of service users. EVIDENCE: The home employs 18 care staff, 9 have a National Vocational Qualification in care at level 2 or above. A further 4 people are working towards the award. There is a twelve-week induction programme for new staff and ongoing training opportunities. The home uses a combination of outside courses and in house training videos. Staff were happy with the level of training available. Service users felt that there were adequate numbers of staff on duty and everyone stated that staff were always available to assist them when needed. All service users who completed questionnaires answered YES to the question “Do Staff listen and act on what you say?” Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 19 The inspector viewed the recruitment files of the three most recently appointed members of staff and noted that there was a thorough recruitment procedure which included obtaining written references and carrying out appropriate checks. Throughout the day service users paid compliments about the staff in the home. These included “they are all first class,” “staff are always happy to do anything for you,” and “the staff really do care.” The inspector observed that staff assisted people in a very respectful manner and all appeared happy and confident in their jobs. Beechwood House Care Home DS0000064801.V353444.R03.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed taking account of the views of staff, service users and their representatives. EVIDENCE: The registered manager of the home is Sandra Barclay. She has many years experience of working with older people and a qualification in healthcare management. She keeps her practice up to date by attending training courses and seeking advice from other professionals. The manager was available throughout the day and demonstrated an excellent knowledge of service users and their needs. Everyone spoken to described the Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 21 manager as open and approachable. One member of staff said that staff meetings were a chance to share views and opinions and that you always felt your views mattered. A service user said that the manager always listened to suggestions ‘even when you know it is not something that she personally agrees with.’ Staff and service users felt that their views influenced the running of the home. As well as informal ways for seeking the views of people using the service there are regular quality assurance audits, which include sending questionnaires to service users and their representatives. The inspector was shown copies of returned questionnaires along with the homes analysis of results. The home does not act as a power of attorney or financial appointee for anyone living at the home but does hold small amounts of money on behalf of some service users. Individual records are held for each service user and the inspector viewed a sample of these. All money deposited or passed to the service user is signed for and a running balance is maintained. Equipment in the home is regularly serviced. All areas of the home are fitted with a fire detection and call bell system which is serviced by outside contractors. The fire log shows that alarms and emergency lighting is tested on a weekly basis. It also gave evidence that some staff have not received training in fire safety for over twelve months. An up to date certificate of insurance and registration is displayed in the main entrance. Beechwood House Care Home DS0000064801.V353444.R03.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 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 4 3 3 x 3 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 3 3 3 x 3 x x 2 Beechwood House Care Home DS0000064801.V353444.R03.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. 1 Standard OP7 Regulation 15 (1) Requirement The manager must ensure that care plans are up to date, comprehensive and give clear guidelines for staff to follow. To give a clear audit trail the manager must ensure that all medication is correctly signed for when administered or refused. All staff must receive up to date training in fire safety. Timescale for action 31/12/07 2 OP9 13 (2) 30/11/07 3 OP38 23 (4) [d] 31/12/07 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 OP9 Good Practice Recommendations All hand written entries on the Medication Administration Records should be signed and witnessed to minimise the risk of errors occurring. Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beechwood House Care Home DS0000064801.V353444.R03.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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