Care Home: Beechwood Nursing Home

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What the care home does well People told us that the staff were `kind ` towards them, and `very helpful`., and staff were calm and gentle when supporting people. People told us they enjoyed the food they were given. One person said `I like the cake`. Another person told us they enjoyed the `savory things` and that the portion sizes were `plenty big enough`. The home was clean and fresh and well maintained. What has improved since the last inspection? Since the last inspection the management team and staff have worked very hard to meet the requirements made at the previous inspection. The way in which peoples care is documented has improved and staff are now given clear instructions in a care plan to ensure they know what to do in order to meet the persons needs. Some bedrooms and communal areas have been redecorated and new flooring laid. Staff said they were happy working at the home and that they `well supported by the new management regime`. New systems and protocols have been introduced and staff said they liked this `structure to work to`. We spoke to a healthcare professional during the visit, who said that she was very happy with the way in which people were being care for. She had reviewed most nursing care clients and was satisfied with the nursing care people were receiving. The pharmacist said that he was satisfied that people`s medication is dealt with properly and that the new systems for checking people`s medication is working very well. Staff training is on going with many staff being trained in things such as first aid, moving and handling, the protection of vulnerable people and fire and rescue procedures. What the care home could do better: The manager must continue to sustain this improvement at the home. People`s care records need continual audit to ensure all their care needs are captured and staff are aware of what is needed of them to meet these needs. People must consent to the care that is given especially care after death. If the person is unable to make these decisions for themselves an advocate should be obtained and consent sought from a multi disciplinary team. Documentation should be kept to evidence that any decision made is in the persons `best interest` . In order to drive the improvement and build upon the hard work that has brought about the changes at the home the manager needs to make an application to become registered with the Commission. Key inspection report Care homes for older people Name: Address: Beechwood Nursing Home Romanby Road Northallerton North Yorkshire DL7 8FH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bridgit Stockton     Date: 2 1 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 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 Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Beechwood Nursing Home Romanby Road Northallerton North Yorkshire DL7 8FH 01609777733 01609780692 carole@premiernursinghomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Premier Nursing Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 60 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, maximum number of places 60, Mental Disorder, excluding Learning Disability or Dementia - Code MD, maximum number of places 60 Date of last inspection Brief description of the care home Beechwood is a purpose built home. It is registered to care for up to sixty people who have dementia and who need nursing or personal care. It is located close to the centre of the County Town of Northallerton and is convenient for the shops and other facilities. Care Homes for Older People Page 4 of 23 Over 65 0 0 60 60 1 4 0 9 2 0 0 9 Brief description of the care home The home has its own enclosed garden area, and there are parking facilities provided at the front. It was opened in October 2000. The accommodation is on two floors. People who need nursing care live on the first floor. Those people living on the ground floor have been admitted because they need personal care only. A passenger lift provides level access to the first floor. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The purpose of this inspection was to assess the quality of the care and support received by the people who live at the Care Home. In addition to this it was to assess how the home had progressed with meeting the requirements made at the previous Inspection in September of this year. The methods we used to gather information included a visit to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. We looked in detail at the care and records of three people, examined other records and looked around the home. We spent six hours at the home. I was accompanied on this visit by a pharmacist inspector who looked at how peoples medication is looked after by the home. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 23 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs will be assessed prior to admission to the home Evidence: The care plans I looked at showed that pre-admission assessments had been carried out before offering someone a place. This is to make sure that the home can meet the persons needs. A senior member of staff usually the manager visits the person at home or in hospital to discuss their care needs. Social Services assessments are also used to determine this as well these were also available to look at. People are welcome to visit the home before reaching a decision and there is other information such as the homes statement of purpose and service user guide available to give more information to prospective residents. Since the last inspection there have been no new admissions but the manager and the area manager talked to the inspectors about the process and we saw the assessment Care Homes for Older People Page 9 of 23 Evidence: documentation. The home does not provide intermediate care. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that health care needs of the people are met safely and properly, however on some occasions documentation was not always clear with regards to how some decisions had been reached. Evidence: At the last inspection peoples care was not documented properly, and lacked instructions for staff to follow to ensure that peoples needs were being met. Since this inspection the staff at the home have worked very hard in putting into place meaningful care plans that give detail and instruction on how to meet peoples assessed needs properly and safely. Staff have had training in writing care plans and the majority have been re written. There were some shortfall surrounding the issue of consent for treatment and for peoples wishes after death. This was brought to the attention of the manager and operational manager who were going to address this. A pharmacist who works for the Commission inspected how peoples medication was managed by the home. Generally he thought this was done well and some good systems had been introduced to ensure that people received their medication properly Care Homes for Older People Page 11 of 23 Evidence: and it was managed safely. We found very few administration gaps indicating that medicines are being given correctly as prescribed. Hand written entries on MARs are now mostly completed correctly and new MARs are being annotated with any remaining medication quantities carried forward. Accurate and complete record keeping can help to prevent medication errors. MARs are now accompanied by individual medication profiles describing the correct use of as required medicines and guiding staff in ensuring each person receives their medicines in a way they prefer and which takes account of any individual concerns such as swallowing difficulties. This good practice helps to make sure all medication is given correctly as directed by the prescriber. We found that medicines are stored securely but the temperature of each medication storage area is not routinely monitored. Checking that all medicines are being stored at temperatures recommended by the manufacturer helps to make sure that staff know they are safe to use when needed. When checking medication disposal records, we found that not all doses of controlled drugs recorded elsewhere as being refused and destroyed could be identified. Medication records should be maintained consistently by all staff to ensure that all medicines received into the home can be accurately accounted for. We saw that the new management team have put into practice many recommendations made by a local NHS medicines management pharmacist. Staff told us that they welcomed the recent changes as they were already bringing about improved care and better teamwork. Personal preferences and special administration directions are recorded for most people. Good records of medication administration, refusals and reasons for omission are kept. The way in which peoples privacy and dignity is protected has improved, how ever there were still some notices pinned on peoples bedroom walls giving details of personal care, for example where cream should be applied and what continence product some people were using. Although it was thought that these notices were well intended this type of information should not be displayed publicly and peoples dignity and right to privacy was not up held on all occasions. Care Homes for Older People Page 12 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Where possible people are given choice and control to maintain Independence. Evidence: During my visit the atmosphere in the home was friendly and welcoming, with visitors coming and going throughout the day. Some people were enjoying chatting with each other; some were listing to music or else reading. During the afternoon some people were taking part in an organised Christmas activity, that staff had arranged. The manager intends to develop activities in the home to include where possible more community based activities. In addition a garden project is underway to assist some residents who would like to do gardening. It is planned to have raised beds with easy access for residents who wish to partake in this activity One person said they could have a sleep in when ever they liked and another person said the staff are superb. The operational manager explained that the way in which the communal lounge and dining area was set out previously had changed. When I visited this area there appeared to be more space for staff to work in and the lay out of furniture was better, giving people more of a choice over where to sit. People told me that the food was lovely another person said I eat very well the food Care Homes for Older People Page 13 of 23 Evidence: is great. The dining tables were nicely set and people told me the food was lovely. One person said, the cakes are very good Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse Evidence: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirm they were aware of these. Staff knowledge of these help ensure that they were able to address any issues or anxieties of the residents, relatives and visitors to the home. The complaints record was inspected. Complaints had been dealt with properly and to the satisfaction of the complainants. Staff told me that some training has taken place in the protection of vulnerable adults in abuse. The manager confirmed that this training is continuing until all staff have completed it. I looked at four personnel files and found that staff recruitment procedures were adequate and staff were employed and deployed following appropriate checks. The manager and staff team were clear and confident in the protection of vulnerable adult procedures. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortable and well maintained enviroment. Evidence: We looked around the home. It was clean and tidy. The manager told me that new flooring had been laid in some bedrooms and some rooms had also been redecorated. The communal lounge/ dining rooms had been rearrranged allowing more space for people to use. A lounge area that was under used previously has been utilised into a room where people now do activites. At the last inspection staff had not been updated on the fire and rescue proceedures at the home, training has now been given in this. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Skilled and competent staff are on duty in sufficient numbers to meet people assessed needs properly. Evidence: During the inspection we spoke to the staff on duty. They all said that they were really happy with the changes that had been made at the home, and were eager to make the changes work and to continue to improve the service that people received at Beechwood Care Home. All the staff spoken to said they felt very supported by the new manager. A new deputy manager has also been appointed to the home, who is driving up standards whilst working along side staff. We looked at the rota and there appears to be enough staff on duty to meet peoples needs. The manager showed me a training matrix, which detailed staff training that had taken place or was planned for the next few months. Training is available to all staff, mandatory training has taken place in moving and handling, medication administration, fire and rescue and first aid. Training in the protection of vulnerable adults has taken place for some staff and this is to continue until all staff have been trained. Records demonstrated that staff had been recruited properly and appropriate checks had taken place before they were accepted to work at the home. Care Homes for Older People Page 17 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well managed and people who live and work at the home can contribute to the decision making processes. Evidence: Since the last inspection there has been a new manager appointed to the home who is experienced in running and managing a care service. She is currently being supported by the operational manager. Very good progress has been made at the home and there were lots of improvements seen at this inspection. The staff spoke very highly of both managers at this inspection and said they welcomed the changes in the home. The manager as yet is not registered with the commission, she must submit her application without delay. Policies and procedures have been reviewed and updated; to make sure they provide relevant information to guide staff on how to act in every situation. We inspected how the home handles peoples personal allowances and finances. Care Homes for Older People Page 18 of 23 Evidence: Accurate records are kept and receipts for transactions were available for inspection. Peoples money tallied with the record. All the regular health and safety checks for the home are carried out in a timely manner. Staff have basic health and safety training. All these measures make sure that the health, safety and welfare of the people who live at the home is promoted and safeguarded. Care Homes for Older People Page 19 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All care plans must be 30/04/2010 reviewed and consent must be gained from either the individual, a representative or an independent advocate, when deciding about arrangements for people following death. This will make sure that peoples wishes are followed and the staff at the home are clear about what should happen following death. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 9 The temperature of all medication store rooms should be monitored regularly. All doses of refused medication, including controlled drugs, which are to be destroyed should be entered in the medication disposal records. The manager needs to make an application to CQC to Page 21 of 23 3 31 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations become the registered manager at the home Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!