Care Home: The Beeches

What the care home does well The residents are encouraged to personalise their rooms. Some rooms are attractively decorated and furnished. Visitors to the Home are made to feel welcome. Relatives are encouraged to visit. Staff are positive about the improvements made and are keen to provide a good standard of care to the residents. Residents have home cooked meals and are offered drinks and biscuits/cakes during the day. The Home has a large, attractive garden for residents to use in nicer weather. What has improved since the last inspection? The acting manager has been appointed as the permanent manager. He continues to provide consistent management of the Home. Staff feel that there is now clearer leadership and direction. The manager and proprietor have plans for further improvements. The hot water temperatures have been regulated to prevent the risk of scalds/burns. Some improvements have been made to assist residents with dementia to find their way around the Home. Staff have received mandatory training. They have also received an introduction to working with residents with dementia. One of the senior staff has started leadership training. The residents are now offered a choice at mealtimes. Meals are served in the dining room so that residents are able to make a visual choice. Referrals to health care professionals are made in a timely way and communication with local health care professionals has improved. The staffing levels have been consistently maintained and are adequate to meet the basic needs of residents. Staff are spending more time in engaging residents in meaningful activities. The care plans have been reviewed and updated. These are now clearer but there is still room for improvement. What the care home could do better: An area of the back garden needs to be made safe before residents use the garden. There are areas of the Home that would benefit from redecoration and there is a need to replace a lot of the bedding. Mealtimes are still, on occasion, chaotic and noisy. There is a need to review this to ensure that residents are eating in an atmosphere that is conducive to residents receiving adequate nutrition and enjoying their meals. There is a need to develop an effective quality assurance system so that the management team can monitor the quality of the service provided at the Home. The care plans need to be more detailed in some instances. They need to be able to provide clear guidance to staff about how to meet individual residents needs. Key inspection report Care homes for older people Name: Address: The Beeches West Harling Road East Harling Norwich Norfolk NR16 2NP     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: Lella Hudson     Date: 1 0 0 5 2 0 1 0 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 25 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: The Beeches West Harling Road East Harling Norwich Norfolk NR16 2NP 01953717584 01953717886 beeches03@aol.com www.beeches-residential.co.uk The Beeches (East Harling) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 44 The registered person may provide the following categories of service only: Care Home only - Code PC, 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 Date of last inspection Brief description of the care home The Beeches is a care home providing personal care and accommodation for 44 older people who have dementia. The home is owned by The Beeches (East Harling) Limited and is located in the village of East Harling and close to local amenities such as shops and pubs. Care Homes for Older People Page 4 of 25 Over 65 0 44 1 7 1 1 2 0 0 9 Brief description of the care home The home consists of a two-storey, converted house that is set in its own grounds. There are four shared rooms, the remainder being single rooms. All rooms have ensuite toilets, washbasins and showers or baths. The majority of rooms are on the ground floor. There are enclosed courtyards and a private garden to the rear and side of the Home. The fees are currently between £425 - £500 per week. Please contact the Home for more up to date information about fees. Care Homes for Older People Page 5 of 25 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 Home was inspected in June 2009 and the quality rating was assessed as being Poor. This remained the same after the Key Inspection in November 2009. However, during this Inspection we can see that improvements have been made to the care provided to the residents. This report includes information gathered about the Home over the last year. This Inspection included an unannounced visit to the Home by two Inspectors on the 10th May 2010. During this visit we spoke to residents, staff, the manager and the proprietor. We looked around some parts of the Home and looked at a selection of records. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: An area of the back garden needs to be made safe before residents use the garden. There are areas of the Home that would benefit from redecoration and there is a need to replace a lot of the bedding. Mealtimes are still, on occasion, chaotic and noisy. There is a need to review this to ensure that residents are eating in an atmosphere that is conducive to residents receiving adequate nutrition and enjoying their meals. Care Homes for Older People Page 7 of 25 There is a need to develop an effective quality assurance system so that the management team can monitor the quality of the service provided at the Home. The care plans need to be more detailed in some instances. They need to be able to provide clear guidance to staff about how to meet individual residents needs. 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 8 of 25 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 9 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home has not had any admissions for almost a year. There is an appropriate admissions procedure in place. Evidence: There have not been any new admissions to the Home for almost a year. The local authorities suspended placements at the Home following its Poor quality rating in June 2009. The proprietor agreed to voluntarily suspend placements at that time so that improvements could be made before new residents moved to the Home. The Manager has an appropriate procedure with regard to new admisssions and the need to carry out effective pre admission assessments. Care Homes for Older People Page 10 of 25 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. The care plans have been improved but there are still areas that need further clarification to ensure staff have clear guidance about how to meet residents needs. The residents health needs are being met in a more timely way. Evidence: During the last two inspections it was found that the care plans provided very little clear guidance to staff about how to meet the residents needs. During this visit we could see that a lot of work has been carried out to make improvements to the care plans. These now provide more information about individual residents needs and include some risk assessments. However, there is a need to ensure that these provide accurate guidance which enables staff to be clear about how to provide care. For example, we spoke to staff about a resident who spends a lot of time in their room. The staff responses were not all consistent with the care plan. We also noted that not all of the daily records were being completed sufficiently. Senior staff need to monitor the use of the care plans and daily records to ensure that staff are clear about the care needed. Care Homes for Older People Page 11 of 25 Evidence: The records relating to falls and accidents is much improved. Action has been taken which has reduced the number of falls that residents have. For example, the manager discussed the layout of a residents bedroom at their home and then moved their bed in their bedroom at the Home. This reduced the number of falls that the resident has as their bed is now in the same position in relation to the bathroom as what they had previously been used to. The manager said that there are now better working relationships with health care professionals than there have been in the past. He said that referrals are made more appropriately so that residents obtain the health care they need in a timely way. Some of the residents have had a medication review recently. Staff said that they receive consistent support from the management team and that there is always a senior member of staff that they can speak to if they are unsure of something. We received two completed surveys from health professionals and they both said that the residents privacy and dignity is respected and that the staff always respond appropriately to concerns about the health of the residents. We received eight surveys from residents, some completed with assistance from staff, and these are mixed between always and usually to the question about whether they receive the care and support that they need. An additional comment was made by a resident - staff help me feel safe and well. The manager has started to make some changes to the environment to assist residents with dementia to find their way around the Home. Several staff have attended an Introduction to Dementia course and the Manager is aware of the need for further training in this area to ensure that the staff are able to fully meet the needs of the residents. At previous Inspections we have noted many examples of the residents privacy or dignity not being respected. During this visit we noted that this has been greatly improved. However, there are a few areas in which this could still be improved. For example, we saw that one of the shared bedrooms does not have privacy curtains dividing the room and that the ensuite toilet only has a shower curtain rather than a proper door. Many of the ensuites in the bedrooms only have a shower curtain rather than a proper door dividing it from the bedroom. We also noted that some of the beds had been remade when they would have benefited from having clean bedding. Care Homes for Older People Page 12 of 25 Evidence: We looked at the medication system and can see that appropriate records are kept relating to the ordering, receipt of and administration of medication. One of the senior staff is responsible for overseeing the medication procedures. Staff only administer medication once they have received appropriate training. Care Homes for Older People Page 13 of 25 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a need for further improvements with regard to the provision of meaningful activities. Residents now have a choice of meals but there is still a need to improve the overall dining experience. Evidence: The provision of activities within the Home has improved but is still not adequate to ensure that residents are supported to take part in meaningful activities. One of the new developments is the provision of a daily newspaper with a reminiscence theme. These are placed around the Home and staff use them as a talking point with residents. We also saw that there were games, such as skittles, being used whilst we were there. The Home had also had their own version of the election. However, the Home does not have dedicated activities staff and so it is only when staff have time that they are able to organise activities or to spend time with residents on a one to one basis. As the majority of the residents have dementia there is a real need for staff to be able to spend time with residents on an individual basis to find out what they are interested in and to be able to support them in whats meaningful to them. Care Homes for Older People Page 14 of 25 Evidence: There have also been improvements with regard to mealtimes. The residents are now offered a choice of the main meal. They are asked for their choice during the afternoon for the next days lunch. It may be more meaningful to ask residents during the morning rather than so far in advance. However, the lunches are now served in the dining room and so residents can see what is available and are able to change their choices if they wish to. We saw that the cook took the dessert trolley around to the residents so that they could see the choices on offer. The manager said that the mealtime experience has been much improved for residents. However, on the day of our visit we saw that residents were sitting at the table for up to 20 minutes before they received any food. The dining room is noisy and residents were seen to take food from other residents plates. Two residents were shouting at each other. We did see some good practice at the mealtime. Staff explained clearly to residents what was on their plate and offered choices. A member of staff quietly and calmly assisted a resident to leave the dining room and eat their meal in another area of the Home as they appeared to be distressed. Care Homes for Older People Page 15 of 25 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. Staff are aware of the whistle blowing policy. Complaints are taken seriously and action taken to address them. Evidence: Since the Inspection in June 2009 the manager and proprietor have worked cooperatively with the Commission and Social Services during safeguarding investigations. At that time staff were not confident in raising concerns about the care provided. Since that time staff have said that they now feel much more confident in raising concerns and that they are dealt with appropriately. The number of complaints about the Home has greatly reduced. The manager takes all complaints/concerns seriously and takes action to address issues arising. The majority of staff have now attended Safeguarding training. Care Homes for Older People Page 16 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides accommodation which meets the needs of the residents. Some areas of the Home would benefit from redecoration. Evidence: There have been several improvements to the accommodation over the last year. For example, the fencing around the garden has been replaced, one of the bathrooms and a toilet have been completely refurbished and missing call bells have been replaced. Since the last Inspection hot water restrictors have been fitted to ensure that the hot water is not a risk to the residents. At the last Inspection we saw that a lot of the bedding was very dirty. During this Inspection was looked at several of the beds and found that a few had sheets and pillowcases which should have been changed prior to the bed being remade. We also noted that the majority of the pillows and duvets were thin and in need of replacement. The proprietor said at the time of our visit that she will ensure that this is done. The Home has a large communal lounge with a conservatory leading from it. These have nice views of the garden. There is also a small quiet lounge which is not used. The Proprietor is aware of the need for some of the corridors and bedrooms to be Care Homes for Older People Page 17 of 25 Evidence: redecorated. The Manager has plans to improve the colours and signage around the Home as per good practice for residents with dementia to aid their recognition. The Home has a large garden and new benches have been purchased for residents to use in nicer weather. There is one area of the garden which would pose a hazard to residents and action needs to be taken to address this prior to residents using the garden. Care Homes for Older People Page 18 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels are adequate to meet the basic needs of the residents. The majority of the staff have now completed mandatory training. Appropriate recruitment procedures are followed. Evidence: There have been improvements with regard to staffing since the last Key Inspection. Staffing numbers have increased so that there are usually seven care staff on duty throughout the day. There were 34 residents at the Home on the day of our visit. There are also catering, domestic and maintenance staff. Discussions with staff confirmed that there are usually seven staff on duty and that they feel that this is adequate to meet the basic needs of residents. They said that there is not a lot of additional time to spend with residents. Staff said that there is always a senior member of staff on duty for them to go to for advice if needed. When monitoring whether staffing levels are adequate the Manager needs to include the fact that staff have a 20 minute break in each shift and that if staff are working long days they have an additional hours break. We could see from the rotas that some staff work long days on a regular basis. The Manager said that he is monitoring this. The Commission received a complaint in April 2010 about staff working over 60 hours Care Homes for Older People Page 19 of 25 Evidence: per week. This was confirmed to be substantiated by the Manager but he said that this no longer takes place. There have been many staff changes over the last year with some staff leaving and a constant programme of recruitment taking place. We looked at a selection of the recruitment files and could see that appropriate checks take place prior to staff starting work at the Home. Not all of the staff receive induction that complies with the Common Induction Standards. Staff training has improved over the last six months and the majority of staff have now attended mandatory training and an introduction to Dementia Care. There is a need to ensure that all staff have training in mandatory subjects but also in subjects specific to individual residents needs. There is also a need to further develop the Dementia training that is provided. One of the senior staff is undertaking leadership training. There is a need for all of the seniors to receive this training to ensure that they are providing clear leadership and supervision to the care staff. We received a completed survey from a regular visitor to the Home who commented that they are always made to feel welcome by the staff and that they have seen great improvements over the last six months. The residents surveys are mixed between always and usually in response to whether staff are available when they need them and if staff listen and act when residents speak to them. Care Homes for Older People Page 20 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager providers leadership to the staff team and a consistent approach to managing the Home. Health and safety issues have been addressed. A quality assurance system needs to be developed to monitor the quality of the service provided. Evidence: After the Key Inspection in June 2009 there was a complete change in the management of the Home. An acting manager was appointed in October 2009 and told us during this visit that he has been appointed as the permanent manager and will now apply for registration with the Commission. The Manager said that he is intending to start the Diploma in Dementia Care this year. Staff said that the Manager communicates effectively with the staff team and that he is approachable. There have also been some changes within the team of senior carers. As previously mentioned in this report there is a need for the seniors to all attend leadership training. One of the seniors has started this already. Care Homes for Older People Page 21 of 25 Evidence: The Manager said that he has started to provide staff with formal supervision but that he has not recorded these. He has started the annual appraisal process by asking staff to complete their self appraisal forms. The outstanding health and safety issues have now been addressed although we identified a further issue in the garden during our visit. The Manager said that he would address this immediately. Whilst there are several audits being carried out on different aspects of the service provided at the Home there is still a need for these to be further developed so that the Home has an effective quality assurance system in place. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 It is required that the care 30/06/2009 plans contain detailed guidance about how to meet the residents needs To ensure that the residents needs are met in a consistent manner 2 33 24 It is required that an effective quality assurance system is in place To ensure that issues are identified and action taken to make improvements 30/09/2009 Care Homes for Older People Page 23 of 25 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 19 13 It is required that the hazards at the back of the garden are made safe To ensure risks to residents are reduced 31/05/2010 2 19 16 It is required that the worn out bedding is replaced To ensure that the residents have comfortable bedding 31/05/2010 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 Care Homes for Older People Page 24 of 25 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 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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