Care Home: The Beeches

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What the care home does well People admitted to the home found the information they received about the home useful, and helped them decide if the home was the right place to meet with their needs. They could visit the home to look for themselves at the facilities offered. Residents living in the home were given a contract that protected their legal rights.Before being admitted people had their needs assessed. This helped to make sure they would receive the right care and support they needed. Important information needed to support them in every day living was recorded. Residents benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Resident`s also benefited from additional specialist support where needed, such as healthcare. Visiting medical professionals considered the staff worked well with them for the benefit of the residents. Relatives visiting and those who provided written comments considered the care provided to be very good. They said they were kept up to date with important issues concerning their relatives` care. Residents were happy with the care they received and considered staff to be `very helpful and supportive.` And `They are always available when I press my buzzer.` `The staff look after us very well`, and `we are looked after`. The right of residents to be treated with dignity and respect was included in staff training. Staff are commended for the care and attention given to resident`s appearance, and how in the course of their duties they were respectful to residents. Residents spoke very highly of the staff, and said there was never any question of their privacy being compromised. One written comment from a resident stated, `I am well looked after and treated with great kindness`. There were no unnecessary rules imposed on residents and their routines in the home were flexible and special to them. Residents were generally satisfied with the activities and entertainment provided at the home. Birthdays and festive celebrations were catered for. Visiting arrangements were very good and the meals provided met with resident`s tastes and choice, and needs. Staff were observed as courteous and attentive when assisting those residents requiring support. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. The company has a free POVA line, and a designated Safeguarding Adults Manager who coordinate with any safeguarding investigations with outside agencies. This meant residents rights, safety, and welfare was promoted. The home was well maintained, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Information received at the Commission for this inspection showed all essential maintenance had been carried out, for example electrical checks. Recruitment of staff was thorough and met with regulatory requirements. Staff interviewed said they enjoyed their work and felt supported by The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 7management. Training was provided and a high percentage of care staff holds a National Vocational Qualification in care level 2 or above. The level of staffing maintained, training provided, and supervision of staff was good which meant competent qualified staff cared for residents. Residents considered staff as being `very good`. Written comments from relatives included, `I visit twice a week and all the staff I come into contact with are caring and helpful`. And `Everyone is very helpful`. `The home has a very nice atmosphere.` There was a warm and friendly atmosphere in the home. Team work amongst staff and management was good with everyone working together for the benefit if the residents. Residents appeared to be very happy. People living and working in the home were `listened to`. They had regular meetings to have their say on issues that affected them. Systems were in place to approach residents/relatives to give their view on the quality of services and facilities in the home, with Quality Assurance carried out. There were clear lines of management and staff accountability within the home. What has improved since the last inspection? There was evidence staff recorded the care and support given to residents. Information recorded on the Annual Quality Assurance Assessment outlined improvements made in the home since the last key inspection. These improvements were very positive for the care of residents and included: Several staff had completed the distance-learning course in Safe Handling of Medicines and more staff is to attend 2009 courses. They have reduced incidence of pressure sores, and have easy and quick access to outside health professionals. Several daytrips were organised and thoroughly enjoyed by the residents. Shopping trips to local supermarket is now going to be a regular activity for the residents. More frequent and regular indoor activities are now taking place for example by popular demand bingo twice a week, manicure session and hand massage, etc. Regular residents meetings are being held and issues raised are dealt with immediately. Safeguarding Adult training is now a mandatory training for all staff, which will be done annually. A free Protection Of Vulnerable Adults (POVA) line is directed to the POVA manager. Flat screen televisions have been installed in all the bedrooms. Some bedroom carpets have been replaced. Garden areas are now more pleasant looking. Staff turnover is very low with only 1 staff having left due to personal reasons. The numbers of staff who are National Vocational Qualified in care level 2 has reached 100% although they currently stand at 91% due to registering a new casual care staff. Staff feel happier coming to work and feel supported all the time. More staff are willing to attend training. Distance learning courses are now accepted for example, safe handling of medication, infection control, and dementia. A very good teamwork between management and staff has meant they deliver a better service to the residents. There is improved awareness and better communication between all the staff, creating continuous care for residents for example regular daily handovers, utilising staff`s communication book etc. What the care home could do better: Care planning should be clearer and more person centred. This will help to make sure individual needs are identified properly and support will be provided in a consistent way. Risk assessment for individual residents should not be generalised such as risk of scalds from hot drinks. This will support residents to maintain their independence and allow for reasonable risk taking to be part of every day normal living. Medication stocks carried over every month must be monitored better. This will keep the supply of medication under control and help identify if any medication such as supplement drinks are not required or refused. It will also support nutritional management of residents identified as being at risk from weight loss. This will help staff to consider if the measures taken were satisfactory and if further support was needed. Medication given as when necessary requires more detail as to when this would be given. Not all residents would be able to communicate their needs sufficiently, and staff need to be aware of how to monitor this. Care plans should include a daily living plan with preferred routines recorded to support residents personalise their day. This will help to make sure all staff will support them as they wish and require.Why relatives feel the home is `understaffed and immediate staff rarely available` should be investigated. This will help to identify if there are times when an increase of staff deployment at specific times would be beneficial. CARE HOMES FOR OLDER PEOPLE The Beeches Yew Trees Lane Dukinfield Tameside SK16 5BJ Lead Inspector Marie Dickinson Unannounced Inspection 12th March 2009 10:00 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 The Beeches DS0000028452.V374029.R01.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. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address Yew Trees Lane Dukinfield Tameside SK16 5BJ 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) 0161 338 4922 0161 303 0058 Meridian Healthcare Ltd Armi Villocillo Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (1), Physical disability of places over 65 years of age (32) The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service user under the age of 63 may be admitted into the establishment. Date of last inspection Brief Description of the Service: The Beeches is a purpose built establishment, situated to the rear of Yew Trees, both homes being owned and managed by Meridian Healthcare Limited. The home is registered with the Commission for Social Care Inspection to provide accommodation for 32 older people, some of whom may have a physical disability. All the bedrooms have en-suite facilities and are above the minimum standard size. The doors are lockable and there is a lockable facility in each room. Bedrooms are located over two floors. Each floor has a sitting and dining area with small kitchens. All areas are equipped to a good standard. An additional small lounge is provided on the first floor for those service users who smoke. Kitchen and laundry facilities are provided by the adjacent home (Yew Trees) and a landscaped secure garden (to the rear) is also shared by both homes. A small external sitting area is also available to the front of The Beeches. Car parking is provided at the front of the building. The home is located within a residential area of Dukinfield, close to shops and on a bus route. The home has a statement of purpose, which is on display in the foyer. The service user guide was reported to be given to prospective service users or their families when they visit the home to look round. The fees for staying at the home were at the time of inspection £405:53. Additional charges are made for toiletries, newspapers, hairdressing, dry cleaning, outings, and chiropody services. The home has a social fund where service users are asked if they would like to contribute, this goes towards the cost of entertainers and outings. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. A key unannounced inspection was conducted in respect of The Beeches on the 12th March 2009. An annual quality assurance assessment (AQAA), was sent to us by the manager prior to this inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service, such as number of staff trained, and of essential maintenance to keep the home safe being carried out. Written comments were also received prior to the inspection from staff employed at the home. They gave their views as to how well the home performed in supporting them in meeting needs of residents. Written comments were also received from residents and their relatives. Discussion took place with the manager, staff on duty and residents during inspection. Documents including policies, procedures, and staff and residents records were looked at. The premises were inspected as part of the process. Areas that had been required to improve were looked at for progress made. Other information was considered such as the homes annual quality assurance survey, and the outcome of a random inspection that took place on the 14th May 2008. Areas that needed to improve from the previous key inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Older People. What the service does well: People admitted to the home found the information they received about the home useful, and helped them decide if the home was the right place to meet with their needs. They could visit the home to look for themselves at the facilities offered. Residents living in the home were given a contract that protected their legal rights. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 6 Before being admitted people had their needs assessed. This helped to make sure they would receive the right care and support they needed. Important information needed to support them in every day living was recorded. Residents benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Resident’s also benefited from additional specialist support where needed, such as healthcare. Visiting medical professionals considered the staff worked well with them for the benefit of the residents. Relatives visiting and those who provided written comments considered the care provided to be very good. They said they were kept up to date with important issues concerning their relatives’ care. Residents were happy with the care they received and considered staff to be ‘very helpful and supportive.’ And ‘They are always available when I press my buzzer.’ The staff look after us very well, and we are looked after. The right of residents to be treated with dignity and respect was included in staff training. Staff are commended for the care and attention given to resident’s appearance, and how in the course of their duties they were respectful to residents. Residents spoke very highly of the staff, and said there was never any question of their privacy being compromised. One written comment from a resident stated, ‘I am well looked after and treated with great kindness’. There were no unnecessary rules imposed on residents and their routines in the home were flexible and special to them. Residents were generally satisfied with the activities and entertainment provided at the home. Birthdays and festive celebrations were catered for. Visiting arrangements were very good and the meals provided met with resident’s tastes and choice, and needs. Staff were observed as courteous and attentive when assisting those residents requiring support. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. The company has a free POVA line, and a designated Safeguarding Adults Manager who coordinate with any safeguarding investigations with outside agencies. This meant residents rights, safety, and welfare was promoted. The home was well maintained, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Information received at the Commission for this inspection showed all essential maintenance had been carried out, for example electrical checks. Recruitment of staff was thorough and met with regulatory requirements. Staff interviewed said they enjoyed their work and felt supported by The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 7 management. Training was provided and a high percentage of care staff holds a National Vocational Qualification in care level 2 or above. The level of staffing maintained, training provided, and supervision of staff was good which meant competent qualified staff cared for residents. Residents considered staff as being ‘very good’. Written comments from relatives included, ‘I visit twice a week and all the staff I come into contact with are caring and helpful’. And ‘Everyone is very helpful’. ‘The home has a very nice atmosphere.’ There was a warm and friendly atmosphere in the home. Team work amongst staff and management was good with everyone working together for the benefit if the residents. Residents appeared to be very happy. People living and working in the home were ‘listened to’. They had regular meetings to have their say on issues that affected them. Systems were in place to approach residents/relatives to give their view on the quality of services and facilities in the home, with Quality Assurance carried out. There were clear lines of management and staff accountability within the home. What has improved since the last inspection? There was evidence staff recorded the care and support given to residents. Information recorded on the Annual Quality Assurance Assessment outlined improvements made in the home since the last key inspection. These improvements were very positive for the care of residents and included: Several staff had completed the distance-learning course in Safe Handling of Medicines and more staff is to attend 2009 courses. They have reduced incidence of pressure sores, and have easy and quick access to outside health professionals. Several daytrips were organised and thoroughly enjoyed by the residents. Shopping trips to local supermarket is now going to be a regular activity for the residents. More frequent and regular indoor activities are now taking place for example by popular demand bingo twice a week, manicure session and hand massage, etc. Regular residents meetings are being held and issues raised are dealt with immediately. Safeguarding Adult training is now a mandatory training for all staff, which will be done annually. A free Protection Of Vulnerable Adults (POVA) line is directed to the POVA manager. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 8 Flat screen televisions have been installed in all the bedrooms. Some bedroom carpets have been replaced. Garden areas are now more pleasant looking. Staff turnover is very low with only 1 staff having left due to personal reasons. The numbers of staff who are National Vocational Qualified in care level 2 has reached 100 although they currently stand at 91 due to registering a new casual care staff. Staff feel happier coming to work and feel supported all the time. More staff are willing to attend training. Distance learning courses are now accepted for example, safe handling of medication, infection control, and dementia. A very good teamwork between management and staff has meant they deliver a better service to the residents. There is improved awareness and better communication between all the staff, creating continuous care for residents for example regular daily handovers, utilising staffs communication book etc. What they could do better: Care planning should be clearer and more person centred. This will help to make sure individual needs are identified properly and support will be provided in a consistent way. Risk assessment for individual residents should not be generalised such as risk of scalds from hot drinks. This will support residents to maintain their independence and allow for reasonable risk taking to be part of every day normal living. Medication stocks carried over every month must be monitored better. This will keep the supply of medication under control and help identify if any medication such as supplement drinks are not required or refused. It will also support nutritional management of residents identified as being at risk from weight loss. This will help staff to consider if the measures taken were satisfactory and if further support was needed. Medication given as when necessary requires more detail as to when this would be given. Not all residents would be able to communicate their needs sufficiently, and staff need to be aware of how to monitor this. Care plans should include a daily living plan with preferred routines recorded to support residents personalise their day. This will help to make sure all staff will support them as they wish and require. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 9 Why relatives feel the home is ‘understaffed and immediate staff rarely available’ should be investigated. This will help to identify if there are times when an increase of staff deployment at specific times would be beneficial. 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. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 10 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 The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 11 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): 2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process ensured peoples needs were properly assessed. Contracts issued, protected resident’s legal rights. EVIDENCE: Information received at the Commission for this inspection informed us, ‘Introductory visits are encouraged.’ And ‘Welcome packs are provided… which includes a comprehensive statement of purpose and service users guide, company brochures and a welcome gift’. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 12 Residents who provided written comments for this inspection said they received enough information about the home before they moved in. This helped them decide if the home was the right place for them. They had received a contract. Those funded by a local authority were issued with a financial contract. This was to agree to the funding arrangements made on their behalf, and people knew how much they would have to pay. All contracts as seen on resident files were signed by the resident agreeing to the terms and conditions of residency. Records showed that prior to any service being provided peoples needs had been assessed. This helped to make sure they would receive the right care and support they needed. Records kept of the most recent admissions showed how planned admissions were managed. When people were referred to the home by social services, information supporting the person’s needs and reason for referral was made available. The manager had completed an independent assessment. This had considered for example, in brief, health and personal care, mobility, and nutrition. Assessment records supported the decision to offer a place at the home. Individual risk assessments had been completed to help staff to know what they need to do and be aware of, to care for individuals safely. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 13 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. Residents had care plans, risk assessments, and a named key worker, which supported them to ensure their health and personal care needs being met in a consistent way. Medication was managed safely. EVIDENCE: The majority of residents who provided written comments, and those spoken to during inspection indicated that they always receive the care and support they needed at the Beeches. Positive comments about the care and attention they receive were made. For example they said, All staff are very helpful and The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 14 supportive.’ And ‘They are always available when I press my buzzer.’ The staff look after us very well, and we are looked after. Staff are very helpful. Staff worked to a key worker system, having responsibility to make sure care needs were personalised for residents. Information seen on care plans included a brief record of peoples past history. This helped staff to understand people as individuals. Needs identified for personal care, mobility, communication, personal safety, medication, medical, and social were not listed adequately, however, how residents were to be supported was generally clear, for example, the support they required with getting dressed and when having a bath. When writing needs assistance, it was not always clear what the assistance to be given was. This could be improved by recording more detail of actual needs and personal wishes of residents for staff to know about, and make the care plan more person centred. Care plans seen had been reviewed and updated. Care staff who provided written comments considered they were given enough information about residents to do their job well. Relatives and people visiting were happy with the standard of care given. They said they were kept up to date with important issues regarding their relatives’ care. Resident’s benefited additional specialist support where needed. This included healthcare. All residents were registered with a GP and accessed local services either in the community, or were supported by visits to the home by health care professionals. This included visits from the district nursing team for nursing intervention required, such as applying dressings. Pressure care was promoted and pressure-relieving aids were used on medical advice. Risk assessments had been completed for moving and handling and were used as guidance for staff to help care for residents safely. People at risk of falls, pressure sores, poor nutrition and other risks had also been identified. This enabled staff to know what to look for and help prevent these happening. More attention should be given to what action staff must take to minimise identified risk. This will help staff to consider if the measures taken were satisfactory and if further support was needed. In some instances risks were generalised such as scalds from hot drinks. This meant individual resident ability to manage a hot drink was not considered. The right of residents to be treated with dignity and respect was included in staff training. The residents spoke very highly of the staff, and there was never any question of their privacy being compromised. Observations showed staff respectful, and personal care provided in privacy such as toilet doors shut and residents spoken to discreetly re these needs. Complimentary remarks about the staff were made, such as very good, and helpful. Staff were instructed on the basic principles of care. Staff and management are commended for their efforts in maintaining peoples dignity in the home. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 15 Observations showed care and attention had been given to resident’s appearance, and staff showed how in the course of their duties they were respectful to residents. Communication difficulties had also been considered such as poor hearing and sight. The home operated a monitored dosage system for the administration of medication. Information received at the Commission showed a number of staff had been trained in medication procedures. The manager said residents had the opportunity to say how they would like their medication managed. This needs to be identified better and risk assessed. An appropriate recording system was in place to record the receipt, administration, and disposal of medication. Medication stocks carried over every month must be monitored better. This will keep the supply of medication under control and help identify if any medication such as supplement drinks are not required or refused. It will also support nutritional management of residents identified as being at risk from weight loss. Medication given as when necessary requires more detail as to when this would be given. Not all residents would be able to communicate their needs sufficiently, and staff need to be aware of how to monitor this. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were given opportunity to live a fulfilling life, which meant they were supported to take part in chosen activities, access community resources and keep in touch with families and friends. The meals provided were sufficient in providing for their tastes, choices, and diet. EVIDENCE: The residents preferences in respect of social activities had been recorded as part of their assessment. Activities for residents were organised and offered a good variety. Comments from residents returned to the Commission as part of the inspection show everyone thought there were activities arranged by the home they could join in. They said, ‘Activities are very good. I like Bingo so much’. ‘Many activities arranged, but I choose not to join in but I am happy not to.’ Staff also considered the home did well with ‘planned activities’. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 17 The home was managed so as to avoid any institutional practice. Although care plans did not include a daily living plan with preferred routines recorded to support residents personalise their day, observations showed residents appeared to have freedom of choice over their lives within their capability. For example several residents said they got up when they wanted and went to bed when it suited them. The residents were able to receive visitors at any time and were able to entertain their guests in private. There was evidence seen in care records that relatives regularly visited the home. Written comments for this inspection supported this, and observations of relatives visiting showed how staff were considerate to their needs and made them feel very welcome. Residents were also supported to continue with their chosen religion. This was recorded in resident’s assessment. Resident’s bedrooms were personalised. They were able to bring in personal belongings and arrange their rooms how they wished. Residents could choose where to eat their meals. Those residents spoken to during inspection said the food was very good. They said they had choices all the time. Menus seen were planned to ensure variety, choice and good nutrition. Residents who provided written comments for this inspection said, ‘I always enjoy my food’. And ‘If I do not want what is offered, staff will provide a snack instead’. The meals served during inspection were well balanced, generous in portion with choices offered. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 18 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. The complaints procedure was available and used properly, which helped residents and other people have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. EVIDENCE: Quality assurance carried out at the home with residents and relatives, showed most people were very satisfied with the service. The complaints procedure was given to residents when they were admitted to the home. The procedure listed in the welcome pack gave clear directions on whom to make a complaint to and the timescales for the process. This information should be included in the procedure that is displayed for visitors to the home. A complaints recording system was in place. The manager who said, people are very open and would say if they had any concern, quickly dealt with issues raised. Residents were encouraged to say what they wanted and were asked The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 19 regularly if everything was all right. Residents spoken to said they had no complaints against the staff. Staff were described as being ‘very good, and obliging’. One relative visiting said she would know who to speak to if unhappy about anything, but up to present never had any reason to make a complaint, as the management and staff were very good and always available to speak to. Staff working at the home said they were trained in adult protection and were aware of the written abuse policies and procedures, which included whistle blowing. They knew their responsibility in this area and were confident they would report bad practice if ever the need arose. In addition to this staff training was provided regularly to ensure new staff understand procedures. To fully safeguard residents, recruitment practices supported the employment of people with good character. As part of employment staff are required to comply with the homes policies and procedures for example the ruling on nonacceptance of gifts, or being involved in wills or bequests. The company has a free Protection Of Vulnerable Adults (POVA) line, and a designated Safeguarding Adults Manager who coordinate with any safeguarding investigations with outside agencies. This meant residents rights, safety, and welfare was promoted. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 20 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): 19,20,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well maintained, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. EVIDENCE: The home is a purpose built establishment, situated to the rear of Yew Trees, in a residential area in Dunkinfield. It is a two-storey property, and the upper floors can be accessed via a passenger lift. Outdoor areas were pleasant with a landscaped secure garden to the rear and shared with residents from the adjacent residential Yew Tree Home. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 21 The home was furnished and fitted to a very good standard. Residents were pleased with the accommodation provided. A combined lounge and dining room with a small kitchen is situated on both floors. To ensure the comfort of all residents, an additional small lounge is provided on the first floor for those residents who smoke, and complies with no smoking legislation. Written comments from residents included, ‘Nice and tidy all the time’. ‘Definitely it is spotless’. All areas were equipped to a good standard. Bedrooms were spacious and accommodated residents personal possessions very well. Bedrooms were en suite and had an emergency call system, flat screen television, and quality bedroom furniture. Carpets, bedding and curtains matched. Doors had locks on and an additional lockable piece of furniture provided. Bathing and toilet facilities were also very good. Kitchen and laundry facilities are provided by the adjacent home (Yew Trees) The home was found to very clean during inspection, and policies and procedures were in place for staff to follow in maintaining this standard. To help prevent the spread of infection, visitors are required to use hand sanitising on entering the home and staff were provided with protective clothing. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 22 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. The numbers of staff employed, training provided, and safe recruitment practices, meant residents should be protected, and their needs effectively met. EVIDENCE: As identified in the random inspection carried out in May 2008, following a review of staffing levels, the manager had maintained an acceptable level of staffing. Rotas completed showed the compliment of staff on duty at any given time. These levels were to cover all essential duties in providing care, and maintaining essential standards in the home such as hygiene and catering, with senior staff on duty at all times. Residents spoken to during inspection and relatives visiting said there was usually no problem around the number of staff on duty. Staff were described as ‘very good’, ‘helpful’, and ‘more like my friends’. Relatives who provided written responses considered staffing levels could be improved. One relative The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 23 commented, ‘We feel the home is understaffed and immediate staff are very rarely available.’ And the service could improve the ‘ratio of carer per patient. For the amount of money… more is expected’. Staff files showed recruitment checks to be complete and met with legislative requirements for Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check being applied for, prior to employment. References had been sought and interview notes taken. On appointment members of staff were issued with a contract of terms and conditions of employment, given a job description and an induction-training programme. Staff who provided written comments for the inspection said the induction they received covered what they needed to know. They also said they were given other training relevant to their role. Records showed the induction-training programme carried out, covered essential training in basic principles of care, and safe working practice issues, such as moving and handling residents and health and safety. A high percentage of care staff hold a National Vocational Qualification in care level 2 or above and the carers who do not have this are to attend the relevant courses for this purpose. Staff interviewed displayed a high degree of job satisfaction within a good team environment. There was evidence of management encouraging staff to improve their skills. Equality of opportunity was demonstrated with training, and learning opportunities were relevant to the homes purpose. Staff felt they were appreciated for their work and were valued in the home. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 24 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): 31,33,35,38 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 and run in the best interests of the people living there. EVIDENCE: Since the last key inspection a new manager has been registered at the Commission. Information received for this inspection informed us the registered manager had achieved a National Vocational Qualification level 4 in The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 25 management and care. She was currently doing Registered Managers Award, and attended continual professional development training. She has been the manager at The Beeches since 2008 and receives regular supervision. A deputy manager is in post. Senior care assistants have delgated authority for more routine management processes and staff meet together daily and have ‘shift meetings’ to discuss residents and other issues relevant to their work for the day and night. The organisation’s strategic and financial planning systems mean the manager works within corporate budgetary control. There are clear lines of accountability and the entire service is audited on a monthly basis. There is evidence emphasis has been placed on improving the home in terms of outcomes for the residents. This has been with continuing investment into the environment and more quality assurance carried out. Results of the latest audit showed a general satisfaction in all areas. Comments and acknowledgements received from relatives and residents included, ‘Everyone is very helpful’. ‘The home has a very nice atmosphere.’ ‘I visit twice a week and all the staff I come into contact with are caring and helpful’. All the records required for the efficient running of the home were available to look at. They were stored securely, readily available for this inspection, and organised. Records showed staff supervision was given providing staff with an opportunity to individually express themselves, their concerns, and their plans for the future or to receive feedback on their performance. Staff received appraisals. Staff meetings were usually held at regular intervals during which staff received information on policies and procedures and had an opportunity to voice their opinion and share information. Observations made during the inspection showed staff worked as a team, and were well thought of by the residents. Arrangements are in place for all new for staff to have mandatory training such as fire safety procedures, food hygiene and first aid training. Information received at the Commission indicated regular maintenance checks and fire safety checks were carried out as required. The home had access to professional business, legal, and financial advice and had all the necessary insurance cover in place to enable it to fulfil any loss or legal liabilities. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP8 Good Practice Recommendations Care planning should be clearer and more person centred. This will help to make sure individual needs are identified properly and support will be provided in a consistent way. When weight loss is identified, additional measures such as food and fluid intake charts should be put in place. This will help staff to consider if the measures taken were satisfactory and if further support was needed. Risk assessment for individual residents should not be generalised such as risk of scalds from hot drinks. This will support residents to maintain their independence and allow for reasonable risk taking. Medication given as when necessary requires more detail as to when this would be given. Not all residents would be able to communicate their needs sufficiently, and staff need to be aware of how to monitor this. Improvements should be made to the monitoring of nutritional drinks to ensure supplies do not build up and that stock is in date. DS0000028452.V374029.R01.S.doc Version 5.2 Page 28 3 OP8 4 OP9 5 OP9 The Beeches 6 OP12 7 OP27 Care plans should include a daily living plan with preferred routines recorded to support residents personalise their day. This will help to make sure all staff will support them as they wish and require. Why relatives feel the home is ‘understaffed and immediate staff rarely available’ should be investigated. This will help to identify if there are times when an increase of staff would be beneficial. The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 The Beeches DS0000028452.V374029.R01.S.doc Version 5.2 Page 30 - 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. 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