Care Home: The Beeches

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What the care home does well Since our last key inspection there has been downward trend in the care and support offered to people living at the home. We are in discussion with our legal department in relation to possible enforcement action against this home. What the care home could do better: No one is at present living at the home but our initial finding of 4th March 2010 indicated a number of areas that needed improvement included: Care plans must be put in place swiftly so it can be demonstrated that needs have been assessed and that the home has the tools to monitor and evaluate the needs of people living in the home. The home must review the fire evacuation procedure for the home and provide the appropriate equipment to ensure that people can be safely moved out of the home. Activities need to be reviewed to ensure these are what people living at the home want and need so they can lead a stimulating and fulfilling life. Systems should be developed so that people`s views on the running of the home are sought and acted upon. The meal time experience should include active choice of food and drink available. Staffing levels need to be reviewed to ensure people`s needs are meet in a safe and consistent manner. We need to be officially notified via the Regulation 37 process of events that effect the health and well being of people living in the home. This ensures that the home can be monitored between inspection visits. Accident records must be completed and audits put in place to monitor the type ofincident, action taken and the outcome. This will help to show up trends and patterns and allow for risks to be reduced or contained. External health professionals must be contacted if a person`s condition deteriorates or changes to ensure that people have access to health interventions which may improve their well being. The home must review how it enables people living in the home to have an active choice in day to day matters such as food and activities. This will ensure their wishes are maintained and respected and that they live a stimulating and meaningful life. Systems must be reviewed in the management and promotion of good infection control, items such as foot operated bins and paper towels should be provided though out the home. Random inspection report Care homes for older people Name: Address: The Beeches 6 Brunswick Terrace Wednesbury West Midlands WS10 9DA two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Karen Thompson Date: 0 4 0 3 2 0 1 0 Information about the care home Name of care home: Address: The Beeches 6 Brunswick Terrace Wednesbury West Midlands WS10 9DA 01215560435 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Dennis Valentine John Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Beeches Residential Home Ltd care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users to be accommodated is 18 The registered person may provide the following category 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: Old age not falling within any other category - Code OP, maximum number of places: 18 Date of last inspection Brief description of the care home The Beeches has been in operation as a care home since 1985 but in May 2006 came under new ownership. It is situated in a cul de sac close to Wednesbury town centre. Local amenities include a library, churches and a varied of shops. The service provides Care Homes for Older People Page 2 of 15 Brief description of the care home predominately long stay accommodation but has offered some short-term care in the past. The house is a large traditional property that has been extended in the past to its present size and layout. Bedrooms are located on both floors of the home. There are a number of toilets on the ground and first floors. The lounge, dining room, kitchen, laundry and office are all located on the ground floor. Ramped access is available to the rear of the property providing access in and out of the home and to the garden. The manager should be contacted for information about the fees charged for this service. Care Homes for Older People Page 3 of 15 What we found: Two inspectors visited the home to carry out a random inspection on 4 March 2010 following concerns being raised with us about the homes ability to meet peoples needs . The home was also visited on 8 April 2010 by a Local Area Manager from the Commission and a representative from Sandwell Metropolitan Borough Council. The outcome of both visits are detailed below. The outcome of the visit of 4 March 2010 is as follows: We looked at the care documentation of three people living at the home during our visit. We also spent time talking to staff and people living at the home. We looked at documentation in relation to people being admitted to the home. We were told that a pre admission assessment is carried out either by the homes acting manager or the deputy and a trial visit was offered. We found no pre admission assessment documentation carried out by the home but there was assessment documentation available which had been carried out by Social workers. We looked at care plans of three people living in the home. We found no evidence of involvement of the person living in the home in drawing up the care plans. We found that for two people the care plans had not been implemented until at least a month after admission to the home. We found an array of risk assessments had been carried out by the home which included, pressure sore risk, nutritional risk, falls risk and personal risk as well as assessments for mental and physical health. There was however no assessment taking place for mental capacity. We looked at how the home manages peoples risk in relation to falls. We found in the three peoples whose records we looked at that the fall risk assessment and the care plan did not provide sufficient information to guide staff. For example one person had experienced numerous falls over a six month period. But the home had completed a risk assessment and which scored as no risk. Despite this score the person continued to fall and sustain injuries as a result. There was no actual care plan for the management of this risk but there were mentions of falls in both the safety care plan and the mobility care plan though neither gave staff suitable guidance. We discussed the possibility of a referral to a falls clinic for this person, but the manager told us this had not happen. In another persons care records we saw that they had returned from hospital with steri strips and glue to a head wound. We did not find any indication in the care records as to how this had happened. We asked the acting manager for the accident records for this, but found that no accident record had been completed in relation to the incident. By reading the persons notes we were unable to determine how the injury had occurred. We were told by other people living in the home how the injury had happened whilst we were talking to them. The acting manager was informed during this inspection that record keeping was not good enough and was not protecting the people who lived in the home. We looked at the way the home manages peoples medication. We looked at three peoples medication and the audit demonstrated people were getting medication as prescribed. The medication trolley is kept in the main entry hall, but is not chained to the wall when not in use. The trolley needs to be chained to the wall to ensure it can not be removed from the home easily. The medication system consists of a mixture of boxed and blister medication packs. There was however no pill counter in the home to allow Care Homes for Older People Page 4 of 15 staff to carry out their own audit of medication received into the home if there were concerns. A pill counter allows medication to be counted without the risk of contamination to the medication and ensure staff are not exposed to low doses of medication whilst counting via absorption though the skin. We were informed that the home has no homely remedies available for people living in the home. Thus people living at the home do not have access to medication for minor aliments such as paracetamol for a headache. Also we were informed that the night staff do not administer medication meaning medication prescribed as required is not given out of a night time. We looked at activity provision in the home. We found that people told us they were often bored, dont go out much, would like to do more. We looked at the written records the home keeps in relation to activity, and saw that most people do take part in a game of snakes and ladders occasionally but the majority of the time there were no planned activities in the home. We looked at one persons care plan which stated they should be escorted outside the home twice a week by staff. The person concerned had only been taken out of the home only once in the past month. We also asked the acting manager why this person had to be accompanied on leaving the home, as there was no evidence of lack of mental capacity or a risk assessment having been carried out to demonstrate there were concerns about their health and wellbeing by leaving the home. We talked to the acting manager about restrictions of liberty and the need to make referrals to the appropriate outside agencies to establish whether this is in the best interest of the person concerned. The acting manager also told us they were currently advertising for an activity coordinator to work two hours per day Monday to Friday. We were also told by the acting manager that the home did not have an allocated budget for activities. People living at the home told us they had not received a Christmas present from the owner last year. The giving of presents at significant calendar events reinforces a sense of worth and value to the person receiving the gift. We saw that staff do not have the time to support people with activities or social interests because they are expected to help out in the kitchen and with the domestic duties in the home. This is contrary to the homes own statement of purpose and the service user guide which tells us there are dedicated cleaning and kitchen staff. The home has a four week menu plan, however we have received concerns telling us the food was of poor quality and the choice was very limited. We looked at the menu and could see that there is a very limited choice of cheese and biscuits or crisps every night for supper. In reality people are only being offered biscuits and tea. We spoke to one person who told us their preference was for a round of toast and a cup of tea for supper but this never happened. The staff had also recorded this preference in the persons care files. Other choices on the menu show that there is a lack of imagination and choice for people. Tea is always a variety of sandwich, or something on toast or soup. People told us the food is not what I would choose for myself and certainly not the quality. We spent time talking to one lady who said that she wanted the curtains put back in her room, at present she has a roller blind and doesnt like, she said it is not cosy. This indicates that peoples choices, wishes and concerns are not being acted upon in an appropriate and timely manner. We were told by the acting manager that staff have not received training in the Mental Care Homes for Older People Page 5 of 15 Capacity Act 2005 and Deprivation of Liberty Safeguards. This is an important piece of legislation that protects and promotes the rights of people with varying levels of capacity to make decisions. Staff need to be aware of their responsibilities in supporting people with varying levels of capacity to make decisions. We looked around the home with a member of staff escorting us. There are two bathrooms on the first floor. One bathroom has been refurbished, the other continues to be out of use. The has been no improvement to this bathroom since our last key inspection June 2009. The bathroom is not suitable for people living in the home. The flooring in this bathroom needs to be replaced as it is cracking, cannot be cleaned properly and is a trip hazard. Bedrooms are situated on both floors of the home. Bedrooms we visited had been personalized with peoples own possessions, reflecting their individuality. Paper towels were not available for people living at the home and staff to dry their hands in all communal toilets and bathroom areas. This limits the bathroom facilities people can use but also poses an infection control risks . Bins for disposal of waste that could be potentially infectious were not foot operated. Good interaction was observed between staff and people living in the home such as staff chatting to people when assisting them. We do however have concerns about the number of staff available though out the day to meet peoples needs in a consistent and safe manner. From four oclock in the afternoon till five oclock there is only one carer available to meet the needs of people living in the home as the other carer on duty is busy in the kitchen preparing the evening meal. Once the evening meal is completed the carer has to go back into the kitchen to ensure the kitchen is tidy and crockery is washed up again leaving only one carer available to meet peoples needs. Carers informed us that some people living in the home do require two carers for assistance and the carer in the kitchen may be required to help and meet the needs of these people. There have been concerns raised with us that the staff duty rotas are not a reflection of staff working in the home. On the day of our visit the rotas did reflect the staff available. The acting manager told us that only recently has she become supernumerary but had been working in the home previously in the role of a carer to ensure peoples needs are being met. We asked for copies of the Regulation 26 visit reports. These are reports that the provider has to keep to demonstrate they or someone representing them has visited the home. The visit should include interviews with people living at the home and staff to form an opinion of the standard of care being provided at the home. It should also include an inspection of the premises and a look at the records of events and any complaints. We were told that no Regulation 26 reports were available for inspection by the acting care manager . The homes current registered manager is one of the providers. The acting manager working in the home has been in post for over six months but has not put an application in to register with the Commission. We found that incidents that the home is required to notify us of were not being reported. We found that accidents such as falls and admission to hospital were not being recorded as accidents. The home did not have a robust fire evacuation procedure in place and did not have an Care Homes for Older People Page 6 of 15 evacuation chair available for use in the event of a fire. An evacuation chair is used in the event of a fire to help move people with limited mobility on the first floor of the home out of danger. A Local Area Manager from the Commission along with a representative from Sandwell Metropolitan Borough Council visited the home on 8 April 2010. The joint owner who is also the registered manager had phoned us to say that he had no money or pay the staff. The home was visited due to our concerns about the financial viability of the home and the health and wellbeing of people living in the home. We have since been informed by Sandwell Metropolitan Borough Council that everyone living at the home has now been moved to another care home and is now empty. What the care home does well: What they could do better: No one is at present living at the home but our initial finding of 4th March 2010 indicated a number of areas that needed improvement included: Care plans must be put in place swiftly so it can be demonstrated that needs have been assessed and that the home has the tools to monitor and evaluate the needs of people living in the home. The home must review the fire evacuation procedure for the home and provide the appropriate equipment to ensure that people can be safely moved out of the home. Activities need to be reviewed to ensure these are what people living at the home want and need so they can lead a stimulating and fulfilling life. Systems should be developed so that peoples views on the running of the home are sought and acted upon. The meal time experience should include active choice of food and drink available. Staffing levels need to be reviewed to ensure peoples needs are meet in a safe and consistent manner. We need to be officially notified via the Regulation 37 process of events that effect the health and well being of people living in the home. This ensures that the home can be monitored between inspection visits. Accident records must be completed and audits put in place to monitor the type of Care Homes for Older People Page 7 of 15 incident, action taken and the outcome. This will help to show up trends and patterns and allow for risks to be reduced or contained. External health professionals must be contacted if a persons condition deteriorates or changes to ensure that people have access to health interventions which may improve their well being. The home must review how it enables people living in the home to have an active choice in day to day matters such as food and activities. This will ensure their wishes are maintained and respected and that they live a stimulating and meaningful life. Systems must be reviewed in the management and promotion of good infection control, items such as foot operated bins and paper towels should be provided though out the home. 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 set out on page 2. Care Homes for Older People Page 8 of 15 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 15 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, 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 3 13 The home needs to make 30/04/2010 needs/circumstances change the needs assessment is updated to refect such changes. This will ensure that peoples needs are meet in an appropriate manner to maintain the health and well being of people living in the home. 2 7 13 Care plans must be based on 30/04/2010 a though assessment of needs and show how care is to be delivered. Care plans must be put in place swiftly and be accessible to the staff delivering the care and be a reflection of the care being given. Care plans must be reviewed and amended at the point where a persons needs change or routinely and staff must be aware of these changes. This will ensure that peoples needs are meet in an appropriate manner to Care Homes for Older People Page 10 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 maintain the health and well being of people living in the home. 3 8 12 People living at the home 30/04/2010 should be referred to the appropriate external professional when needs are identified as requiring this. This will ensure that health, well being, safety and rights are promoted and protected. 4 9 13 The medication trolley must 30/04/2010 be secured to solid wall when not in use. This will ensure that measures are in place to safety secure medication within the home. 5 27 18 Staffing levels must be reviewed in the home. So that people living in the home receive care that does not put them at risk and is appropriate to their needs. 6 34 25 A certificate of insurance for The Beeches Residential Homes Ltd in respect of liability which may be incurred by the company in relation to the care home in respect of death, injury, public liability, damage or other loss. To establish the financial viability of the home. 7 34 25 A copy of your accounts to 15/04/2010 Page 11 of 15 30/04/2010 15/04/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 date prepared and certified by an accountant. To establish the financial viability of the home. 8 34 25 A statement as to whether 15/04/2010 the Responsible Individual has been adjudged bankrupt or a sequestration of your estate has been ordered or have you made a composition or arrangement with or granted a trust deed for your creditors. This means that you must state whether you have, in the past, been made bankrupt (either by your own application or the result of others action) or have had your property seized by a Court Order; or an arrangement has been made whereby your creditors have been promised money from your property or businesses. To establish the financial viability of the home. 9 34 25 A statement as to your 15/04/2010 ability to ensure the financial viability of the establishment for the purposes of achieving the aims and objectives of the establishment or agency set out in its statement of purpose. To establish the financial viability of the home. 10 34 25 A reference from your bank 15/04/2010 Page 12 of 15 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 expressing an opinion as to The Beeches Residential Home To establish the financial viability of the home. 11 34 25 Information about the 15/04/2010 financing and cash flow of the service a business plan or equivalent. This should include details of the running costs of the care home, including rent or mortgage payments and expenditure on food heating and salaries and wages of staff. To establish the financial viability of the home. 12 38 26 The provider should vist the 30/04/2010 home in accordance with this regulation and a report must be written and held at the home. This will ensure that the conduct and events within the home are monitored and can be demonstrated as being as to promote the health and well being of people in the home. 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 9 A medication pill counter should be obtained so that tablets can be counted with out risk of contamination. Page 13 of 15 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 2 9 The home should have a supply of homely remedies to administer agains a policy for each person living at the home if they should suffer from a minor ailment for example a headache. The policy and procedure for homely remedies should involve the consultation of the persons GP and the homes pharmacist. Activities should be reviewed and based on individual needs. Following this review an action plan should be drawn up and findings implemented. It is recommended that the home obtain a copy of the Department of Health guidance Mental Capacity Act 2005 core training set, published July 2007 and staff are provided with training, so that staff are aware of their responsibility and peoples rights are protected. The home should review with people living at the home the provision of meals to ensure that it meets their needs, wishes and expectations. A refurishment plan should be drawn up and action taken address these in a timely manner. The home should contact the Infection Prevention and Control Team at Sandwell PCT, they will assist the home to carry our an infection control audit. This will help identify any concerns and ways in which they can be reduced. They are based at Kingston House, 438 High Street, West Bromwich, B70 9LD. Telephone number: 0121 612 1627. Arrangements for the evacuation in the event of a fire must be reviewed to ensure that persons and staff in the care home are not subject to any unnecessary risk. This should include the provision of a fire evacuation chair and a fire evacuation risk assessment. Accidents must be recorded in line with current legislation and be monitored and audited. 3 12 4 14 5 15 6 7 19 26 8 38 9 38 Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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