Care Home: The Beeches

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What the care home does well The Beeches provides a friendly, caring, clean and safe environment for service users who are satisfied with the care provided. Service users said that their needs were fully met by a respectful and supportive staff team. Comments included: "They have really done me proud, I couldn`t complain about anything, they`re very good". "I can say that anything you need is provided for". "I have been here a while and it`s always clean, you can talk to the staff and the care is good". "I wouldn`t move". "I feel I`ve made the right choice and can`t really fault anything". "My health has really improved in the short time I`ve been here so they must be doing something right, I feel so much better". "You do as you please, they want you to be happy and it shows". "When we visit we are made to feel welcome, it is a friendly place and we are satisfied with the care here". What has improved since the last inspection? This is the first inspection for the care home since being registered under new ownership. CARE HOMES FOR OLDER PEOPLE The Beeches 28 South Street Louth Lincs LN11 9JT Lead Inspector David Bacon Unannounced Inspection 11th February 2008 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Beeches DS0000070326.V356381.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 DS0000070326.V356381.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address 28 South Street Louth Lincs LN11 9JT 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) 01507 603862 01507 603862 Selvanathan Kuppusamy Mrs Jacqueline Prior Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 needs on admission to the home are within the following categories: 2. Old Age, not falling within any other category - Code OP. The maximum number of people who can be accommodated is: 22 Date of last inspection N/A Brief Description of the Service: The Beeches is a listed Victorian Building situated in the market town of Louth and is approximately a 5-minute walk from the shops and local facilities. The home is registered to provide care and accommodation for 22 service users over the age of 65 years. Accommodation is situated on 3 floors. There are 2 lounge areas and 1 main dining area. All bedrooms are single of which 9 have en-suite facilities. Bedrooms are located on first, second and third floors and are served by a shaft lift and two stair lifts. At the front and to one side of the home are small garden areas and a courtyard area is at the rear. The manager said that copies of inspection reports are made available in the home. The range of fees is up to £394 per week. The Beeches DS0000070326.V356381.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 stars. This means the people who use the service experience good quality outcomes. This key unannounced inspection took place during February 2008 and the visit to the home was undertaken over approximately 4 hours. This is the first inspection of the care home since being registered with new owners. The previous registered manager remains in charge of the care home. The care received by three service users was looked at in detail. This process is called “case tracking” and individual service users care records and general home records were looked at as part of this along with discussions with service users about their experience of life within the home. We spoke with twelve service users, three representatives of service users, three staff members and the registered manager. Prior to the visit, we reviewed any information relating to the service as part of the overall review of the service. A partial tour of the premises was conducted including areas relating to the service users who were case tracked. Staff records were also inspected along with policies/procedures and administrative systems. What the service does well: What has improved since the last inspection? This is the first inspection for the care home since being registered under new ownership. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a range of information that allows them to make a choice of where to live. Service users are assured that their needs can be met by way of a thorough assessment process of which they are included. EVIDENCE: A statement of purpose is in place, which details and the services provided by the home, the rights of people who use the service, terms and conditions of residence and the homes philosophies of care. Copies of this are maintained in the hallway. A service users guide is currently being produced of which the manager said will be placed in each bedroom. Other information relevant to life within the home is on display. The care records seen clearly identified that an assessment of each service users care needs had been undertaken and records provided staff with clear details of how any needs were to be met. Details of service users personal The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 9 daily living preferences were noted and identified where service users had been involved in the assessment process, of which the service users spoken with were fully satisfied. Comments included: “I was told everything I need to know but really you just have to ask, all the staff are approachable if you need to know anything”. “I’m so much better now I’m here and I feel better, I can thoroughly recommend them”. “I have a care plan and I’m encouraged to say if I want or need anything, I can’t say I need for anything”. “There is information about the place if you need it or they are happy to tell you”. The care home does not provide intermediate care. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are satisfied with how they are treated, they are supported to maintain their independence and they can be assured that their care needs will be met by a caring staff team. Procedures for the administration of medication are safe overall. EVIDENCE: Service users said they were satisfied that their care needs were properly met and confirmed that staff were consistently supportive and helpful. Comments included: “Well, the nice thing is that you are properly treated, I’d certainly say that you get the care you need”. “You do get well looked after, there’s no question about that”. “I’ve no complaints, no it’s alright”. “I think we all get on well with each other and you get the care here”. “They encourage you to stay independent where you can but the care is always there, I wouldn’t move”. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 11 Information gathered during the initial assessment is used to complete a care plan of which service users are involved. The records seen documented each individual’s care needs and provided staff with clear guidance about how any needs were to be met. This included any risks relevant to the individual and how these should be minimised. Care records were regularly reviewed and updated as necessary although the manager acknowledged that this was not always clearly recorded and agreed to address this. The staff members spoken with confirmed that they received awareness training appropriate for their roles, which was also evidenced in the training records seen. Policies and procedures promoting service users rights, privacy and dignity provide further guidance regarding this. Systems are in place to support service users to administer their own medicines where this is risk assessed as appropriate. Staff whom administer medication receive awareness training regarding this. Medicines were properly stored and records documented medicines as administered although not fully as receipted into the building, which the manager agreed to address. The manager also said that disposal records are maintained although these were not available for inspection. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Service users can choose how they spend their time and to maintain any community links as they prefer and they are consulted with about life within the home. Service users enjoy the meals provided overall although individual choices are not fully promoted. EVIDENCE: Service users personal likes, dislikes and any preferred routines are sought as part of the admission process, which is recorded in their individual care plan. Service users said that there were no restrictions as to how they could spend their time and that their visitors were made welcome. Comments included: “They want you to do what you like to do and you can do as you please”. “I’ve always done what I want to”. “We’ve always been made welcome here, you can ask the staff anything and it is always a pleasure to visit”. “I feel much safer since I moved here, I can still do as I like but there is help when I need it, they’ve not said I can’t do anything”. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 13 Service users said they enjoyed the activities available overall and comments included: “We have someone come regularly to entertain us, its good fun but I don’t think we want much to do”. “There are a few things to do, they come and ask you but I don’t want to get involved”. “We sit and chat or do as we like”. “Yes, we have meetings and are encouraged to say if we want anything else to do, it’s our choice”. Regular activities include: entertainer, cards, dominoes, films and clothes parties. Service users said that residents confirmed that meetings are held and that they had opportunity to express their views about life in the home. Service users dietary needs and preferences are assessed upon arrival of which the homes kitchen staff are made aware. A four-week rolling menu is in place and the daily menu is displayed in the home although this does not note that a choice is available. Service users said that choices were available at teatime but not fully at lunchtime. The cook said that an alternative would be provided where kitchen staff were aware of any service users specific food dislikes or requirements. Records of any alternative foods provided are maintained along with records of meal and equipment temperature checks. Comments regarding meals included: “Its okay food here, yes, generally good”. “We speak with the cook if you don’t like something but there’s not a choice at lunch time”. “There’s just one thing on the menu at lunch”. “If you don’t like something you wouldn’t have to go without”. A discussion was held with the manager in relation to putting systems in place to further enable service users to have their say regarding the homes provision of meals, which actioned during the visit. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate systems are in place to enable service users to complain about the care they receive and to protect them from abuse. EVIDENCE: There has been no safeguarding adult’s referrals or complaints since the home has been under new ownership. The homes complaints procedure is displayed in the hallway and information regarding this is located within the statement of purpose. The service users and representatives spoken with said they felt able to express their views about the care they received and life within the home. Comments included: “Well, if things weren’t right I’d tell them, no, but they are good and you just have to say”. “We’ve not needed to complain about anything but they seem to have good staff who will listen to you”. “I would say what I needed to and yes, I think they would be alright”. Policies and procedures are in place to protect service users from abuse and to enable them to express any views regarding the services provided. The staff members spoken with were aware of the need to safeguard service users from abuse and the correct action to be taken in the event of a concern being identified and confirmed they had received awareness training regarding this. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 15 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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a clean, comfortable, safe and generally wellmaintained environment. EVIDENCE: The service users spoken with were satisfied with the standard of cleanliness of the home. Comments included: “My room is kept nice, they do it each day then the carers do bits at the weekend”. “It’s nice and clean when we visit”. “It would benefit from some decorating and the sun lounge roof needs looking at but it seems a nice place overall”. “It needs a few bits touching up but its clean and homely”. Service users are supported to personalise their own rooms. The areas seen were clean, tidy and well maintained overall although many areas would benefit from some redecoration. For example, the paper in the dining room and upstairs bathroom and were peeling. Also, the manager said The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 16 that the conservatory room roof was in need of repair but that this was scheduled. The manager confirmed that a rolling programme of maintenance and decoration had been put in place following the new ownership of the home. An environmental risk assessment has been undertaken and an individual risk assessment is undertaken for each service user. Substances identified as being potentially hazardous to health are stored appropriately and information sheets are in place to provide guidance for staff who confirmed they received health and safety awareness training. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff, appropriately recruited, deployed and well trained to allow them to care for service users who are satisfied with the care provided. EVIDENCE: The homes staff rota was seen, which indicated that the staff hours provided are adequate to meet the current needs of service users. The staff and service users spoken with further confirmed this. Staff were observed to be taking time to interact socially with service users, and there was a friendly and relaxed atmosphere within the home. The service users spoken with were satisfied that their care needs were appropriately met and said that staff were supportive and helpful. Comments included: “Honestly, they have saved me, I was so poorly when I came but I feel so much better, thanks to them here”. “I’d heard that the care was good and it is, you get the care you need and they look after you”. “We are satisfied and it’s a friendly place, it does put your mind at rest”. “No, you don’t wait too long, they get to you as quickly as they can”. The records viewed evidenced that recruitment checks had been undertaken prior to staff commencing work at the home. These included: criminal record bureau checks, obtaining professional references and staff completing The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 18 application forms. Equal opportunities policies and procedures are also in place. The manager said that newly appointed staff receive a formal induction, which was further confirmed by the staff members spoken with who also said they received training specific to the needs of service users of which records are maintained. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 19 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 systems are in place to safeguard service users. Service users are supported to express their views regarding the care they receive. EVIDENCE: The service users and representatives spoken with said that they were satisfied with the management of the home and the care provided. Comments included: “The manager is always happy to talk and they listen, well they all do really, I’ve not had a problem”. “They are respectful but good fun, you can have a laugh which is nice”. “I’ve not been here long but they have made me very welcome and you can see that they are helpful, there is not a problem”. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 20 “I’m very satisfied, I’d heard about the place before and it was right”. The staff members spoken with said they were satisfied with the management support provided and that their views were listened to. The manager said that an annual quality review survey was due to take place and demonstrated the action taken following the previous survey. Service users meetings are also held of which the service users spoken with were satisfied. Comments included: “You have the chance to say your bit but they also tell you what’s happening, its good really”. “They have meetings to talk about the home and you can attend if you like.” Policies and procedures are in place to protect service users where the home has any involvement in their finances and records of any relevant expenditure are maintained. Fire safety policies and procedures are in place, including regular safety tests although records of all emergency lighting tests could not be located during the visit. The manager took immediate action to address this. A formal risk assessment of the premises has been undertaken, which identifies risks to service users and health and safety policies and procedures are in place as part of this. Safety tests had been undertaken regarding legionellosis and the manager said that they were seeking advice to undertake a formal risk assessment regarding this. Water temperature safety checks are undertaken of which records are maintained. The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 21 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 2 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Beeches DS0000070326.V356381.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP1 Regulation 13 (2) 5 (1) Requirement All medicines must be recorded as received. A service users guide must be produced and made available to service users. Timescale for action 01/04/08 01/04/08 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 OP15 OP38 Good Practice Recommendations It is recommended that the choices of food are more clearly promoted for each meal and that this is displayed. Records of emergency lighting checks should be clearly maintained. 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