Care Home: The Beeches

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What the care home does well Residents spoke favorably about the care, support and attention they are given by the staff at the home, people told us they were happy. Relatives we spoke with also gave a number of examples of their satisfaction including the quality of care and food provided at the home. Information contained within individual staff files were all of a consistent standard. The files for three staff were reviewed; including a recently recruited staff member. All of the required information had been obtained to ensure the safety and protection of those who live at the home. Staff files also contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good. The home continue to redecorate and refurbish the home in order that standards are maintained, new furnishing and decor have enhanced the home. What has improved since the last inspection? All of the five requirements and the one recommendation made by us during our last visit to the service in July 2008 had been met and appropriate action had been taken by the home to comply with the National Minimum Standards set for older persons services. The home ensure that peoples health needs are met, at our last visit to the home we made a requirement that the home must contact an individuals general practitioner (GP) to request an assessment of the individuals mental health. This was to ensure that they were being supported fully with the emotional aspects of their health. Promptly after our last inspection the home contacted the individuals GP and action was taken to support the individual. The home record the amounts of stock held medication and also record who audits and checks these amounts. Improvements since our last visit to the service were noted. The home have completed a risk assessment in respect of potential allegations. This assessment made reference to the homes safe guarding policies and procedures and whistle blowing policies in order to ensure the safety and wellbeing of both the individual concerned and staff. Glass in the internal entrance door had been made safe, this was to reduce the likelihood of injury to those who live and work at the home. Attention had been given to an area in the home where we had noted an unpleasant odour during our last visit, no offensive odours were noted during this site visit. What the care home could do better: In order to build and improve upon the information held at the home, the registered person must ensure that care plans contain clear information and guidance in respect of individuals religious and cultural needs. This is too ensure that individuals wishes and choices are known and met by the home. Furthermore, care plans must be keptunder review and be updated as and when required, this is to ensure that individuals changing and current needs are recorded and are being met. The home should review the completed deprivation of liberty assessments they have completed, this is to ensure they are in line with legal requirements, furthermore it is important that these assessments are dated and record who had been involved within the assessment and decision making processes. The registered person must ensure that accident reports consistently record what action has been taken following an incident, this is in order to evidence that appropriate action has been taken to ensure the welfare and safety of the individual involved. The registered person should ensure that the homes fire risk assessment is dated to evidence the date of its completion and review. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Beeches 163 High Street Hanham South Glos BS15 3QZ     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 1 4 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Beeches 163 High Street Hanham South Glos BS15 3QZ 01179604822 01179857190 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Miss. Julie Alexandra Windows,Ms Janet Margaret Windows care home 23 Number of places (if applicable): Under 65 Over 65 23 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 23 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Beeches is an extended, detached Victorian building situated in Hanham High Street. There is parking to the front and a small parking area to the side of the house for three or four cars. There is a small garden to the rear with a patio area. The larger of the gardens has been built upon and the former garden has been reinstated. The home is close to local shops and amenities and is also on a main bus route between Bristol and Bath. The home is arranged on two floors. The home has two double bedrooms, both with en-suite facilities and nineteen single bedrooms, seven of which are en-suite. There Care Homes for Older People Page 4 of 31 Brief description of the care home are two lounges and two dining rooms one of which has a small conservatory leading from it. The home is managed and owned by three generations of one family. Fees at this home range from £417 - £499 per week and are dependent on individuals assessed need. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit as part of the key inspection process. The purpose of the visit was to review the progress to the requirements and recommendations from the visit in July 2008 and monitor the quality of the care provided to the individuals living in The Beeches. There have been no additional visits to the service since July 2008. The Commission for Social Care Inspection, now known as The Care Quality Commission have received no complaints about the service. There has been no changes within the management structure at the home since the last visit. The provider has kept the Care Quality Commission informed throughout the Care Homes for Older People Page 6 of 31 process.The registered manager was on duty on the day of the visit. The focus of this inspection visit was on the general care of a sample group of people who use the service and the environment, including a general tour of the premises and a review of staffing records such as recruitment, selection and training. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service. The manager completed an annual quality assurance assessment in June 2009. In addition views were sought through surveys to relatives (8), staff who work at the home (2) no surveys were received from people who use the service. The inspection was conducted over 7.45 hours. What the care home does well: What has improved since the last inspection? What they could do better: In order to build and improve upon the information held at the home, the registered person must ensure that care plans contain clear information and guidance in respect of individuals religious and cultural needs. This is too ensure that individuals wishes and choices are known and met by the home. Furthermore, care plans must be kept Care Homes for Older People Page 8 of 31 under review and be updated as and when required, this is to ensure that individuals changing and current needs are recorded and are being met. The home should review the completed deprivation of liberty assessments they have completed, this is to ensure they are in line with legal requirements, furthermore it is important that these assessments are dated and record who had been involved within the assessment and decision making processes. The registered person must ensure that accident reports consistently record what action has been taken following an incident, this is in order to evidence that appropriate action has been taken to ensure the welfare and safety of the individual involved. The registered person should ensure that the homes fire risk assessment is dated to evidence the date of its completion and review. 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have sufficient information available to them prior to moving into The Beeches. There are processes in place to ensure that the assessed care needs of the individuals can be accommodated at the home. Individuals are assured of an open transparent service in relation to the payment of fees and additional costs, as this information is included in the contract of care for the individual. Evidence: The Beeches is a residential care home and is registered with The Care Quality Commission to provide a service for up to 23 older people. The home supports people Care Homes for Older People Page 11 of 31 Evidence: with individual assessed needs, there are people living at the home with physical and sensory impairments, there are also people who live at the home who have a dementia and they are well supported with their needs by the staff at the home and other external support services. During this visit we reviewed the homes Statement of Purpose, we have reviewed this document at previous visits to the care home and have found that the document contained all of the information needed, as required. The registered manager informed us that since our last visit the home have developed a website in order to make information about the services and facilities provided at The Beeches more accessible, this was not viewed by us during this visit. The home have a clear admissions processes and upon discussion with one of the registered providers and the manager of the home it was clear that they fully understood the range of needs that could be accommodated at the home and that those people who required nursing care would not be able to be supported at the home. We reviewed the admissions process for one of the most recently admitted people into the home, we saw that the home followed their own procedure and that the individual was well supported to settle into The Beeches. The individual had a clear assessment completed by the local authority and this was received by the home prior to the individual moving in, the home had developed their own care plan and this was sufficiently detailed. The admissions process is well recorded within the homes statement of purpose. The home offers a four week trial in order that all parties can be satisfied with the service provided, this can be extended in special circumstances if necessary in order to allow a full assessment and to also provide additional time for the placement to settle. We spoke to a relative who had recently placed their mother at the home, they told us that they had looked at a number of homes before deciding on The Beeches, they told us that they believed their mothers health had improved since moving into the home and that they were very happy with the care and attention their relative received. We saw that individuals had in place a contract, this outlines the terms and conditions of the placement between the home and the individual accommodated, these contracts contained all of of the required information in respect of fees and service that would be provided, we did note that within these contracts that they still referred to The Care Quality Commission as The Commission for Social Care Inspection and to ARCHA (Avon residential care homes association), which is now known as Care and Support South West and is an organisation that provides information and guidance to care home providers. Mr Windows confirmed to us that he would make arrangements for Care Homes for Older People Page 12 of 31 Evidence: this information to be amended. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at the home can be assured that because of the homes knowledge of individuals, they will be well looked after. However, the home must ensure that they keep care plans under review and ensure that they contain clear information to demonstrate that individuals cultural and religious needs have been identified and the home must record how these will be met. Evidence: The care planning files of four residents were examined. The care plans on the whole were well written and detailed the needs of the individuals and what actions the care staff were to take. One care plan required improvements in recording the religious and cultural needs of one of the residents who live at the home, it should also be noted that this important area of this individuals life had not been evaluated or recorded within the care management assessment completed by the local authority prior to this individual being admitted into the home. These issues were discussed with the manager during the inspection. Of the four plans of care we reviewed we saw the two Care Homes for Older People Page 14 of 31 Evidence: of these care plans have been reviewed on a monthly basis, the other two had not been reviewed since April and May 2009. Care plans must be kept under review at a minimum of a monthly basis as well as being updated as and when required, this is to ensure that individuals changing and current needs are recorded and are being met. During our last visit to the service we were concerned about the emotional wellbeing of an individual who lived at the home due to their complex mental health needs, we made a requirement that the home must contact the identified individuals general practitioner (GP)to request an assessment of this person mental health needs in order that they can be fully supported at the home. Promptly after our inspection the home contacted us to notify us of what actions they had taken to respond to our concerns, a review of information at this visit confirmed to us that this requirement had been met. The home had contacted the individuals general practitioner as needed. Those living at the home are registered with a number of different GP practices. Where possible, residents are encouraged to retain the services of their family general practitioner. Records are maintained of all contacts with GPs and any other healthcare professionals. We saw that individuals are supported to access primary healthcare services and other more specialist services when a need has been identified. We spoke with the manager about the arrangements in place should there be an outbreak of swine flu at the home, we were informed of the current and proposed infection control measures and were satisfied with the homes response. Relatives we spoke to during our visit said their family members were well looked after and they were always kept informed of any changes, or significant events. This information was also confirmed to us prior to our visit in surveys that had been completed by residents who live at the home and their relatives. The home has sound procedures in place for the ordering, receipt, storage, administration and disposal of medicines. During our last visit to the home we were not satisfied with the recording of medication at the home in respect of stock held medication, we made a requirement that the home must record the amounts of stock held medication and also record who audits and checks these amounts. A review of stock held medication and records pertaining to this evidenced to us that this requirement had been met. Records were well maintained and a random check showed us that a sound system was in place. During the course of the inspection, the staff team were seen going about their duties in a kind, friendly and courteous manner. They were heard being respectful and polite to residents, using first names to address each individual. One person said that they were helped with personal care tasks in privacy, but the staff encouraged them to do Care Homes for Older People Page 15 of 31 Evidence: for themselves where possible. The person was satisfied with this level of support. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported to participate in social activities. Those living at the home receive a well balanced diet and are offered choices at mealtimes. Evidence: The home has a recorded plan of activities and details of forthcoming events and entertainments is displayed in the entrance hall of the home. There was generally a positive response from the residents about what happens during the day. One person said they liked to pass the time of day sitting quietly whilst another said, the girls do their best. It was during our visit we saw that a number of people enjoyed visits from their relatives and others participated in a game of bingo. Those who were able to, were seen moving independently around the home using their walking aids, whilst others were asked where they wanted to spend their time. The home has a four-week menu plan. There is a choice of meals at and people were heard being encouraged to make choices about what they wanted to eat. Since our last visit new dining tables and chairs have been provided, giving more room and making these area a pleasant one in which to eat. One of the people at the home Care Homes for Older People Page 17 of 31 Evidence: required support at lunchtime,this was undertaken sensitively and in an unhurried manner. On the day of the inspection there was roast turkey with fresh vegetables, followed by bread and butter pudding served with custard. The meals looked appetising and were attractively served. Residents made positive comments regarding the meals. The cook on duty explained that all dietary needs can be catered for, and gave some examples if individuals preferred choices and told us how these are met at the home. We saw that this information had been recorded within individuals care records. The home were visited by Bristol City Councils environmental health department in April 2008 and were awarded a five star award for food hygiene, the home are to be commended for this. During our visit we reviewed the care and associated documents for an individual who has some specific cultural and religious needs. We saw that the care management assessment ans care plan completed by the placing authority made no reference to this important are of this individuals life. The home had done well to complete their own care plan which had been based on their own observations and assessment planning processes, however it remains that this individual had needs that are not being met and the individual has not contributed to their care plan and their wishes about how they wish to be supported are not fully known or recorded. Furthermore this individual has no relatives who live nearby and this individual does not speak any English. It is recommend that the home should contact an individuals placing authority in order to request that an assessment is undertaken to determine the suitability for independent advocacy support, the advocacy provided must be able to communicate with the individual in order that they ascertain the views and wishes of the individual concerned. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient systems and processes in place in order to ensure that people are able to raise any issues of concern about the services provided. Adult protection protocols are in place and staff know their responsibilities in this area. Evidence: The home has a complaints procedure and this is displayed in the main entrance area of the home, and is included in the homes statement of purpose. The Care Quality Commission have not received any complaints. The manger has handled any complaints made to him appropriately and has kept records to show how any concerns have been handled. This means that those living at The Beeches and their relatives can be assured that any concerns they have will be listened to and acted upon. We noted that within care records the home had started a process of completing deprivation of liberty safeguarding forms, whilst the intent to complete these assessments is acknowledged it is recommended that the home review the completed assessments to ensure they are in line with legal requirements, furthermore it is important that these assessments are dated and record who had been involved within the assessment and decision making processes. There have been no referrals made under protection of vulnerable adults procedures. The homes manager has previously demonstrated a good knowledge of the procedures Care Homes for Older People Page 19 of 31 Evidence: to take, should any concerns be raised. During our last key visit to the service a requirement was made by us that the home must complete a risk assessment in respect of potential allegations ensuring that the assessments make reference to the homes safe guarding policies and procedures and whistle blowing policies in order to ensure the safety and wellbeing of both the individual and staff. We were contacted by the home shortly after our last visit to be informed that this had been completed, a reviewed of documentation found that the assessment had been completed as required. The home has a copy of the South Gloucestershire Councils protection of vulnerable adults policy. Discussions with some of the staff evidenced their knowledge of adult abuse issues and an awareness of their responsibilities if they witness any bad practice. We also noted that staff have received training in the protection of vulnerable adults. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at The Beeches live in a clean, homely, safe environment. Evidence: The Beeches is located within the residential area of Hanham, it is set back slightly from the main road and there are easy access to bus services. The home is near to local shopping areas of Longwell Green and Hanam High Street. There are local amenities nearby, within walking distance; such as public houses, churches and local shops. Since our last visit to the home there have been a number of refurbishments, the home have recently upgraded the emergency call bell system and this was seen to be in good working order with staff seen responding promptly to requests for assistance from residents. We saw that new furniture had been purchased, this included dining tables and chairs, beds and bedding and new vanity units had also been installed. We saw that some bedrooms had been redecorated as had the hall stairs and some of the landing areas within the home. Residents spoke favorably about the redecoration saying It looks so much brighter and fresher now, Am very happy with the new decor, much nicer. a relative we spoke to said that since their relative had moved into the home they had noted improvements to the decor in the corridor and told us that this had stopped prior to their relatives room and were concerned that the Care Homes for Older People Page 21 of 31 Evidence: redecoration had stopped, we raised this with Mr Windows who assured us that this was not the case and redecoration and refurbishment of the home was an ongoing long term project. The home has sufficient toileting and bathing/showering areas for individuals use. These areas are close to peoples rooms. The temperature in the home at the time of our visit was warm and comfortable. The home is appropriately adapted to meet the needs of the current group of people who live in the home. Specialist equipment has been obtained for individuals following identified need; examples of these include mobility, sensory aids, continence aids and equipment to assist with manual handling. We also saw a passenger lift and a hoist is in place to support those with limited mobility. We saw the passenger lift in good working order and saw maintenance records to evidence that this is serviced, as required to ensure it remains in good working order. We saw evidence that the home is well maintained; see the management section of this report for further information in respect of this. Attention had been given to an area in the home where we had noted an unpleasant odour during our last visit, no offensive odours were noted during this site visit. At this visit all areas seen were clean and tidy. During our previous two visits to the home a requirement was been made that the glass in the internal entrance door must be made safe, this was in order to reduce the likelihood of injury to those who live and work at the home. We saw that perspex and additional metal rods had been fitted, making the glass safe and the requirement met. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that all staff have been employed following robust recruitment and selection processes. Staff are trained to support older people, and core skills have been undertaken by staff. Evidence: There is a well-established staff team at The Beeches. During the visit the registered provider, the registered manager and staff were able to demonstrate a clear understanding and knowledge of the individuals who use the service, and of their role in the home in ensuring that individuals needs are known and understood. The manager was able to demonstrate that he and the staff team have developed good relationships with those who live at the home and have a sound understanding of their needs, wishes and aspirations. These are generally well recorded in individuals records. The staff team have a varied range of knowledge and skills, they were observed by us to be good listeners, effective communicators and were interested and motivated in meeting the needs of those living at the home. On duty on the day of the visit was the Registered Manger Mathew Windows, one of the the Registered Providers Julie Windows, a senior staff member, three care staff and a cook. At night there are two Care Homes for Older People Page 23 of 31 Evidence: members of staff, one who is awake, one available on call in order to support people during the night. Information contained within individual staff files were all of a consistent standard. The files for three staff were reviewed; including a recently recruited staff member. All of the required documentation was in place in respect of robust recruitment and selection practices. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with, including two references being taken up, a Criminal Record Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults had been checked before the staff started working at the home. During this visit we saw that staff were respectful to those who live at the home and their privacy was respected. Staff spoke to people living in the home discreetly and politely, doors were knocked before entering and staff were heard asking permission and did not presume that it was okay to enter. Residents told us staff are lovely, I am well looked after, individual members of staff were named and examples were given to us by residents of how they are assisted with their care. A visiting relative told us that staff were approachable, caring and friendly in their approach. No concerns or complaints were raised to us. We spoke with a member of staff who had been the most recently appointed to the home. They told us about their induction process and of the training they had received. The information given to us was confirmed within the individuals training record. We saw that staff at the home receive core training in areas such as first aid, basic food hygiene, manual handling and protection of vulnerable adults.The manager and staff also informed us that care staff at the home are currently in the process of completing a distance learning course in Dementia Care, provided by the Forest of Dean college and also deprivation of liberties awareness. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Beeches is well managed and individuals live in a well maintained, safe environment. Evidence: The Beeches is privately owned and is the sole care home of The registered Providers. Mr Mathew Windows took over as Registered Manager of the home in 200. Mr Windows has completed an NVQ at level 4 in care and the Registered Managers Award. The statement of purpose for the home states that Mr Windows has also completed training in areas such as first aid, protection of vulnerable adults, moving and handling, basic food hygiene. Basic health and safety, drugs administration, and he is currently completing training in dementia care and equalities and diversity. Mr Windows fully engaged with us during this visit and was able to locate all of the necessary information and documents easily. This shows that generally the home has good systems in place and is well run. Care Homes for Older People Page 25 of 31 Evidence: Prior to the site visit the Commission received from the registered provider a completed annual quality assurance assessment. The annual quality assurance assessment (AQAA) is a process that is being used for all regulated services from April 2007. The AQAA is in two parts: Part one is a self-assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the registered was sufficiently detailed. Staff files also contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good and staff had received the required sessions. Areas of discussion included guidelines and policies of the home, individuals expectations and an evaluation of their performance and how this can be developed. The home are currently in the process of developing and improving the current staff appraisal form this was following the providers recent attendance at a Care Learning Conference. The proposed new format will include clear quality monitoring and auditing of staff performance; questions will be explored such as does the staff member deliver the planned care and participate in the evaluation of residents ?, and are the professional and legal requirements with regard to storage, handling and administration of drugs ?, Mr Windows informed us that this new tool will enable the home to manage staff performance in an effective manner. We look forward to reviewing the effectiveness of this at our next key visit. There were no current health and safety issues. The fire logbook evidenced that tests and checks of the system are taking place at the appropriate intervals. The workplace fire risk assessment is well completed and covered areas such as smkoking, cureently safety factors and checks in place, however the assessment was not dated. It is recommended that the registered person ensures that the fire risk assessment is dated to evidence the date of its completion and review. Staff confirmed that they have had fire training and have participated in fire drills. We saw evidence within maitence records that the boiler was fully serviced in April 2009 and a detailed gas installation check was completed by an appropriate contractor also in April 2009. The home maintainz records of weekly water temerature checks, and those recorded were of a consistent safe water temperature. Within individuals files we saw that the home had completed manual handling and general/individualised risk assessments in place, those seen were sufficiently detailed and recorded the implications, likelihood of injury and details of what actions should be taken to prevent injury. During this visit we reviewed accidents that had occurred at the home, we saw that Care Homes for Older People Page 26 of 31 Evidence: there were occasions when accident reports did not record what action had been taken after an incident. it is recommended that the registered person must ensure that accident reports consistently record what action has been taken following an incident. This is in order to evidence that appropriate action has been taken to ensure the welfare and safety of the individual involved. Prior to our visit to The Beeches we sent surveys to those who live and work at the home and other people who have an association with the home, such as relatives, social and health professionals. We received 10 replies and all indicated levels of satisfaction with the service. Comments made included: The Beeches provides a safe, friendly and homely atmosphere, staff always do there best to be cheerful, friendly, helpful and encouraging Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that care plans are kept under review and updated as and when required to ensure that individuals changing and current needs are recorded and are being met. 07/09/2009 This is to ensure that individuals current and changing needs are known, recored and are being met. 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 14 The home should contact an individuals placing authority in order to request that an assessment is undertaken to determine the suitability for independent advocacy support. The home should review the completed deprivation of liberty safeguard assessments. This is to ensure these DOLS assessments for those who live at the home are in line with legal requirements, furthermore it is important Page 29 of 31 2 17 Care Homes for Older People that these assessments are dated and record who had been involved within the assessment and the decision making processes. 3 38 The registered person should ensure that the fire risk assessment is dated to evidence the date of its completion and review. The registered person must ensure that accident reports consistently record what action has been taken following an incident in order to evidence that appropriate action has been taken to ensure the welfare and safety of the individual involved. 4 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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