Care Home: The Beeches

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What the care home does well The process of admission and moving to the home is well managed at the Beeches. Information provided by the home is good and ensures that people are able to decide whether the home is where they want to live. The robust pre admission assessment and information obtained by staff at the home also provides staff with enough information to decide whether the home can meet their needs. People who use the service and their families have opportunities to visit the home prior to making a decision and find the website useful. People who use this service are treated with respect, and receive the care they need to help them stay well. Staff interact with people in an affectionate and unhurried way and speak to people with respect. The majority of people said the nursing care at the home was excellent. Staff ensure people who use the service access NHS and specialised healthcare services. Staff at the home are using national schemes, records and projects to improve care for people who are dying. As a result end of life care at the home is excellent. Care plans and written records are well maintained and show that needs are met in a safe and consistent way. People using the service are given the opportunity to maintain contact with family and friends. People at the home enjoy the meals provided and are encouraged to take part in the formal and informal activities at the home. Concerns and complaints are dealt with promptly arrangements are in place to protect people from abuse. and appropriatePeople who use the service are cared for by a stable group of staff who have had the necessary pre employment checks, staff induction and training. Education of staff is promoted at the home. People at the Beeches live in a pleasant, clean and well-maintained home and enjoy being surrounded by their personal possessions. The home is well managed and run in the best interests of the people who live there. What has improved since the last inspection? The Provider and manager have worked to address the Requirements and Recommendations made at the previous inspection but have also identified other areas of improvement that have also been addressed. The management of medications has been improved with the introduction of a new policy and folder of patient information leaflets to reference. The manager has also reviewed staff training in medication. A decision has been made in this care home to only allow registered nurses to manage medications. NVQ 3 care staff, who have done medication training, are then used to check controlled drugs. The recruitment process has improved at the home with checks in place, which ensure evidence is provided to show that two references and CRB (police check) are obtained and POVA first (Protection of vulnerable adults) checks performed before employment starts. The training at the home has been addressed since the last inspection. The home has nominated one registered nurse to perform moving and handling updates for all staff. The manager has also sourced an external training programme for other mandatory training subjects with the exception of first aid training. The manager and provider have also worked through a set of policies and procedures to ensure staff have up to date guidance for all aspects of care. The manager has made sure these policies match local agreed guidance to ensure care is consistent. New environment risk assessments have been introduced and systems introduced for the prevention of legionella. The home, one of a small number of homes in Cornwall, have introduced a national recognised scheme called the gold standard framework. (This scheme plans to improve the standard of care for people with an end stage illness, improve working relationships with other healthcare professionals and reduce unnecessary hospital admissions.) The `Liverpool Care Pathway` (a care plan that prompts staff to look at needs such as pain relief, psychological and spiritual care and support for the family) is now being used at the home to improve end of life care. As a result of this the care planning has improved at the home and the manager is looking at further ways to improve care planning. The home have also been nominated by the university to be a recognised placement for student nurses. CARE HOMES FOR OLDER PEOPLE The Beeches St Georges Road Hayle Cornwall TR27 4AH Lead Inspector Clare Medlock Unannounced Inspection 30th January 2008 09:45 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 DS0000008967.V349822.R02.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 DS0000008967.V349822.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address St Georges Road Hayle Cornwall TR27 4AH 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) 01736 752725 01736 754324 www.thebeechescornwall.co.uk Mr Peter Ian Pool Mrs Lesley Jennifer Pool Email pip@thebeechescornwall.co.uk Mrs Marian Rich Care Home with nursing 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (5), Terminally ill (5) of places The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Accommodation can be provided to service users aged 50 years and above who have a physical disability or terminal illness. 16th October 2006 Date of last inspection Brief Description of the Service: The Beeches is registered to provide accommodation and care, with nursing, for up to 28 older persons. The registered providers are Mr P I Pool and Mrs L J Pool. The registered manager is Mrs Marian Rich. The home is in a pleasant area of Hayle. There are 22 single rooms and three shared rooms. All the bedrooms have en suite washbasins and toilets. In regard to access for people with mobility problems, there is a small step at the main front door, but a portable ramp is available for wheelchair users. The ground floor is level and there is a passenger lift to the first floor. Communal space comprises a large dining room, a lounge and a conservatory. There are attractive and spacious gardens providing areas accessible to service users. A copy of the inspection report is available from management and available at the entrance of the home. The range of fees at the time of the inspection is £525 to £695 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and took place on Wednesday 30th January 2008. Prior to the inspection, the homes manager sent a detailed annual quality assurance assessment. This told us what the home had achieved in the last year, what areas they need to develop and what plans they have for the next year. On the day of inspection we looked around the home. We spoke in detail with two people who use the service and more generally to many more during the inspection. We spoke with five members of staff, the manager and to five relatives visiting the home. We looked in detail at what it was like living at the home for four people. We looked in detail at their records, care plans, bedroom and what they did during the day. This is referred to as case tracking, and helps us to understand the experience of people living in the home in more detail. We also looked at records. These records included care plans, pre admission assessments and other records kept on people who use the service, staff recruitment files, medicine charts, accident records, finance records, staff training records, information posters, and letters from families. What the service does well: The process of admission and moving to the home is well managed at the Beeches. Information provided by the home is good and ensures that people are able to decide whether the home is where they want to live. The robust pre admission assessment and information obtained by staff at the home also provides staff with enough information to decide whether the home can meet their needs. People who use the service and their families have opportunities to visit the home prior to making a decision and find the website useful. People who use this service are treated with respect, and receive the care they need to help them stay well. Staff interact with people in an affectionate and unhurried way and speak to people with respect. The majority of people said the nursing care at the home was excellent. Staff ensure people who use the service access NHS and specialised healthcare services. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 6 Staff at the home are using national schemes, records and projects to improve care for people who are dying. As a result end of life care at the home is excellent. Care plans and written records are well maintained and show that needs are met in a safe and consistent way. People using the service are given the opportunity to maintain contact with family and friends. People at the home enjoy the meals provided and are encouraged to take part in the formal and informal activities at the home. Concerns and complaints are dealt with promptly arrangements are in place to protect people from abuse. and appropriate People who use the service are cared for by a stable group of staff who have had the necessary pre employment checks, staff induction and training. Education of staff is promoted at the home. People at the Beeches live in a pleasant, clean and well-maintained home and enjoy being surrounded by their personal possessions. The home is well managed and run in the best interests of the people who live there. What has improved since the last inspection? The Provider and manager have worked to address the Requirements and Recommendations made at the previous inspection but have also identified other areas of improvement that have also been addressed. The management of medications has been improved with the introduction of a new policy and folder of patient information leaflets to reference. The manager has also reviewed staff training in medication. A decision has been made in this care home to only allow registered nurses to manage medications. NVQ 3 care staff, who have done medication training, are then used to check controlled drugs. The recruitment process has improved at the home with checks in place, which ensure evidence is provided to show that two references and CRB (police check) are obtained and POVA first (Protection of vulnerable adults) checks performed before employment starts. The training at the home has been addressed since the last inspection. The home has nominated one registered nurse to perform moving and handling updates for all staff. The manager has also sourced an external training programme for other mandatory training subjects with the exception of first aid training. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 7 The manager and provider have also worked through a set of policies and procedures to ensure staff have up to date guidance for all aspects of care. The manager has made sure these policies match local agreed guidance to ensure care is consistent. New environment risk assessments have been introduced and systems introduced for the prevention of legionella. The home, one of a small number of homes in Cornwall, have introduced a national recognised scheme called the gold standard framework. (This scheme plans to improve the standard of care for people with an end stage illness, improve working relationships with other healthcare professionals and reduce unnecessary hospital admissions.) The ‘Liverpool Care Pathway’ (a care plan that prompts staff to look at needs such as pain relief, psychological and spiritual care and support for the family) is now being used at the home to improve end of life care. As a result of this the care planning has improved at the home and the manager is looking at further ways to improve care planning. The home have also been nominated by the university to be a recognised placement for student nurses. What they could do better: The manager must now ensure all improvements that have been introduced are maintained and continue. Mandatory training must be improved by the addition of first aid training to the programme. The management of medication should be improved by reminding staff to get another member of staff to check when a handwritten entry is made onto the MAR (medicine administration record) sheet. This will prevent any errors being made when entries are recorded. The manager should also review the current system for managing peoples personal money that is held for small transactions such as hairdressing and chiropody. Money that is pooled does not show that the safekeeping of a person’s property is robust. By obtaining two signatures for each transaction would provide further safeguards for both people who use the service and staff. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 8 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 DS0000008967.V349822.R02.S.doc Version 5.2 Page 9 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 DS0000008967.V349822.R02.S.doc Version 5.2 Page 10 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): 1,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedure ensures that people are able to decide whether the home is where they want to live and provides staff with enough information to decide whether the home can meet their needs. EVIDENCE: A brochure is available for people to use. This brochure contains the Statement of Purpose and details about the home. Both documents contain the information needed for people to decide whether the home can meet their needs. People we spoke to and their relatives said they had been given some ‘paperwork’ but they got most information from speaking with the manager and staff at the home. The manager explained that someone from the home The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 11 visits the person prior to moving into the home. The pre admission document, nursing assessment and multidisciplinary care plan are stored in the persons care plan and used to make a plan of care. Initially a ‘baseline’ assessment is formed and then a system of care planning tools formed to provide a plan of care. During the inspection the manager was heard taking a detailed history of a person hoping to move to the home. The manager asked detailed questions and document responses. The people we spoke with all said that they were too unwell to look around the home prior to moving to the home but that members of their family had looked around. One relative told us we looked at several homes and this one was the best by far. One person said healthcare professionals had suggested the home. Another relative said they thought the home’s website was very useful. The manager explained that staff at the home, work as a team and collectively have the skills to care for a variety of needs. Records showed that referrals to specialist healthcare professionals are made for appropriate and guidance. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 12 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): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are treated with respect, and receive the care they need to help them stay well. The standard of end of life care at the home is excellent. Care plans and written records show that people needs are met in a safe and consistent way. Minor improvements are needed in the administration of medicines so that people living at the home are protected from unnecessary risks. EVIDENCE: All people we saw and spoke with appeared well cared for with the finer details of care given. For example appropriate footwear, hearing aids and glasses in place and oral hygiene needs met. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 13 When case tracking we looked at four care plans and spoke and spent time with two of the people they referred to. One person was too poorly to speak with us and another had visitors present. We observed interaction between other people in the home and the staff. We saw many examples of good practice, where staff interacted with people in an affectionate and unhurried way. Staff spoke to people with respect and worked at a pace that was correct for the person. The majority of people said the nursing care at the home was ‘outstanding’, ‘excellent and ‘faultless’. One person said generally staff are very kind and explain what is happening but one or two sometimes rush, but always apologise when this is done. The manager said that this had been identified and addressed. All of the people who use the service we spoke with said staff were kind, caring and very friendly. People told us that they always receive the care and support they needed, and always have the medical support they need. Comments included ‘I ring the bell and they come’ and ‘a doctor is called if needed’. Another person said they thought the staff worked very hard and were able to offer as much or as little help as needed. People said generally staff knock on their door before entering and call them by their chosen term of address. People who use the service said that when staff assist them in the bath, they make sure their dignity is maintained and allow as much privacy as is appropriate. People also said they receive their medicines on time and never have to wait if pain relief is requested. Shared rooms are provided with appropriate screens. One person told us staff always knock before coming into their room. People said that generally they do not have to wait very long for the bell to be answered and staff will apologise if there has been a delay. One person said staff are sometimes busy with the other people in the home. Each person has a set of records which are used on a daily basis to show what care has been needed. The manager told us that these records work but has plans to upgrade these to improve record keeping at the home. Each person had pre admission assessments, which were used to generate the initial assessment when arriving at the home. Following this each person had care plans, which identified how care was to be provided with records showing that reviews had taken place. Each person had risk assessments in place for mobility, risk of falls, skin assessment, and nutritional assessments. All records seen had been reviewed and updated where necessary. Care staff also have their own set of records, which are completed on a daily basis. These include personal care records and menu records which are used to show care has been provided and who provided this. People we spoke with said they see their GP when needed. Records also confirmed that access to NHS services are also maintained. Examples included community psychiatry nurses, speech and language therapists and out patient appointments. The registered nurses told us each nurse is a ‘link’ nurse for The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 14 specialist areas to ensure their practice is up to date. Examples included continence care, Parkinson’s, palliative (end of life) care and tissue viability (skin care) care. Appropriate pressure relieving equipment is supplied and adjustable nursing style beds are provided where needed. One person we case tracked was using an appropriate mattress for their condition. Records showed that an alternative mattress had been purchased, as another mattress was no longer required because of the improvement in skin condition. There is suitable equipment in the home for moving and transferring people in a safe way. Staff told us one of the registered nurses provides training in house to use this equipment. Other specialist equipment was available and included sit on scales for the monthly weights that are performed on those people at risk of being under or over weight. The registered nurses are responsible for the ordering, storage, and administration of medicines at the home. Policies regarding medication have been reviewed since the last inspection. Patient information leaflets are now stored for reference if required. Storage of medicines is safe and secure. Medicines are disposed of appropriately through a waste disposal company. Generally the medicine records are satisfactory however an existing requirement to obtain two signatures onto the medication administration charts had not been addressed. Records are generally satisfactory however any transcribing onto the medication administration charts must be witnessed and signed by the two people involved; the registered manager and deputy manager agreed to address this with the nursing staff. The registered manager and deputy manager told us this had been done but said they would remind the nursing staff. Staff told us that although many care staff have NVQ 3 and have been trained to administer medicines this role remains the responsibility of the registered nurses. Care staff told us they check controlled drugs with the nurses when needed. There were some very frail people being cared for at the home. These people appeared warm, comfortable and pain free. Specialist equipment was in place and records showed that a high standard of nursing care was provided. The manager explained that the home had been chosen as one of two homes in Cornwall to introduce a national recognised scheme called the gold standard framework. This scheme plans to improve the standard of care for people with an end stage illness, improve working relationships with other healthcare professionals and reduce unnecessary hospital admissions. As part of this programme the manager has completed a degree module in specialist palliative care and has accessed much training for the staff at the home. Whilst undertaking this scheme the manager has also introduced a national recognised recording tool called the ‘Liverpool care pathway’. This tool prompts staff to look at needs such as pain relief, psychological and spiritual care and support for the family. Staff told us that they are all responsible for using the The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 15 ‘pathway’ document and it has improved the standard of care for those people who are very unwell. A letter from a relative supported the fact that the level of care provided for people who die at the home is high. This letter read ‘I wanted to write and thank you and your team for the excellent and caring way in which you looked after him during his life at the beeches, especially during that difficult time when he became more dependent on you. I believe we were very lucky that we had found him a place at your home for his last two years. He was so clearly much better and happier. He never had any complaints or grumbles.’ The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are given the opportunity to maintain contact with family and friends. They have access to a balanced diet and are encouraged to take part in activities. EVIDENCE: Staff told us there were general routines at the home but these were flexible and really depended upon what people wanted at the home. Staff said there were no set answers as everyone at the home was very different and liked different things. Staff were able to explain the individual preferences of people such as what time people liked getting up and going to bed. People living at the home confirmed this, with one person saying they liked going to bed at a similar time and liked getting up early which staff respected. People who use the service told us there is plenty going on at the home and that they can chose which activities they attend. One person said they had attended bingo for the first time in their life and had won a prize. This person also said the home work very hard when organising trips out of the home and The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 17 ensure as many people go as chose to do so. This person also said ‘Christmas was a joy and especially enjoyed seeing the manager dress as a fairy’ People told us they could go out for the day if they chose and staff try their best to get them ready in time. There is an activities coordinator in the home. Posters are displayed to inform what is on offer. Activities include entertainers, crafts, bingo, games and visiting entertainers. On the day of inspection people who use the service were joining in a word game which including spelling. Some people were enjoying the social aspect of the visiting hairdresser. Following the inspection we were informed that the home consider activities have been improved at the home including 1:1 trips to local garden and shopping centres. There were many visitors coming and going on the day of the inspection. Relatives and friends of people at the home spoke very positively regarding the care received. Visitors said they felt welcome by staff. The people who use the service can receive their visitors either in their bedrooms or in one of the communal rooms. One relative said ‘everything is excellent’ another said ‘we looked at many homes and this is the best by far’ Another said the staff are wonderful but sometimes rushed’ People told us they could bring their own possessions into the home, which was very comforting. Information regarding contacting advocacy services is contained in the service user guide. The registered provider has a satisfactory policy regarding anti discrimination. Spiritual needs are Christian focused with weekly communion services being available for people in the home. There are currently no service users from ethnic minorities, although staff stated the home would be more than happy to accommodate service users from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality, gender and disability seem to be suitably addressed. Feedback regarding food was overwhelmingly positive with only one comment describing them as ‘sometimes bland’. One person said the food was ‘absolutely excellent resulting in a substantial weight gain.’ Another said the food is ‘always good’. On the day of inspection roast lamb and apple crumble were being served. People told us staff tell them what is for lunch and ask for requests before suppertime. People told us staff know what they dislike and there are always alternatives if requested. One person said requests for daily salads have been acted upon and that staff really try to suggest alternatives when the appetite was low. Staff at the home suitably records the meals and drinks taken. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place so concerns and complaints could be dealt with promptly. Appropriate arrangements are in place to protect people from abuse. EVIDENCE: The Commission for Social Care Inspection have received one complaint since the last inspection. Discussion with the manager, observation in the home and inspection of records showed that appropriate and timely action has been taken and the complaint is now closed. The Statement of Purpose included a detailed, easy to follow complaints process with contact details of other organisations the complainant could contact. People who use the service told us that they were able to make their concerns known. Many people told us the home was wonderful and the staff very good. One person said she had not needed to make any formal complaints but ‘grumbles are made to staff who sort them out or pass them to the manager to deal with’. Another person said she had not needed to complain but would speak with any of the staff and felt confident that they would be dealt with’. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 19 The majority of relatives agreed with this. One relative said they tended to speak with the staff on duty before issues became complaints. One visitor said that they knew their relative did not want to make a fuss so any problems were dealt with when they visited. We were told these problems had been dealt with quickly. Only one negative comment was received about how the home dealt with complaints. People told us that they felt safe at the home. The majority of people were very complimentary about staff in the home. Many people described staff as ‘wonderful’ and ‘super’. One person said staff sometimes rush but were still kind and caring. Discussion was held about risk assessments suggested by the Health and safety executive for making sure bed rails were safe to use. This assessment was downloaded and printed off prior to the end of inspection. The manager told us the home had not received any vulnerable adults referrals but gave an example where the home had appropriately raised concerns with vulnerable adult agencies regarding specific issues. Staff told us they had attended POVA (Protection of vulnerable adults) training and this had consisted of initially watching a video and working through and induction pack and then attending a POVA training session, organised by a safeguarding adults multidisciplinary team. All staff knew who to report concerns to even if the manager or provider were not at the home. Newly recruited staff told us that the home performed a POVA pre employment check and CRB (Criminal records bureau-police check) before they were able to work. Three staff files were inspected which showed that POVA and CRB records are stored in staff files. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at the Beeches live in a pleasant, clean and well-maintained home. EVIDENCE: The home is an extended period property situated in a small Cornish town. The outside and inside of the house are well maintained with a continual programme of routine and ad hoc repairs being carried out by the provider and outside contractors. All areas of the home were well decorated and domestic in style. Lighting and ventilation was good throughout the home. People told us the home always The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 21 smelt clean and fresh. Relatives told us the only smell they found was that of home cooking. There were shared rooms at the home, which were provided with screening to promote privacy. One room off the dining room was still in use as a bedroom but was provided with screening. People who use the service have access to assisted specialist baths. People told us they can chose whether to bath or shower; with one person saying she enjoyed alternating. One person told us there is a set day for their bath but understood that this was because there were so many people in the home. Another person said they were able to request a different day and that staff would try to ‘juggle things to fit them in’. Each bedroom has ensuite facilities and toilet facilities in close proximity to communal areas. Grab rails, ramps and call bells are available to promote independence. People can use the stairs to get to the first floor or use the lift if chosen. Specialist equipment was present to promote independence. Call bells were within reach of all the people we saw and were used with prompt response by staff. People said they do not usually have to wait long for staff to respond to call bells and that if there is a wait staff apologise and explain that they were with other people at the home. One person told us the call bell had been extended to enable them to reach it at all times. The home has separate laundry facilities. Washing machines have separate cycles to reach high temperatures where needed. Staff explained that they have access to hand washing facilities, gloves and aprons and that infection control training has been attended. People who use the service told us that staff wear gloves and aprons when providing personal care. A tour of the kitchen showed that cleaning programmes are in place and freezer temperatures were recorded. A recent Environmental Health Office inspection did not highlight any major concerns but suggested that the home introduce the government recommended ‘Safer food better business’ programme. The manager explained that the chef was in receipt of this document. Automatic self-closing devices and fire doors with new fire regulations were seen throughout the home to enable people to have their doors open if they chose but able to close in the event of fire. Radiators were low surface temperature. People told us the home was always clean and tidy and that cleaning staff kept their rooms tidy. People told us that it was lovely to be able to bring small items of furniture with them to the home and liked having their own telephone in their room. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 22 The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place mean that people are cared for by a stable group of staff who have had the necessary pre employment checks, staff induction and training. EVIDENCE: Staff told us that normally there are two registered nurses and five care staff on each morning, four care staff in the afternoon and two care staff overnight with one registered nurse. Off duty records and the statement of purpose also support these numbers. The people who use the service told us that they thought that there are enough staff generally to meet their needs. One person said that the manager was ‘not afraid of rolling her sleeves up to help’ which was ‘very good’. Another person said there were enough staff but sometimes when a ‘few of them needed staff at one time there was a wait’. The people who use the service said they did not need to wait long if they rang their bell and that they got their medicines on time. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 24 Three of the five relatives thought that there were enough staff, but two of the relatives said ‘staff sometimes forget the little things when they are busy’ and ‘the staff work very hard but sometimes they are short staffed’ Staff told us that the Provider and manager encouraged and supported them to do NVQ (formal care qualification) training. Many staff had achieved NVQ 2 and three training. New staff told us that they considered their recruitment to be thorough. Staff told us they were instructed to bring many documents with the to the interview. Three staff files were inspected and showed that staff are expected to complete an application form, which contains employment history, medical and criminal declaration and details of qualification. Forms of identification are checked for the POVA and CRB checks and references obtained prior to working. Staff also told us that the induction consisted of a ‘walk round the building to see fire exits and emergency equipment, followed by working with someone, having mandatory training and a meeting with the manager’ where further learning needs are identified. Staff told us that there were always opportunities to attend training at the home. Educational posters and training advertisements were displayed within the main office. Registered nurses and care staff said there were always opportunities to further knowledge. All staff told us they had attended training in addition to mandatory subjects. One registered nurse explained she was undertaking a teaching qualification in preparation to accept student nurses. The manager told us that the university had performed an audit to ensure The Beeches was a suitable venue for student nurses to attend. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 25 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): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Beeches is well managed and run in the best interests of the people who live there. Further improvements to the systems used for personal ‘pocket’ money management would protect both people who use the service and the staff at the home. EVIDENCE: The manager is a registered nurse and has many years experience in the care of older people. She has completed an NVQ level 4 in care management, the The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 26 registered managers award, further courses in coaching and mentorship and has recently completed a degree module in specialist palliative care. All comments received about the manager were complimentary. Staff said she was ‘brilliant’ and ‘the best manager I have had’. People who use the service said she was ‘a good leader’ and ‘firm with the staff’. Relatives described her as ‘excellent’ ‘approachable’ and ‘very good’. Staff said they felt that there was a very good team atmosphere at the home. Care staff said they felt valued and included when planning care. Staff said communication was very good at the home with detailed ‘handover’ reports each day, staff meetings and the daily presence of the manager. The manager explained that the day-to-day running of the home was very smooth at present with a stable staff group. The manager told us that since the last inspection the provider and herself have gone through a purchased set of policies and procedures and changed to ensure they are relevant to the home and work in conjunction with best practice and local multidisciplinary policies. In addition to this the manager has completed the annual quality assurance assessment provided by the Commission for Social Care Inspection. The manager explained that these projects had been a very useful quality assurance process. People who use the service told us that the home encourages family or representatives to have control over their finances where they are not able. The manager explained that a very small amount of ‘personal money’ is held on behalf of people at the home and then used to pay for chiropody, hairdressing and other small transactions. Records are maintained of all transactions and receipts are kept. Each entry is signed by one person and remaining money left in one pooled cash box. Inspection showed that one person was in debt by a few pounds. The manager explained that this has never caused a problem as money is requested from the family when a shortfall is noted. The manager also explained that two people check the total periodically, and sign on the records. Discussion was held regarding the suitability of pooling everyone’s money, the inability to provide an accurate correct audit trail, and does not show robust safe keeping systems for each persons money. Staff told us they have regular staff supervision and appraisal sessions but that the manager is present regularly and will pick up on things as a matter of routine. Accident records were completed and then kept in care plans. First aid boxes were present throughout the home. The manager explained that first aid training had been difficult to access at a reasonable cost but that she was continuing to find a suitable training provider. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 27 Staff told us they had received mandatory training in moving and handling and this has been done in house by one of the registered nurses who is an approved trainer. Training records for moving and handling showed that the programme is on going with dates booked for further sessions. Staff also told us that they had received training in Infection Control, Fire safety, health and safety, POVA and food hygiene. Staff told us that questionnaires are done for some of these subjects, which are then sent off for certificates to be issued. The manager told us that a new risk assessment audit has been introduced which will be repeated annually. The manager also explained that a risk assessment for legionella prevention has been started with water temperatures being recorded. Fire doors have been replaced and the services of a fire advisor booked. The fire logbook records tests, training and any events relating to fire safety at the home. The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 28 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 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 X X 3 3 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 3 3 x 2 3 3 2 The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(4) Timescale for action The Manager must make suitable 01/07/08 arrangements for training staff in first aid to ensure a first aider is on duty at all times Requirement 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. OP9 2. OP35 Refer to Standard Good Practice Recommendations The Manager should minimise the risk of errors by reminding staff to obtain two signatures when copying prescriptions onto the MAR sheet. The manager should ensure systems are in place with regard to the safekeeping of ‘personal money’ stored at the home. It is recommended that • Money is not pooled • Two signatures are obtained for each transaction The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Beeches DS0000008967.V349822.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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