Care Home: The Beeches Care Home

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What has improved since the last inspection? A number of refurbishments had taken place within the home including redecoration and new carpets. Senior staff had undertaken specialist training in dementia. Additional staff had been provided at night following the findings of the inspection report carried out in July 2008. What the care home could do better: Staff recruitment information must include full employment histories so that a clear audit of all employment is available that accounts for any gaps. The number of staff on duty should be kept under review to ensure that there are always enough to meet peoples` needs. The staff training programme on dementia should ensure that those staff who have not yet completed the training are prioritised n 2009 and all staff should have up to date food hygiene training. Peoples` weight should always be recorded as indicated by their care plan.The Beeches Care HomeDS0000069993.V374776.R01.S.doc Version 5.2 Page 7 Key inspection report CARE HOMES FOR OLDER PEOPLE The Beeches Care Home Darnhall Crescent Bilborough Nottingham NG8 4QA Lead Inspector Janet Morrow Unannounced Inspection 25th March 2009 10:30 DS0000069993.V374776.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Care Home Address Darnhall Crescent Bilborough Nottingham NG8 4QA 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) 0115 929 4483 0115 916 1539 beechescare@hotmail.co.uk Beeches Care Homes Limited Mrs Joy Farrell Care Home 43 Category(ies) of Dementia (43), Old age, not falling within any registration, with number other category (43) of places The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registerd provider may provide the following category of service only: Care Home Only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following category: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 43 12th December 2007 2. Date of last inspection Brief Description of the Service: The Beeches Care Home, situated close to a variety of shops and local facilities, within a housing estate, can accommodate up to 43 people, has recently been purchased, and is run by Beeches Care Home Ltd. The accommodation, situated over two floors, with a shaft lift for independent access, is homely and pleasantly decorated. There are well-kept gardens, providing an outdoor seating area, with a car park at the front of the building. The current fee levels are between £368 and £395 dependent on levels of care needs, the contracting authority or privately funded. The fees do not cover items such as hairdressing, toiletries, clothing or trips. The registration certificate was displayed in the foyer area, showing the category of people the home can accommodate and the updated service user guide and statement of purpose were on display for everyone to see when signing into the home, with copies available if needed. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection visit was unannounced and took place over two days for a total of 9 hours. A short focussed inspection had taken place in July 2008 in response to complaints received at the office of the Care Quality Commission (then the Commission for Social Care Inspection). It is referred to in the relevant sections of this report. Care records and staff records and a sample of policies and procedures were examined. Nine members of staff, nine of forty-two people currently accommodated, two visiting professionals and one relative were spoken with. One visiting professional was contacted by telephone following the inspection visit. Fifteen surveys were received; six from people using the service, five from relatives and four from staff. A tour of the premises was undertaken. Written information supplied by the home in April 2008, recent notifications of incidents in the home and complaints received in 2008 were discussed with the manager and informed the inspection process. What the service does well: The Beeches has a number of staff who have worked at the home for several years, which helps to provide a stable and caring environment. All the people who were able to express their opinion and relatives spoken to were pleased with the service provided. One person said she ‘loved being here’. The environment was well maintained and effort had been made in making a specific room into a reminiscence area that contained memorabilia from the past that was relevant to people living in the home. Meals and activities were well managed and one survey from a person living in the home said ‘I enjoy my meals’ and another that ‘they have an excellent The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 6 choice for breakfast and lunch’. People said they ‘liked the food’ during the inspection visit. The home responded well to allegations of abuse and followed safeguarding procedures properly to ensure investigations by the relevant agency took place. They had also responded to complaints thoroughly and documented the action taken. Staff gave positive feedback about the management arrangements and stated that they worked together well as a team and had the right support and guidance to enable them to do their jobs. One staff survey said everyone ‘worked well together’ and another described the home as ‘good’. Relatives described the home as ‘pleasant and friendly’ and ‘welcoming’ and a visiting professional described it as ‘very caring’. One survey from a relative commented that the home was ‘excellent’. The manager was positive in her attitude about the care and support for people with dementia and was striving to improve the standards in the home and access better training for staff. What has improved since the last inspection? What they could do better: Staff recruitment information must include full employment histories so that a clear audit of all employment is available that accounts for any gaps. The number of staff on duty should be kept under review to ensure that there are always enough to meet peoples’ needs. The staff training programme on dementia should ensure that those staff who have not yet completed the training are prioritised n 2009 and all staff should have up to date food hygiene training. Peoples’ weight should always be recorded as indicated by their care plan. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 7 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 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. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 8 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 Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Standard 6 was not applicable, as the home did not provide intermediate care. People using the 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 was sufficient admission information to establish that the home was able to meet peoples’ needs. EVIDENCE: The home’s statement of purpose was clear in its philosophy of care for people with dementia and emphasised that it was based on peoples’ individual needs. It stated that ‘all care is individualised and emphasises the need for positive The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 10 relationships’. It contained all the information legally required by Schedule 1 of the Care Homes Regulations 2001. The annual quality assurance assessment from April 2008 stated that ‘the manager or deputy carries out a visit & conducts pre-admission assessment’. Four peoples’ care records were examined and all had an admission assessment in place, and information from external professionals, where applicable. This information included risk assessments for nutrition and pressure sores as well as a general moving and handling assessment, plus a social profile giving details pf peoples’ personal history. The information available established that the home was able to meet peoples’ needs and relatives interviewed also confirmed that needs were well met. One relative spoken with said they were ‘more than satisfied’ with the care and another said they had ‘no worries’ about the care of their relative. General observation in the home showed that needs were addressed on an individual basis. Two visiting professionals spoken with also confirmed that peoples’ individual needs were met and that that staff were ‘helpful’. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs were met and the care of people living in the home was planned and given in a way that respected individuality. EVIDENCE: The home’s statement of purpose stated that the care was based on ‘the maintenance of hope, dignity, sense of self and purpose along with notion of control’ and that this was achieved through individualised care plans developed around choices and strengths. The annual quality assurance assessment stated that ‘we ensure that a person centred care plan is in place for each service user’ and ‘we keep a daily log for The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 12 each service user and care plans are reviewed each month’. Four peoples’ care files were examined and all had a care plan in place. The detail of the plans showed that issues related to risk assessments were addressed. For example, an identified nutritional risk had an eating and drinking plan. The service also compiled a twenty-four hour care plan that highlighted peoples’ routines and preferences for getting up and going to bed. Family histories were being compiled for all people to ensure that individual likes and dislikes, important events and people were incorporated into the daily lives of people at the home. The manager was keen to move the service forward in its approach to dementia care and was due to implement a twenty-four chart to assess peoples’ mood to assist in improving well-being. Weight was generally recorded on a monthly basis (although one person’s file had a three month gap between November 2008 and February 2009) and there was access to health professionals such as district nurse, optician and dentist. Visiting professionals spoken with confirmed that they were called out appropriately and that staff followed the advice given. One said that the home was ‘very good’ at having the relevant information ready and another said they were ‘good’ at following the advice given. One relative said their family member had progressed well and become more independent since being at the home and described the difference as ‘outstanding’. Another said that they were ‘happy with the care’. Five of the six surveys from people living in the home responded that they ‘always’ received the medical support they needed and one responded that they ‘usually’ did. All six surveys said that staff listened and acted on what they said. A recent outbreak of an infectious disease had been managed properly and care records showed that appropriate action had been taken to control the spread of infection. The inspection visit undertaken in July 2008 had looked at issues related to care as a complaint had been received stating that people were not getting the help they needed. However, this visit found that people living in the home and their relatives praised the care with the exception that there was sometimes a wait for assistance as there were not many staff. Privacy and dignity was upheld and people living at the home were observed to have warm relationships with staff. Relatives interviewed confirmed this and described the staff as ‘caring’, ‘very nice’ and their relative as ‘so happy’. An internal survey from a visiting professional described staff as ‘always friendly’ and the care as ‘good, improving’. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 13 A general check on four medication administration record (MAR) charts showed that generally charts were completed properly and corresponded with the medicine in the blister pack. One chart had not been signed on one day for one medicine and this had been noticed and addressed in an audit undertaken by a senior member of staff. Two people signed hand written charts, indicating that they had been checked for accuracy. The home had some controlled drugs in use for specified people. A check on the records and stock showed that these corresponded and two people were signing the register for their administration. There was secure storage for these medicines. A general check on medicine stocks was carried out and found to be satisfactory with no medicines seen being past their expiry date. The medication refrigerator temperatures were recorded daily and were within safe limits. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities, community contact and meals were well managed, which enhanced peoples’ quality of life. EVIDENCE: People living in the home and their relatives spoken with confirmed that the routines of the home were flexible and it was observed that people had the choice of whether or not to participate in activities. Detailed information was maintained on individuals’ past history and likes and dislikes, which were incorporated into their social care plan. Observation showed that people were able to undertake various activities; one person chose to read, another to look after a pet, others were enjoying a game with staff and others chose to stay in their rooms. There were smoking The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 15 facilities available and an outside terrace area that people used in good weather. The statement of purpose said that the home had an activities co-ordinator for twenty hours per week and that there was ‘a structured plan that included trips out at least monthly’. Records were kept of the activities undertaken and indicated whether the person concerned had enjoyed these. Special occasions were catered for with party food and celebration cakes. Four of the six surveys from people living in the home responded that there were ‘always’ activities arranged, one responded that there ‘usually’ were and one that there ‘sometimes’ were. One relative’s survey received commented that more simple craft activity would be beneficial for their relative. The inspection visit undertaken in July 2008 had looked at issues related to activities and food as a complaint had been received that stated there were few activities and food was not very good. This visit found that there were detailed records of activities and that people not able to come to communal rooms had individual time from staff. It also found that people were happy with the food and the meal served during the visit was appetising and nutritious and staff were observed offering choices of food to people. The serving of the lunch-time meal during this inspection visit also showed that the food was plentiful and nutritious with a choice offered. Those people spoken with during the lunch-time period said that they enjoyed their food. Menus were examined and showed that there was good variety of nutritious and wholesome food. Food stocks were good and there was fresh fruit available. Specialist diets, such as diabetic, were catered for. Two of the six surveys from people living in the home responded that they ‘always’ enjoyed the meals, and four responded that they ‘usually’ did. One survey commented ‘there is always a choice. I can always get something to eat if I miss a meal’ and another commented that the meals were ‘very satisfactory’. The manager was aware of who to contact for an advocacy service and was aware of the Mental Capacity Act 2005 and its implications for decision making with people who have impaired abilities. She stated that no one in the home currently had an advocate. Training for staff on the Mental Capacity Act was organised for April 2009 and there was information in the home about the Act and the associated ‘Deprivation of Liberty Safeguards’. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were in place to ensure that complaints and safeguarding issues were responded to appropriately, which meant people were protected and their concerns handled objectively. EVIDENCE: There had been a number of complaints and safeguarding issues received at the home and at the office of the Care Quality Commission (then the Commission for Social Care Inspection) since the last key inspection visit in December 2007. A short focussed inspection had taken place in July 2008 to gather information regarding three complaints received by the Commission regarding the care provided. The findings of these are detailed in that report. The enquiries made showed that the majority of complaints had been addressed appropriately or were unfounded. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 17 On this visit, the home had a clear complaints procedure and maintained records of complaints received. These were examined and showed what action had been taken to resolve them. Three relatives spoken with knew how to make a complaint and were confident of a courteous response. Five of the six surveys received from people living in the home said they knew how to make a complaint. One did not have a response. All five surveys from relatives also said they knew how to complain and that any concerns had been dealt with properly. The home had a policy on safeguarding adults that stated any allegation of abuse must be reported to the appropriate authority. Two safeguarding incidents had been referred to the Local Authority and appropriate action had been taken. A copy of Nottingham and Nottinghamshire Local Authority safeguarding adults procedures was in place. Staff spoken with were aware of their responsibility to report any incidents. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, and 26 People using the 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 provided a homely, clean, safe and well-maintained environment, which ensured people living there had comfortable and pleasant facilities to enjoy. EVIDENCE: A tour of the building showed that the home was clean, tidy and odour free at the time of this inspection visit. Five of the six surveys received from people The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 19 living in the home responded that the home was ‘always’ fresh and clean and one responded that it ‘usually’ was. Individual rooms were personalised with furniture, ornaments and pictures. For people who chose to smoke, a small, well-ventilated lounge was available and there was also the option of using the covered area of the outside terrace. A reminiscence room had been developed with memorabilia from the last century and there were also quiet areas with seats around the home. The laundry was viewed and was neat and tidy and all equipment was in working order. The annual quality assurance assessment stated that ‘we work closely with infection control (NHS), we have antibacterial hand wash & gel around the home and some of the cleaning products that we use have antibacterial properties in them’. Staff spoken with were aware of how to control the spread of infection and confirmed that there was always a plentiful supply of protective equipment such as gloves and aprons. A recent outbreak of an infectious disease had been managed properly and relevant specialist advice had been sought. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the 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 were sufficient, well trained and qualified staff available to ensure peoples’ needs were met. EVIDENCE: Staff working during the day were sufficient in number to meet peoples’ needs, with five carers, including a senior, carrying out the necessary assistance, supported by kitchen and domestic staff. There were three carers working on the nightshift. This had been increased following the inspection visit in July 2008 that made enquiries into complaints received regarding insufficient staffing, particularly at night. It found that there were insufficient carers to carry out assistance for people using the service when there were only two staff on duty at night. Staff spoken with during this inspection visit confirmed that there were sufficient staff on duty, although one said they could always use an extra person. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 21 Three of the six surveys received from people living in the home responded that there were ‘always’ staff available when needed and three responded that there ‘usually’ were. One commented that ‘can sometimes wait a long time when I press the call button’. Three of the five relatives’ surveys received responded that the home ‘always’ provided the care expected, one responded that it ‘usually’ did and one that it ‘sometimes’ did. One survey commented that ‘sometimes there does not seem to be enough staff’. There was mixed feedback on staff surveys regarding the number of staff available. One survey responded that there were ‘always’ enough staff, two that there ‘usually’ were and one said there ‘never’ were, commenting that ‘there is no way four or five staff can give 43 people the proper care they want at all times’. Three visiting professionals spoken with all described the home as ‘busy’ and one said that the home could probably do with more staff on in the morning. However, none of the professionals spoken with had concerns that peoples’ needs were not being met and described the home as ‘good’ and ‘very caring’ and staff as ‘helpful’. The varied comments received regarding staffing in the home indicate that although there are sufficient staff on duty, this is the minimum that the home can operate with and leaves little time available for any time consuming activities or interactions. Four staff files were examined and generally showed evidence of good recruitment processes. Most of the documentation required by Schedule 2 of the Care Homes Regulations 2001 was in place, including a Criminal Record Bureau check, evidence of identity, a Protection of Vulnerable Adults (POVA) First check and two written references. One staff member commented that ‘I wasn’t allowed to start my job until they had received my POVA check.’ However, the application forms on two files were not completed sufficiently to show reasons for gaps in employment as they only gave an employment history for the last five to six years. Written information supplied by the home stated that sixteen of twenty-six care staff had achieved a National Vocational Qualification (NVQ) at level 2 and a further nine were undergoing the training. This meant that the home was exceeding the target of 50 of care staff achieving an NVQ at level 2 or above and it is therefore commended for its commitment to qualification training. Training information provided by the home showed that mandatory health and safety training took place as well as in areas related to care. There was The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 22 introductory and more advanced training available on caring for people with dementia. The inspection visit in July 2008 made enquiries about the training for staff to equip them to assist people with dementia and found that some staff were unsure how to help people with dementia. Although dementia training took place in 2008 and 2009, the records provided showed that there were eight staff who had not undertaken any form of dementia training since the last inspection in December 2007. However, all senior staff, with the exception of one, had completed the advanced level training. The manager stated that there was an ongoing programme of dementia training and that all staff, including domestic, kitchen and handyperson, would be completing it. Other training courses that had occurred during 2008 were in dealing with challenging behaviour, medication and continence. The manager also stated that training in the Mental Capacity Act and its implications was scheduled for April 2009. All four staff surveys received responded that they had training relevant to their role and that kept them up to date and helped them understand the individual needs of people living in the home. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the 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 management of the home was based on openness and had a wellsupported staff team, which ensured that it was run in the best interests of people living there. EVIDENCE: The manager was competent and committed to the care of people with dementia and had many years experience in caring for older people. She had completed the Registered Managers Award. She was able to demonstrate in The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 24 discussion that she was familiar with the needs of people with dementia and had undertaken an intensive training course on dementia care mapping. She was also able to identify areas of development and plans for improvement of the home; for example, improving the management structure and having a training co-ordinator. The manager received positive feedback from relatives with one describing her as ‘an absolute treasure’. Two staff surveys responded that they ‘sometimes’ received the support from the manager and one commented that this was ‘not on an individual’ basis. Two surveys said they met ‘regularly’ with the manager and one described her as ‘very approachable’ and another commented ‘I receive a lot of support from my manager and meet with her regularly to discuss my progression’. Quality assurance processes were well established and surveys were undertaken, analysed and action taken on the comments received. The most recent survey was undertaken in June 2008 and generally positive comments about the quality of care were received such as ‘very good’, ‘alright’, ‘feels like my home’ and ‘I am very happy to stay’. Feedback had been received from visiting professionals and one had commented that the home was ‘always friendly’ and that the co-operation of the staff was ‘excellent’. The statement of purpose said that meetings for relatives took place every six months and every three months for people living in the home to obtain their feedback and suggestions. Three peoples’ financial records were examined and were completed accurately and cash held corresponded with the written record. There were receipts available for identified purchases. Cash was stored securely. Staff training records and the written information supplied by the home indicated that training had been undertaken in mandatory health and safety subjects such as first aid, moving and handling, food hygiene and fire safety in 2008/9. Staff spoken with confirmed that this training took place. However, there was no evidence available that one member staff was up to date with their food hygiene training, although the manager stated that it had been obtained in previous employment. Regular maintenance of equipment took place and examination of records showed that this included the electrical wiring in September 2008, hoists in March 2009 and portable electrical appliances in September 2008. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 25 The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 (1) (b) Requirement The home must ensure when staff are recruited that full employment histories are in place so that any gaps in employment cab be accounted for. This is to ensure suitable staff are employed and people living in the home are safe. Timescale for action 01/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP27 Good Practice Recommendations Peoples’ weight should always be recorded as indicated in their care plan. The number of staff on duty should be kept under continuous review to ensure there are always enough staff on duty to meet peoples’ needs. The home should continue its staff training programme in dementia and ensure that those people who have not undertaken the training are prioritised for training in 2009. DS0000069993.V374776.R01.S.doc Version 5.2 Page 28 3. OP30 The Beeches Care Home 4. OP38 All staff should have evidence of up to date food hygiene training. The Beeches Care Home DS0000069993.V374776.R01.S.doc Version 5.2 Page 29 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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