The Beeches Nursing Home Care Home Service Adults Ladysmill Court Off Limekilns Road Dunfermline KY12 7YD

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1 The Beeches Nursing Home Care Home Service Adults Ladysmill Court Off Limekilns Road Dunfermline KY12 7YD Inspected by: Timothy Taylor Type of inspection: Unannounced Inspection completed on: 14 February 2012

2 Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 5 3 The inspection 10 4 Other information 20 5 Summary of grades 21 6 Inspection and grading history 21 Service provided by: HC-One Limited Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Timothy Taylor Telephone enquiries@scswis.com The Beeches Nursing Home, page 2 of 22

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Environment 5 Very Good Quality of Staffing 5 Very Good Quality of Management and Leadership 5 Very Good What the service does well This is a well run care home with a stable and happy staff group. It provides individualised care for its users and provides a safe and warm environment. What the service could do better The service needs to ensure that staffing levels reflect the needs of users and that the food on offer is varied and appetising. The service should provide more activities that take residents out of the home. What the service has done since the last inspection The service is installing a wet room on the upper floor - which is nearly ready to use. Some refurbishment has taken place in the downstairs dining room. Conclusion The service is now under a new provider (HC1) and the early signs are that it is continuing to provide a good level of care. Who did this inspection Timothy Taylor Lay assessor: Ms Dianne Howieson The Beeches Nursing Home, page 3 of 22

4 1 About the service we inspected This service is a 40 bed unit which provides residential and nursing care. It is based in the Fife town of Dunfermline. It provides a warm and friendly atmosphere for older people many of whom have dementia needs. The home has recently been reregistered with a new provider HC1. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 5 - Very Good Quality of Management and Leadership - Grade 5 - Very Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. The Beeches Nursing Home, page 4 of 22

5 2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection This report was written following an unannounced inspection that took place on February and involved an inspector and a lay assessor who spoke with residents and relatives who visited the home. During the inspection evidence was gathered from a number of sources including: Informal discussion with service users. Informal discussion with relative/carers. A review of service users personal plan documentation and other records. Discussion with staff and manager. Observation of staff interaction with residents. Observation of the environment. An audit of recruitment records Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. The Beeches Nursing Home, page 5 of 22

6 Fire safety issues Inspection report continued We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at The Beeches Nursing Home, page 6 of 22

7 What the service has done to meet any recommendations we made at our last inspection N/A The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. A comprehensive self assessment was completed within timescales, for this service. Taking the views of people using the care service into account The lay assessor gathered views from 11 residents on the day of inspection. Here are some of the points and observations made:- All the residents I saw were very neatly dressed and well groomed. I saw several residents being taken, one after the other, fully clothed, to the bathroom, some in wheelchairs (I assumed for a bath). There were staff members in both lounges any time I passed or visited either and a nurse readily to hand on the floor. The care staff struck me as very visible throughout the time I was in the home. There was a relaxed, happy atmosphere about the place - and visitors were coming and going most of the time. All the staff were cheerful, smiling and chatted quite a bit to the residents, often taking time to sit down alongside one and talk a bit more. They worked well together. They were respectful and polite to the residents but not distant. They seemed friendly but also very capable and caring. The staff certainly used residents' names - and knew exactly which rooms they occupied. The Beeches Nursing Home, page 7 of 22

8 Inspection report continued The staff seemed to me to make an effort to make lunch time enjoyable for the residents - and were attentive about who was slow or losing interest in the food. They made sure people knew what they were eating - but I did not see the initial "order taking". There was a choice of main course - and I heard lots of comments about how much the meals had been enjoyed. Several people had seconds of the pudding (homemade Bakewell tart and custard) and one or two were tempted to think about seconds of the main course (although I think in the end they decided against.) I did notice that everyone was given full cream milk to drink with lunch although' a few obviously were regular water drinkers instead. It was a relaxed, pleasant atmosphere in both dining rooms. The residents I spoke to were all happy with how they were living. Most mentioned the good food - but did not go into details. One said, if anything, the portions were too large - but no-one complained about the food or the menus. One said "They are terribly kind" and then later "It's a wonderful place". She specifically told me she did not take part in the activities - but knew what was available and did go on outings. She mentioned that the staff had brought her a bottle of diluting juice so as to encourage her to drink more in her own room - and she was genuinely touched by their consideration for her - and enjoyed the juice. Another resident told me how delighted she had been to get a bath. She got these often - but last time she had not realised she was going for a bath - and it had been a lovely surprise. Another said the staff did so much for her that she always made a point of thanking them just to show she appreciated them. Another said simply "They are lovely staff". Only one resident seemed to be a bit dissatisfied with her soundings. She was seated in the lounge but did not like having the TV on most of the time (which it was). She was mobile - but preferred the lounge to her own company. Her attitude was one of resignation. I met nobody "wandering" in the course of the day. The hairdressing salon was in full swing when I arrived. There was one hairdresser and 2 driers - so there were three clients being seen to at any one time. 15 hairdos were booked for that day - but the hairdresser knew that not all 15 might want to come. She knew and understood all her clients - and had been coming to the home weekly for I think she said 13 years. There was quite a buzz of conversation in the place - I visited 3 times and each time it was the same. I visited 5 bedrooms in all - and those residents who could talk told me how much they liked their rooms - and how comfortable they were in them. One proudly showed me inside her wardrobe because she was so pleased at how tidily it was kept (which it was.) The rooms were well ventilated, very clean and tidy - some with personal furniture. I did not look into any private bathrooms. The Beeches Nursing Home, page 8 of 22

9 Taking carers' views into account The lay assessor spoke with 5 visiting relatives to the home. Here are some of the points and observations made:- The relatives I spoke to were realistic but hugely appreciative of what the home did for their resident relative. One relative said "Some of the carers are absolutely brilliant". Another said "We now have peace of mind" and a third said "On the whole they are fantastic". Both residents and relatives commended the laundry service - no one had a complaint of any sort. Relatives also spoke of how clean and well cared for the home was, and how conscientious the cleaning staff were. Relatives told me they were encouraged to do what they wanted décor-wise with their relatives room. The rooms overlooked a large garden area, mainly grass and trees with a wide walkway all round and at least 6 three seater garden seats. Two or three of the residents drew my attention to the garden and said how much they enjoyed it. One relative mentioned a monthly church service held in the home which her relative attended and much enjoyed, particularly because of the hymn singing. Relative spoke highly of how much was done - and how much support the management gave them if they wanted to take their relative out. I thought it was to the home's credit that there was a steady flow of visitors all the time that I was there - and that the manager seemed to know them all. The Beeches Nursing Home, page 9 of 22

10 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The service was found to provide a very good level of service user and stakeholder participation. The following areas were highlighted at inspection: Residents participate in care reviews - where their views are listened to and acted upon. Another mechanisms for participation is a complaints procedure. Each resident has a named nurse and a keyworker Interviews with residents and relatives indicated a strong sense of belonging and a high level of positive interaction with the staff. Staff themselves felt part of a team where management listened to their views and allowed them to participate in how the home is run. The home offers a monthly stakeholders meeting which includes relatives and anyone else who has an interest in the home. This is minuted and any issues are actioned. They staff have a monthly meeting at which they can have their say about how the home operates. Areas for improvement The service should continue to seek ways to improve the quality of its participation practice. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Beeches Nursing Home, page 10 of 22

11 Statement 3 We ensure that service user's health and wellbeing needs are met. Service strengths Inspection report continued The service had a very good system for ensuring service users health and wellbeing needs were met. Here are some of their strengths:- All users now have support plans in place. A sampling of these showed that each resident had an individualised plan that addressed their needs and they showed that where there were concerns about an aspect of a person's care that the nursing staff were good at calling in and working with a variety of external health professionals. The service has effective links with local general practitioner's practices. Medication is reviewed regularly and consultation with the local pharmacy takes place. Staff have basic training in moving and handling, food hygiene, challenging behaviour and infection control. Other training included palliative care, cancer care and prevention of harm. Staff know emergency procedures e.g. what to do if there is a fire. The home have a large number of staff with SVQ qualifications. The home employs an activities co-ordinator who works with residents and organises meaningful activities for them. Other staff also participate in activities with residents. The Beeches Nursing Home, page 11 of 22

12 Areas for improvement When staff were interviewed they all felt that there were times, when they had a lot of residents with high levels of need, that they were not able to meet all the needs as quickly as they were able. A recent complaint was upheld in relation to staffing levels - which were below the agreed schedule of several occasions. The care provider in conjunction with the manager of the home should review staffing levels in a more proactive way to ensure needs are met. See requirement 1. It was also noted that residents were not getting to leave the home for recreational purposes very often and that as part of a range of meaningful activities trips out should be on offer more often. This may have been related to staffing levels also but it is felt that residents would benefit form the positive experience and stimulation of experiencing different environments to the home. See recommendation 1. It was noted during the inspection that the food on offer at breakfast was lacking in variety as the same thing was offered every day (porridge, cereals and toast). No cooked food was ever on offer. See recommendation 2. Grade awarded for this statement: 4 - Good Number of requirements: 1 Number of recommendations: 2 Requirements 1. The home should review staffing levels so that at all times residents needs are being met. See The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations Welfare of users 4.-(1) A provider must- (a)make proper provision for the health, welfare and safety of service users. This should be done with immediate effect. Recommendations Inspection report continued 1. As part of a range of meaningful activities trips out should be on offer more often. See NCS 17 Care Homes for Older People - Daily Life: You make choices and decisions about day-to-day aspects of your life and about how you spend your time. 1 The social events, entertainment and activities provided by the care home will be organised so that you can join in if you want to. The Beeches Nursing Home, page 12 of 22

13 2. Breakfast for residents should be more varied and appetising and include a cooked option. See NCS 13 Care Homes for Older People - Eating well. Your meals are varied and nutritious. They reflect your food preferences and any special dietary needs. They are well prepared and cooked and attractively presented. 2. You are offered a daily menu that reflects your preferences. The menu varies regularly according to your comments and will always contain fresh fruit and vegetables. 3 You have a choice of cooked breakfast and choices in courses in your midday and evening meals. The Beeches Nursing Home, page 13 of 22

14 Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 2 We make sure that the environment is safe and service users are protected. Service strengths This service ensures residents are safe. Here are some points of evidence:- The home has detailed and comprehensive risk assessments in place. These are reviewed on a yearly basis or more frequently if required. The home has has maintenance contracts in place for all major areas and equipment and service checks are in place with professional contractors. The home has a fire evacuation plan which is on display throughout the home. All staff are trained on fire safety, moving & handling, food hygiene, infection control, COSHH. The home is inspected annually by Environmental Health and as required by the Fire Brigade - reports were available. Accidents and incidents are reported and monitored. There was evidence of that the home was aware of safety and restraint issues. A secure door system has been fitted into the high risk parts of the home to ensure safety of residents with dementia. The home has a user friendly garden which is fully enclosed and maintained for safety purposes. Areas for improvement The service should continue to monitor and improve its safety practice. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Beeches Nursing Home, page 14 of 22

15 Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths Inspection report continued This service provides a very good environment for its residents to use. Here are some points of evidence:- On the day of the inspection, which was unannounced, the home was warm and clean and there were no lingering bad smells. Communal areas of the home were bright and clean and had plenty of space. The dining areas were clean and bright as well. If residents require a private space there is a room that can be used. The garden area of the home was very spacious and well maintained - there were plenty of sitting areas and plants and tree to provide decoration in the summer months. there was evidence of residents and relatives being involved in gardening. Visitors were made to feel welcome. Areas for improvement The service should continue to ensure a good environment for residents. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Beeches Nursing Home, page 15 of 22

16 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths The service was found to provide a very good level of service user and stakeholder participation. The following areas were highlighted at inspection: Residents participate in care reviews - where their views are listened to and acted upon. Another mechanisms for participation is a complaints procedure. Each resident has a named nurse and a keyworker Interviews with residents and relatives indicated a strong sense of belonging and a high level of positive interaction with the staff. Staff themselves felt part of a team where management listened to their views and allowed them to participate in how the home is run. The home offers a monthly stakeholders meeting which includes relatives and anyone else who has an interest in the home. This is minuted and any issues are actioned. They staff have a monthly meeting at which they can have their say about how the home operates. Residents are consulted in relation to any new staff that are recruited having been introduced to candidates. Areas for improvement The service should continue to seek ways to improve the quality of its participation practice. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Beeches Nursing Home, page 16 of 22

17 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths Inspection report continued This service provides a very good standard of staffing to work in the home. Here is some evidence of its strengths:- Staff have a high level of training in care related topics such as moving and handling, food hygiene, challenging behaviour, nutrition and hydration and palliative care. The service keeps a staff training record and has a training plan. Senior staff are beginning the process of registering with the Scottish Social Services Council and all staff are aware of the SSSC codes of practice by which they must abide. The home has an ongoing programme of SVQs which ensures and confirms staff competence in care practice. All staff are subject to a supervision and appraisal process which ensures their practice and training needs are met. Staff who were interviewed felt they had a say in how the home was run and that their views were listened to. They felt they had good working conditions at the home. Observation of staff showed them to have good working relationships with residents. The manager attends wider managers meetings and is kept up-to-date on developments in practice by the provider. There are monthly staff meetings. Areas for improvement Staff interviewed did not have a working knowledge of the National Care Standards. The service should ensure that staff use these to inform their practice within the home. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. The service should ensure that staff are aware of the National Care Standards and how they apply to their practice. See NCS 5 Care Homes for Older People - Management and Staffing Arrangements. 4 You are confident that all the staff use methods that reflect up-to-date knowledge and best-practice guidance, and that the management are continuously striving to improve practice. The Beeches Nursing Home, page 17 of 22

18 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The service was found to provide a very good level of service user and stakeholder participation. The following areas were highlighted at inspection: Residents participate in care reviews - where their views are listened to and acted upon. Another mechanisms for participation is a complaints procedure. Each resident has a named nurse and a keyworker Interviews with residents and relatives indicated a strong sense of belonging and a high level of positive interaction with the staff. Staff themselves felt part of a team where management listened to their views and allowed them to participate in how the home is run. The home offers a monthly stakeholders meeting which includes relatives and anyone else who has an interest in the home. This is minuted and any issues are actioned. They staff have a monthly meeting at which they can have their say about how the home operates. Areas for improvement The service should continue to seek ways to improve the quality of its participation practice. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 The Beeches Nursing Home, page 18 of 22

19 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths Inspection report continued The service has a very good system for ensuring quality within the home. Here are some points of evidence:- The Quality Assurance manager visits monthly to conduct a thorough audit of the service provided by The Beeches and a Quality Inspector visits to conduct a full inspection. Monthly Audits are undertaken in house in areas such as Medication, Catering, Infection Control, Health and Safety and Care Planning. The Home Manager regularly does a spot inspection by walking the home and observing practice and care delivery. The home has posters displayed throughout giving advice on how the Care Inspectorate, Social Work and Advocacy services can be contacted if so desired. Comprehensive risk assessment procedures encompassing fire, the kitchen, infection and the building are done within the home. The staff have supervision, appraisal and a training schedule to adhere to. Areas for improvement As part of their quality assurance the home should send out satisfaction surveys to stakeholders. See recommendation 1. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 1 Recommendations 1. As part of their quality assurance the home should send out satisfaction surveys to stakeholders. See NCS 5 Care Homes for Older People - Management and Staffing Arrangements. 4 You are confident that all the staff use methods that reflect upto-date knowledge and best-practice guidance, and that the management are continuously striving to improve practice. The Beeches Nursing Home, page 19 of 22

20 4 Other information Complaints There was a complaint upheld in relation to staffing levels - this subject has be addressed in the body of this report. See 1.3. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information None noted Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). The Beeches Nursing Home, page 20 of 22

21 5 Summary of grades Quality of Care and Support Good Statement 1 Statement Very Good 4 - Good Quality of Environment Very Good Statement 2 Statement Very Good 5 - Very Good Quality of Staffing Very Good Statement 1 Statement Very Good 5 - Very Good Quality of Management and Leadership Very Good Statement 1 Statement Very Good 5 - Very Good 6 Inspection and grading history All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. The Beeches Nursing Home, page 21 of 22

22 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by SCSWIS. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@scswis.com Web: The Beeches Nursing Home, page 22 of 22