Inspection on 22/07/09 for Beaconsfield Care Home

This is the latest available inspection report for this service, carried out on 22nd July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beaconsfield Care Home 28/01/08

Beaconsfield Care Home 28/06/07

Beaconsfield Care Home 14/09/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Beaconsfield Care Home 13 Nelson Road Southsea Hampshire PO5 2AS Lead Inspector Annie Kentfield Key Unannounced Inspection 22nd July 2009 10:45 Beaconsfield Care Home DS0000066435.V376192.R01.S.doc 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 home adults 18-65 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. Beaconsfield Care Home DS0000066435.V376192.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 Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beaconsfield Care Home Address 13 Nelson Road Southsea Hampshire PO5 2AS 02392824094 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) triniraj@sky.com Beaconsfield Care Ltd Mrs Yvonne Mary Catherine Donkin Care Home 21 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 2. Learning disability (LD). The maximum number of service users to be accommodated is 21. Date of last inspection 29th July 2008 Brief Description of the Service: Beaconsfield is an end of terrace, period property that has three floors, a converted basement and a ground floor extension. Bedrooms are both single and shared with a wash hand basin. There are shared bathrooms on each floor. There is a small courtyard garden at the rear of the building. Residents have access to a dining room, two lounges, smoking room and an additional room in the basement. Access to all of the floors is via stairs and the home is suitable for residents who are fully mobile. There is no parking at the premises, however parking is available on the street and public transport in the area is good. The home is situated only a short walk from the main shopping area of Southsea, in addition a number of local convenience stores are accessible to the residents and their visitors. Details of fees and any additional charges are available from the home. Beaconsfield Care Home DS0000066435.V376192.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 one star. This means the people who use this service experience adequate quality outcomes. We made an unannounced visit to the home on 22 July 2009 and we were in the home from 10.45 am to 5.45 pm. The visit was with one inspector who was accompanied for part of the day by an ‘expert by experience’. The expert had lunch with all of the residents and spent time talking to residents and staff individually and in groups and also spoke to two visitors. Feedback from the expert is included in the body of the report. We spoke to the registered manager and two of the staff and looked at the home’s records for care planning, medication, staff training and recruitment and some of the health and safety records. Before the visit we received the Annual Quality Assurance Assessment. This is a self-assessment that all services complete and gives us information about the service, what they do well, and where further improvements are planned. We sent surveys to residents (10), staff (10), and health and care professionals who visit the home (5). We received completed surveys from 2 health and care professionals, 7 residents, and 4 staff. All of the feedback that we received about the service was positive. We spoke on the telephone with a representative from Social Services/Primary Care Trust to gain additional feedback about the service. The service has been part of our improvement strategy because of previous concerns about the safety of the residents in the home and concerns about the management of the home. We have received feedback that practice in the home has improved and the new registered manager has taken action to ensure that care planning, risk management and the safe administration of medication meets regulatory requirements and protects the safety and well being of people living in the home. Other comments are included in the body of the report. What the service does well: Residents that we spoke to were complimentary about the manager and staff and one person told us “they are always here to help us”. Other residents confirmed that they are happy in the home and comments from residents and visitors indicated a good level of satisfaction with the quality of care provided by the manager and staff. Some of the residents are in shared bedrooms, however, one person told us they “didn’t mind” sharing a room. The expert by experience commented on the warm and friendly atmosphere in the home and these observations were confirmed by feedback from residents. Routines in the home are flexible and some of the residents are supported to do the things they like to do: one resident was out on a trip to London with a member of staff and other residents follow interests and activities of their Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 6 choice. Privacy is respected and residents are free to come and go as they choose. A health and social care professional told us that the home do well in meeting the needs of people with complex care and support needs and are good at communicating and working with community health and social care services to ensure that residents have the help and support they need to meet their healthcare needs. What has improved since the last inspection? What they could do better: The registered manager must continue to develop person centred care to ensure that all residents have the opportunity to access social, leisure and educational activities of their choice. One area of the home must have suitable floor covering installed to replace soiled and stained carpeting to ensure that the home can be maintained in a clean, hygienic, and pleasant manner for the benefit of all the residents. The registered person must demonstrate that there is an ongoing programme of refurbishment and decoration to ensure that the home provides a comfortable and suitable environment for the residents at all times. The registered person must demonstrate that regular inspections of the home are carried out to ensure that the service is providing a good quality of care for the people in the home and meets regulatory requirements. These inspections are a legal requirement and written reports should be made available for inspection. Guidance on making inspections under Regulation 26 of the Care Homes Regulations 2001 is available on the commission website www.cqc.org.uk Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 7 The registered manager must ensure that staff receive regular supervision as part of their training and development programme. 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. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 - 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. New residents have their care and support needs assessed before they move into the home. People are encouraged to visit the home before they decide to move in. EVIDENCE: Since the last inspection, a new resident has moved into the home. The annual quality assurance assessment states that prospective residents are encouraged to visit the home any number of times before making the decision to move in. The manager has taken action to incorporate previous good practice recommendations so that the process of moving into the home takes into account the individual needs and concerns of new residents. Records show that the manager carries out an assessment with the prospective resident and gathers relevant information from other people involved in the person’s care. We were not able to speak to the newest resident to gain some feedback, but the care records show that since moving into the home, the care of the resident has been reviewed each month to ensure that the care and support plan is still relevant. The home has gathered relevant social and personal information with individual residents to put in a personal ‘pen picture’ Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 10 along with a photograph. This means that residents are fully involved in the assessment and care planning process. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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): 6, 7 and 9 - People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Person centred care plans demonstrate that emphasis is placed on consulting with residents to ensure that changing needs are reflected in individual plans. However, care plans contain little information about residents’ choices about leisure and social activities. Residents are supported to take risks as part of an independent lifestyle. EVIDENCE: Care plans were seen for three residents and these had a pen picture with a photograph and this provided information for care staff about each resident. The registered manager has reviewed and updated the way that residents’ care and support is recorded and the records provide evidence of a more person centred approach that demonstrates greater consultation with the residents about the way they want to receive care and support. Residents indicate their Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 12 agreement by signing the care plan and the care plan reviews. The manager has improved practice by ensuring that details of any changes to the care plan are highlighted so that care staff are aware of any changes. Care and support plans are reviewed monthly or more frequently if required. The home is aware of the need for confidentiality and residents are asked for their agreement and consent as to who information can be shared with. Previous inspections have raised concerns about the way that the home identifies and manages any risks to residents’ health and well being. Records looked at during our visit demonstrate that all aspects of daily living activities are assessed and any risks are recorded with clear guidance for staff on how risks or events are to be managed or minimised. We also received feedback from health and social care professionals who told us that care plans, risk assessments and risk management plans are greatly improved. One person told us “the service communicates really well with all professionals when there have been either difficulties or positive events”, affecting people who live in the home. The home recognises the rights of the residents to make their own decisions and choices and residents are able to be involved as much or as little as they want to in the daily life of the home. The expert by experience observed that staff are good at working with some of the residents on a ‘one to one’ basis and staff demonstrated high levels of awareness and knowledge of some of the residents and their choices and preferences, and staff demonstrate that these choices and preferences are respected. However, the care and support plans do not contain a record of activities or outings or other events that residents’ have taken part in or what individual residents aspire to do. The manager told us that this is an area she plans to develop because she and the staff have identified that some of the residents need specific support and encouragement to be able to identify their personal goals and aspirations. Whilst some of the residents are receiving the specific support they need, some of the residents may not receive the support and encouragement they need to help them identify and develop interests and activities. The manager told us that she would like to develop the key worker role for staff so that residents have more opportunities for social and leisure activities they would like to do. This was also identified as an area for the home to develop in the comments that we received from health and social care professionals. One person told us that now the manager has efficiently organised the way that personal care is provided in the home “it would be good to provide more activities and involve the residents in this”. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 - People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered support to maintain contact with family and friends and to access the local community. However, there is no structured plan for activities or events or ways of supporting those residents who may find this difficult. Residents are offered a good choice of wholesome meals and snacks. There are limited opportunities for residents to make their own snacks or drinks. EVIDENCE: At the last inspection the previous manager told us that the home wants to “continue to encourage residents to become more assertive and independent” and told us that the home wanted to develop the opportunities for residents to access leisure, social and educational resources. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 14 Although there was evidence that some residents are supported to access leisure and social resources, this is not happening in an organised way and some of the residents may not be receiving the level of support they need to do this, or be supported sufficiently to help them develop skills in decision making and other independent skills of daily living. The expert by experience spoke to some of the residents and was told that two of the residents enjoy football and attend matches regularly; another resident had gone for a day out to London. One resident has recently expressed an interest in going to the cinema and was accompanied to see a film by a member of staff. Some of the residents enjoy going out to the shops if they can be accompanied by a member of staff. One resident said that the home used to have their own transport for occasional outings but this is not now available. The expert looked at the minutes of residents’ meetings, however, the meetings are not held regularly and items for discussion did not appear to be followed up at subsequent meetings. Residents had recently enjoyed a barbecue party in the garden. However, the home does not have a programme of events or activities so that residents can make an active choice to join in or not. Some of the residents do not take part in any activity at all and there is nothing recorded in their plan of care to indicate if this is their choice or not, or if activities have been offered. The manager told us that the home is still in the process of developing person centred care planning and it is planned to develop an independent living skills assessment tool with guidance for key worker staff on using this. All of the comments that we received from care staff made positive suggestions for what the home could do better to improve life for the residents: organise more outings and provide more time for staff to spend social time with the residents. Five of the residents have visits or outings with a ‘befriender’, this service is provided by a local organisation. Three residents have regular contact with family and friends and the expert by experience spoke to two visitors to the home who were very complimentary about the home and the care provided to their relative. The expert by experience had lunch in the dining room with the residents. Residents commented positively on the quality and choice of menu. Residents are served their meals on a plate and do not have the opportunity to serve themselves or help themselves to vegetables from a serving dish. Drinks are made up in plastic glasses and served to the residents although at other times residents can help themselves to hot and cold drinks in the kitchen. One resident requires soft food and this was served in the way the resident prefers. We were told that fresh fruit is always available but this is not left out in the dining room and the quantities of fresh fruit in the kitchen store-room were minimal with minimal variety of fruit to choose from. The expert found the Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 15 dining room pleasant but made a positive recommendation that the dining tables would look more attractive and homely if they had some decoration such as vases of fresh flowers. The manager has taken action on a previous recommendation and the home now keeps records of what residents eat at each meal every day. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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): 18, 19 and 20 - 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 medication at this home is well managed and the arrangements in place ensure that residents’ medication needs are met. The health and personal care needs of the residents are met in ways that promote privacy, dignity and independence. EVIDENCE: We looked at three care plans and spoke to some of the residents and staff. We looked at the storage and recording of medication. The care plans clearly set out how residents prefer to receive care and cover personal care, health care needs, dietary requirements and a medication profile. The care plans provide evidence of residents being supported to access health care services and attend any health appointments. Most of the residents are independent in personal care but the care plans contain guidance for staff where prompting or support has been agreed. Care plans are Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 17 reviewed every month and changes agreed with residents. Changes to care are highlighted to ensure that staff are aware of peoples’ changing care needs. Any events or incidents affecting the physical or mental health of the residents are separately recorded with details of action taken. Two health and social care professionals told us that the home communicates well with all professionals involved in the care of the residents. One person told us that the home works well with people who have complex physical and mental health care needs. All of the residents at the home are registered with a number of GP’s and dental checks are arranged through a local health centre or with a local dentist. There is a visiting optician and chiropodist every 8 – 10 weeks. Care plans also contain records of contact or reviews with community health services. Improvements to the way that medication is managed in the home have been sustained and the registered manager has taken action to put in place previous recommendations for good practice. Residents who are able to self-medicate have been assessed and written agreement recorded with the resident and their GP. The manager has written agreement with a resident and their GP where the time that the medicine is dispensed has needed adjustment to fit in with personal choice and preference. Medication is safely stored and recorded and the manager undertakes regular audits of medication in the home. The storage and recording of controlled drugs meets current legal requirements. We observed medication being dispensed and procedures were safe and residents receive their medication as prescribed. Six staff have completed an NVQ (National Vocational Qualification) in the safe administration of medication and other staff will be enrolled to achieve this. The registered manager monitors staff practice in the administration of medication to ensure that practice is safe. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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): 22 and 23 - 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 has a complaints procedure to follow in the event of a complaint being received. The registered manager is aware of responsibilities to protect residents from the risk of harm or abuse and ensures that staff follow safeguarding policies and procedures. Most of the residents have independent access to their own finances and action has been taken by the home to protect residents’ financial interests. EVIDENCE: We have not received any complaints about the home and the annual quality assurance assessment for the home has stated that no complaints have been received by the home. The home has a formal complaints procedure in place and information about this is available for residents and visitors. In practice, residents said (in comments in the surveys) that they would speak to the manager of a member of staff if they had any concerns or complaints. In the surveys from care staff, people told us they would know what to do if anyone had concerns about the home, or the safety of the residents. Staff have received training in safeguarding awareness and the home has a policy and procedures for staff to read and follow. Comments from staff confirmed that the manager is approachable and available to discuss any concerns or issues. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 19 Since the last inspection the home has taken action to enable residents to manage their own finances. We made a previous regulatory requirement to ensure that residents’ finances are protected and for monies to be only held for individuals in accounts in the name of the resident to which it belongs. Previously the monies of some residents were held in a corporate bank account, by the home. All but three residents have been able to open their own bank account and the manager confirmed that agreed procedures are in place for those residents whose monies are still managed by the home. A previous regulatory requirement has been met and the registered manager notifies the commission of any event in the home that affects the safety and well being of any resident. The registered manager has demonstrated that appropriate action is taken by the home if there are any concerns about the safety of residents. This was confirmed by a representative from Social Services who told us that the manager makes appropriate safeguarding referrals whenever there is a concern about a resident. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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): 24 and 30 - People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe and adequately maintained building. However, the home does not have an ongoing programme of redecoration and refurbishment. Generally the home is clean although there are some areas of the home that require attention to maintain good hygiene at all times. There are procedures in place for dealing with soiled laundry to ensure good practice in the control of infection. EVIDENCE: The home employs a cleaner for 20 hours each week. We were told that care staff also do some of the cleaning and assist residents with bed making and keeping rooms tidy, and undertake laundry duties. Since the last inspection the home has developed a policy and procedure for dealing safely and hygienically with soiled laundry. Staff now have hand washing facilities in the laundry room. One area of the home had an unpleasant odour and it was Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 21 evident that the carpet is too stained and soiled for this to be remedied by occasional carpet cleaning. We have previously mentioned the odour of damp or mildew in the corridor of the ground floor extension. This is still evident and we have been told that the provider has been unable to identify the source of the damp smell in order to rectify the problem. Residents have access to a large sitting room, a dining room and a designated smoking room. There is also another small sitting room on the ground floor and a ‘workshop’ space next to the dining room. The workshop space is not used by the residents and does not have any equipment for any kind of workshop activity. The main sitting room has a television and single high back chairs that are arranged around the edge of the room, the sitting room does not have any sofas or a range of comfortable seating for the residents to use. The expert by experience observed that some of the chairs look quite worn and scruffy and the room does not have a co-ordinated colour scheme or pictures and ornaments that have been chosen by the residents to make the room look comfortable and homely. The annual quality assurance assessment did not provide any information about a planned programme of decoration and refurbishment for the home. The bedrooms vary in size and not all of the residents are able to have a single bedroom. One bedroom that is shared had a curtain in the middle of the room to provide some privacy but the curtain had come away from the curtain track. Another resident who has lived in the home for a number of years expressed satisfaction with their bedroom and the room was personalised with pictures and personal items. Bathrooms and toilets are located on each floor. A shower room has been installed on the lower ground floor, however, the shower surround and tiles have become very stained and damaged and the toilet in the shower room was blocked and overflowing during our visit. All of the bathrooms contain fittings that have been in place for some time and look worn. Residents have access to a small garden area at the rear of the house. There is some seating for residents. We received comments from some residents and visitors that the garden area could be used more and the garden better maintained. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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): 32, 34, 35 and 36 - 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 is a training programme in place to ensure that residents are supported by competent and qualified staff. The home does not have a structure in place to ensure staff receive regular and planned support and supervision. Residents are protected by the home’s recruitment practice that demonstrates that staff are suitable to work in the home. EVIDENCE: We looked at the staff training records and these demonstrate that there is a staff training programme that covers all areas of safe working practice as well as specific areas of knowledge such as mental health care and dementia care. Although all staff have not completed all of the mandatory training, the manager told us that training is being arranged to ensure that staff complete their basic training. Nine out of 16 staff are currently enrolled to achieve an NVQ (national vocational qualification) in care at level 2 and two members of staff have achieved an NVQ at level 3. The manager told us that a training matrix provides a reminder of when training updates are due and prompts for Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 23 training that some staff still have to complete. Records confirm that six staff have completed an NVQ level 2 in the safe administration of medication and it is planned for more staff to achieve this. Two staff are currently undertaking training in palliative care and five staff are doing training in nutrition. One member of staff has completed training in the Mental Capacity Act – deprivation of liberty safeguards and it is planned that this will be ‘cascaded’ to all staff in the home. Comments and feedback from staff confirm that the training opportunities for staff have improved. One member of staff told us that they really enjoyed working in the home. All of the staff comments were positive about the changes in the management of the home and staff were positive about taking more responsibility for their work and developing a key worker system in the home. Staff comments indicated that developing the key worker role has improved the rights and choices of the people living in the home. Observation of practice and discussions with staff by the expert by experience confirm that staff have a good knowledge of the residents and understanding of mental health issues. Some of the residents have benefited positively from consistent levels of staff support on an individual basis. We looked at the recruitment records for a member of staff who has been employed since the last inspection. Records demonstrate that preemployment checks are satisfactorily received for new staff to demonstrate that new staff are suitable to work in the home. We did not find evidence of a planned induction for new care staff. The home has previously told us that they have acquired a copy of the ‘skills for care’ induction to care. It is recommended that new staff follow a planned induction to ensure that staff have the knowledge and skills for the work they do. The registered manager has not yet put in place a structure for organising planned staff supervision, although it is evident that staff receive ongoing and informal supervision. It is good practice, and a regulatory requirement, for staff to be formally supervised, to monitor practice in the home, and as part of the staff training and development programme. The manager told us that she would feel more confident about providing supervision when she has received some training in the supervisory role and this is planned. Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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): 37, 39 and 42 - People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has a good understanding of the areas in which the home needs to improve. The home has not yet developed a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives. The health and safety of residents and staff is promoted and protected. EVIDENCE: Since being appointed earlier this year, the registered manager has demonstrated that the service has sustained improvements in important areas of practice in the home: care planning, management of risk and ensuring that residents are safe, and making sure that medication is safely and correctly dispensed. Comments from residents, staff, visitors and health and social care Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 25 professionals confirm that the management approach of the home is organised, open and supportive and residents benefit from this. The manager is aware that the home needs to improve opportunities for residents to access social, leisure and educational resources and has positive plans in place to do this. Comments from staff indicate that staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. However, staff have also commented that they need more allocated time to work individually with residents and more time to arrange activities and outings. We spoke to a member of staff who has responsibility for fire safety, health and safety checks and some of the health and safety training for staff. Records were organised and up to date and demonstrate that action is taken to promote health and safety and meet the requirements of relevant legislation. The annual quality assurance assessment (AQAA) was completed by the registered provider. The AQAA did not provide very much information about how the service has developed effective quality assurance systems. The previous AQAA told us that the service would be “auditing, monitoring and taking residents’ views into consideration, and the home will continuously review and develop its’ service”. However, we did not find sufficient evidence to demonstrate a good programme of self-review and evaluation. There are some internal audits in place for medication, review of care plans and monitoring of work practice. The registered provider has not been undertaking regular inspections of the service to monitor the quality of the service. The home does not have a programme for decoration and refurbishment of the building and some areas of the home are in need of urgent attention. Beaconsfield Care Home DS0000066435.V376192.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 Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 2 Version 5.2 Page 27 Beaconsfield Care Home DS0000066435.V376192.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA12 Regulation Requirement Timescale for action 30/09/09 12(5)(M)(n) Residents must be consulted about their social interests and arrangements made to enable them to engage in local, social and community activities. Consultation with residents must be made about the programme of activities and facilities for recreation, fitness and training to meet the different needs of the residents. The home must be free from offensive odours. Suitable arrangements must be made to maintain satisfactory standards of hygiene in the home. Residents must live in an environment that is pleasant and hygienic. Staff working in the home must be appropriately supervised. Establish an effective system for evaluating the quality of the service provided by the home. The responsible individual must visit the care home and undertake an inspection of the conduct and organisation of the DS0000066435.V376192.R01.S.doc 2. YA30 12(5)(j)(k) 30/09/09 3. 4. 5. YA36 YA39 YA43 18(2) 24 26 30/09/09 30/09/09 30/09/09 Beaconsfield Care Home Version 5.2 Page 28 service each month. A written report must be available for inspection by the commission. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beaconsfield Care Home DS0000066435.V376192.R01.S.doc Version 5.2 Page 29 Care Quality Commission South East Region Citygate Gallowgate Newcastle upon Tyne NE1 4WH 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. 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