Inspection on 24/07/08 for Beaufort Lodge

This is the latest available inspection report for this service, carried out on 24th July 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beaufort Lodge 02/08/06

Beaufort Lodge 30/01/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Beaufort Lodge 10/12 St Vincent`s Road Westcliff on Sea Essex SS0 7PR Lead Inspector Carolyn Delaney Unannounced Inspection 24th July 2008 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beaufort Lodge Address 10/12 St Vincent`s Road Westcliff on Sea Essex SS0 7PR 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) 01702 353640 01702 353640 beaufortlodge@btconnect.com Mr Navneet Singh Johar Mrs Aunjali Johar Mrs Susan Anne Brown Care Home 21 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (21) of places Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Total number of service users for which personal care can be provided must not exceed twenty one. Personal care to be provided for up to four older people aged over 65 years who have dementia. 31st July 2007 Date of last inspection Brief Description of the Service: Beaufort Lodge is registered for twenty-one older people. The accommodation is on two levels with a stair lift to enable access to both floors. It has two lounges, one with a dining area, nineteen single bedrooms and one shared bedroom. It has a large enclosed garden and there is limited parking to the front of the property. At the time of the site visit, the care home had only one functional bathroom located on the ground floor. It is understood that prior to recent building work to convert a double room into two single rooms the home had two bathrooms. Plans are in place to add a two-storey extension with two bedrooms and a second ground floor bathroom with specialist bath and shower attachment. Beaufort Lodge is situated within easy reach of the seafront and a local shop area at Westcliff on sea. The town centre and shopping centre of Southend on sea is a bus or train ride away. The home is close to rail and bus links. The current scale of charges as at the site visit was £420 to £610 per week. Hairdressing, chiropody, toiletries and newspapers are charged at cost. Beaufort Lodge DS0000063576.V368653.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 was a routine unannounced inspection, which included a visit made to the home between the hours of 11.30 and 19.30 on 24th July 2008. As part of the inspection process we used the information provided by the manager / proprietor in the Annual Quality Assurance Assessment. This document provides us with a self-assessment carried out by the manager as to the services they provide to people living in the home. In addition we reviewed information provided over the last twelve months including notifications sent to us by the manager of any event in the home, which affect residents such as injuries, deaths and any outbreak of infectious diseases. People who live in the home were spoken with to obtain their views about the care and support they receive. Residents, staff and relatives were offered the opportunity to complete surveys as part of the inspection process. Five residents, two relatives and four members of staff completed surveys. During the site visit, records including residents’ care plans and assessments, staff recruitment files and training information were examined. A brief tour of the premises was carried out and communal areas including lounge, dining room and bathrooms were viewed. In addition some residents’ bedrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. What the service does well: People who are looking for a care home are provided with detailed information about Beaufort Lodge, and they, or their relatives are offered the opportunity to visit the home to assist them in deciding if it would be suitable for them. Senior staff will carry out a detailed assessment of a person’s needs in respect of daily living activities before the individual is offered a place in the home. Each person living in the home has a plan of care, which describes the care, and support they need. This plan is reviewed as necessary such as when there are changes to the condition of the person. Residents have access to medical Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 6 and healthcare treatments they need and staff monitor resident’s health through regular checks such as weight monitoring and assessing risks to a persons health and safety. Staff listen to residents and make relatives feel welcomed and included in the support provided. There are opportunities for socialising and activities including some trips outside of the home. People who live in Beaufort Lodge feel free to raise any concerns and know that staff will deal with these issues appropriately. Staff work hard to minimise risks to the welfare of residents and treat residents as individuals in a way which respects the persons privacy and dignity. The home is clean and residents have comfortable communal and personal accommodation. The home is well managed and staff are recruited in a thorough way, trained and supported so that they provide consistent care. Staff take pride in their work and enjoy working in the home. What has improved since the last inspection? What they could do better: Staff could record more thoroughly the support required by people who may be aggressive as part of their medical condition so as to ensure that care is consistent and effective. There were some issues observed in the practices for storing medicines in the home and these have not been rectified since being identified at the last inspection. The manager / proprietor has failed to comply with the requirements made by the local Fire Authority in linking the back gate to the home’s fire alarm system rather than having it padlocked which could potentially hinder evacuation in the event of a fire at the home. Hot water temperatures in one area of the home where residents have access was noted to be very hot and could cause burns. This had been identified when the water temperatures were checked however no action had been taken. There is only one bathroom in the home, which is insufficient for the numbers of residents. There are plans to provide a new bathroom, which will be more suited to the needs of the people living in the home. This was identified by the owner to be completed at the time of the last inspection and needs to be actioned as soon as possible. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beaufort Lodge DS0000063576.V368653.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 Beaufort Lodge DS0000063576.V368653.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who chose to live in Beaufort Lodge are assured that their needs will be assessed and met. EVIDENCE: The manager told us in the home’s Annual Quality Assurance Assessment that an assessment of each person’s needs is completed before they are offered a place in the home and that wherever possible people are invited to visit the home before making their decision as to whether they feel it is suitable. Relatives who completed surveys and who spoke with the inspector confirmed that they had been given information and the opportunity to visit the home to help them decide if their loved one would be happy there. One resident who was spoken with said that they had been invited to the home to look around and they ‘decided Beaufort Lodge was right for them’. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 10 On the day of the visit the home’s pre-assessment procedure was available and the pre-admission assessments for two people who had moved into the home since the last inspection were examined. Both assessments had been carried out prior to the person being offered a place in the home. The assessments were written in clear English and described the individual’s needs and capabilities in respect of daily activities of living including communication, sight and hearing, mobility, nutrition, elimination and social and mental health. Records included details of how the person wished to be addressed and information about their social and family history. Information recorded was detailed and reflected the individual’s particular needs and preferences from which a person centred and holistic plan of care could be developed. Each of the four staff members who completed surveys said that they are provided with information about each person’s needs so as to be able to support individuals. It is the home’s policy following on from the assessment process to provide a ‘welcome letter’ to prospective residents, which confirms that following the assessment that the home will be able to meet the persons assessed needs. Copies of this letter were kept in individual resident’s files. From the Annual Quality Assurance Assessment we were told that during the past twelve months that there had been no placement breakdowns (where the home had been unable to meet the needs of people admitted there). Four of the five residents who completed surveys said that they had been given enough information about the home before they moved in so that they could decide if it was the right place for them. Throughout the inspection it was noted that residents had access to information about the home including details on meals, activities and laundry services provided and information on how to complain if they were unhappy with any aspect of the service. Each resident has a copy of this information in his or her bedroom. As part of the home’s process for maintaining and improving the quality of service provided residents and relatives were surveyed in January 2008 and asked about their experience regarding choosing to move into Beaufort Lodge. 93 of the twenty-one residents surveyed made comments and indicated that they had ‘visited the home and liked it’, that the home had been ‘recommended by a friend’ and one person commented that they had visited the home and found it ‘friendly, welcoming and clean’. Beaufort Lodge does not provide rehabilitative or intermediate care. Beaufort Lodge DS0000063576.V368653.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Beaufort are well cared for and are happy with the support they receive. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that people living in Beaufort Lodge have a care plan that supports their needs and that staff follow these plans so as to deliver the best possible care. She also said that the home is supported by good input from outside health and medical professionals such as general practitioners and community psychiatric nurses. Each of the five people who completed surveys said that they receive the care and medical support that they need. Residents said that staff are ‘caring, kind and available to help them.’ From the clear and detailed information recorded during the initial assessment, staff develop a plan of care for each resident. The care plans for four residents Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 12 were examined during the inspection visit. Information about residents’ needs was recorded in a very clear and detailed way so that staff have a clear picture of how each resident should be supported in the majority of care plans, which were assessed. Care plans generally included information provided by the resident or their relative, in particular information about the individual’s preferences and wishes for how they wish to maintain personal hygiene and food likes and dislikes. Risks to residents’ health and safety were assessed and plans developed to minimise injuries, malnutrition and skin damage (due to decreased mobility). Records in respect of accidents and injuries were well maintained and from the service history (notifications of events in the home sent to the Commission) we note that there have been no serious injuries to residents living in the home within the past twelve months. There were records in resident’s files in respect of general practitioner, district nurse and other allied professionals including chiropodist visits to the home and any prescribed treatment as a result of these visits. However information in respect of managing resident’s verbal or physical aggression was not well recorded. Staff recorded in daily records that one particular resident was aggressive on a number of occasions. However there was no plan of care developed regarding this issue and how staff were to manage these issues. Staff update care plans when there are any changes to residents or the care and support they need. Resident’s wishes for how they would wish to be cared for in the event of their condition deteriorating were recorded. These records included information as to whether residents would wish to be cared for in the home or in hospital as they reach the end of their lives and any specific wishes they have in respect of arrangements after death. Relatives who completed surveys said that the home meets the needs of residents as agreed or expected and that they are kept up to date with any important issues affecting residents. One relative commented that staff ‘makes quality of life for my mother very good’. Another commented that staff ‘treat everyone as an individual and meets their appropriate needs’. There is a policy and procedure in the home in respect of the safe receipt; storage, handling, administration and disposal of medicines and all staff who are responsible for dealing with medicines have had recent training. As part of care planning for each resident staff record what medicines the individual is to have as part of his or her treatment with the reason for its use and possible side effects. Some residents retain control of medicines such as inhalers and topical creams where they would wish to and are capable of doing so safely. There were assessments in respect of the residents capabilities to safely keep and administer their medicines. However in general residents rely upon staff to administer medicines. Senior staff were observed when administering medicines to residents at lunchtime. Staff administered medicines in a safe manner ensuring that residents took tablets etc before signing the Medication Administration Records Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 13 (MAR). Residents were offered pain-relieving medication where this was prescribed on an ‘as required’ basis. The Medication Administration Records were examined. These were well maintained and there were no omissions of staff signatures. There is a policy in the home whereby the senior staff on duty checks that medicines have been administered and records are completed accordingly. At the time of this inspection two residents living in the home were prescribed medicines which are designated Controlled Drugs. These medicines require special arrangements for storage in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973 as amended, including that they are stored in a Controlled Drugs cabinet, which is securely fixed to a solid wall. At the time of the last inspection issues were identified in respect of the storage of Controlled Drugs. It is disappointing to note that at the time of this inspection these medicines were stored in a cabinet, which was not fixed securely to a solid wall. While this practice does not impact upon residents directly it is not safe practice for storage of medicines in the home. Beaufort Lodge DS0000063576.V368653.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Beaufort Lodge enjoy a lifestyle experience, which reflects their wishes and capabilities. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that there is a range of activities offered at the home which are flexible and optional and which reflects the individuals’ preferences. We were also informed in this document that resident’s family and friends are welcomed to visit and participate in planned activities and events in the home and are offered refreshments when they visit. Resident’s wishes and preferences are recorded as part of their care plans. Residents have daily routines records completed which describe the times they wish to rise in the morning, where they like to have their meals and how and where they wish to spend their time during the day. This information helps staff to support residents in the way in which they prefer. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 15 Residents and relatives who completed surveys as part of the home’s quality assurance monitoring made positive comments about the activities provided. Comments made by residents on these survey’s indicated that they had choices about how they spent their time and that there were activities available, which they enjoyed. Some people commented that they preferred not to participate. Some relatives commented that they would like to see more outings arranged such as lunches at local restaurants as these seemed to be ‘particularly enjoyed by residents’. Another person said that ‘staff always make visitors feel welcome and that there is a varied programme of activities’. Other relatives commented that there could be more music and exercises such as chair exercises. During the inspection copies of planned activities were noted to be displayed throughout the home. These indicated that there was a wide range of activities available including visits by relatives to play music on the homes piano, games, puzzles and current affairs and news etc. Residents who are able to, go out with family and friends for lunch etc. Five residents completed surveys as part of the inspection. The majority of the five said that there were activities arranged by the home that they can take part in. Some people indicated that they preferred to watch rather than participate. Relatives who completed surveys as part of the home’s quality assurance process and surveys from the Commission indicated that they were always made to feel welcomed to the home. The manager / owner prides themselves on the food offered in the home and the manager told us in the Annual Quality Assurance Assessment that menus had been reviewed to better suit residents’ preferences. Menus were seen during the inspection and these indicated that there was a varied menu with a good range of choices for residents. As part of the initial assessment process resident’s food likes and any dislikes are recorded and this information is used to plan menus and meals. Residents who were spoken with during the inspection commented that they enjoyed the meals provided. One resident who completed a survey commented that the meals ‘were very good and staff know I do not like cheese’. The serving of the lunchtime meal was observed. Tables were laid nicely with tablemats, napkins and a selection of condiments and sauces to compliment the meal were readily available. Residents were offered a choice of shepherd’s pie or cauliflower cheese served with a selection of vegetables. Staff offered residents a choice of vegetables and gravy was served at the tables. Residents appeared to enjoy their food and the atmosphere was pleasant and unrushed. Some residents require more support and time to eat their meal and staff serve these residents approximately fifteen minutes before other residents to allow them the extra time they require. Staff were observed to ask people if they would like second helpings and asking if people enjoyed their meal. Hot Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 16 and cold beverages and snacks are readily available for residents throughout the day. When people move into the home their nutritional needs are assessed and their weight is monitored periodically as part of the persons overall health monitoring. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Beaufort Lodge and their relatives are confident that any complaints and concerns will dealt with and resolved. Residents are safeguarded from harm, neglect and abuse. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that all complaints are responded to and followed up in accordance with the home’s complaints policy. People living in the home and their relatives are provided with information on how to make a complaint or raise any concerns if they are unhappy. The home’s complaints policy was available and staff who were spoken with during the inspection were aware of the appropriate action to take if a resident or visitor to the home made a complaint or raised concerns. Records were maintained in respect of complaints received and there had been three complaints received since the last inspection. These complaints had been investigated and responded to in accordance with the home’s policy. There had been no complaints made to the Commission in respect the home. Each of the five residents, and two relatives who completed surveys and one relative who was spoken with, said that they knew how to make a complaint if they were unhappy. One resident commented that ‘they had never had to Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 18 complain’. Another resident said that ‘happily I have rarely any complaints but if I did need to complain the manager is available and always ready to listen’. One relative who was spoken with during the inspection said that ‘they did not have any issues or complaints about the home’. Residents and their relatives are surveyed annually by the home to obtain their views so as to help maintain and improve standards. As part of this process residents and relatives were asked if they feel able to discuss issues or problems with staff and all those who completed the surveys responded positively. Staff who were spoken with during the inspection and those who completed surveys said that they how to act if a resident, relative or other person had concerns about the home. There is a policy and procedure in respect of safeguarding people living in the home from abuse, harm or neglect. Three members of staff who were spoken with could say what was the correct action to take if they witnessed or suspected any ill treatment of people living in the home. The manager told us in the Annual Quality Assurance Assessment that all staff working in the home had undertaken training in respect of safeguarding residents. A copy of the staff training summary was provided and reviewed after the inspection visit. From this we determined that of the thirteen care staff, two had not received safeguarding training. Of the remaining eleven staff, five staff had not received safeguarding training since 2005. This does not ensure that all staff working at the home have up to date information to enable them to act in a consistent way. During the inspection staff were observed to treat residents in a polite and courteous manner, and residents looked well cared for. There have been no safeguarding alerts or concerns raised in respect of the home since the last inspection. The records kept at the home in respect of accidents and injuries to residents and the information kept by the Commission in respect of notifications of any events or occurrences in the home, which may affect residents, were reviewed as part of the inspection process. From these we can see that residents are so far as possible protected from injury and harm. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in Beaufort Lodge enjoy a comfortable, clean and generally safe environment. EVIDENCE: Beaufort Lodge provides accommodation in an older style property, which comprises two houses that have been converted to one property. Accommodation is provided over two floors with access via two staircases, one that is equipped with a chair lift so that less mobile people can access the first floor. The manager told us in the Annual Quality Assurance Assessment that all but one of the bedrooms within the home had been converted from double to single rooms. During the inspection visit a tour of the premises was carried out and it was noted that there were nineteen single and one double bedroom. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 20 Four of the bedrooms have ensuite with toilet and hand washing facilities. As identified at the last inspection the home has only one bathroom and construction of the planned second bathroom had not yet started. The home’s owner said that having looked into the planning process that local council planning permission would not be required and that work to construct the new bathroom would be commencing shortly. Each of the five residents who completed surveys, residents and the visitor who were spoken with during the inspection commented that the home is always very clean and fresh. One resident said that ‘there is never any nasty smells around and staff are forever cleaning and dusting’. During the inspection the home was noted to be clean and free from unpleasant odours throughout. Some residents’ bedrooms were viewed and these were clean and equipped with storage space for residents’ belongings. Bedrooms were bright and nicely decorated and residents had personal items such as photographs, ornaments and furniture. During the inspection hot water temperatures were checked in the bathrooms and toilet areas. In one of the toilets the hot water was in excess of 55 degrees Celsius, which could cause burns to residents. The manager was asked to display a notice to warn residents of the danger and to deal with the issue as a matter of urgency. Following the inspection the proprietor informed the Commission that a thermostatic valve to regulate the temperature of the water had been fitted to this hand basin. There are two lounge areas available to residents one which is a ‘quiet lounge’ and the other a large lounge dining room with patio doors, which lead out to a well-maintained enclosed garden with wheelchair access. On the day of the inspection, a number of residents were noted to spend time enjoying the good weather in the garden. Suitable seating and parasols are provided in the garden. Two relatives commented that the provision of a ramp at the front door would make access to and from the home easier for wheelchair users. There is a plan and risk assessment in place at the home in respect of dealing with any outbreak of fire. Shortly after the last inspection we had received a copy of a letter of non-compliance from the Essex County Fire & Rescue Service. This was with regard to the current arrangements for the emergency routes and exits. The external gate from the rear of the premises was padlocked shut. Urgent attention was required so as to ensure that residents had a safe exit from the premises in the event of a fire at the home. It is disappointing to note that at the time of this inspection that this issue had not been dealt with. The owner said that arrangements would be made to comply with the Fire services regulations within one week. At the time of writing this report we had not received confirmation that this had been completed. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 26, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in Beaufort Lodge are supported and cared for by staff who are recruited thoroughly and employed in sufficient numbers to meet their needs. EVIDENCE: The home’s owner told us during the inspection that staffing levels are calculated for the home by determining the dependency levels for people and using the residential forum guidance. This is a tool used to calculate the number of staff hours needed based upon the dependency levels of people living in the home. The staffing levels are reviewed regularly and this was reflected in the staff duty rotas, which were provided during the inspection. Staffing levels for the home excluding the manager were three staff during the morning and afternoon duty and two staff for the evening and night duty. The manager was on annual leave at the time of the inspection and an extra senior carer was employed during this period. Each of the five residents who completed surveys said that staff are available to them when needed. Throughout the day staff were observed to work very hard and to be attentive to the needs and wishes of residents. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 22 From the home’s quality assurance questionnaire for residents it was noted that 100 of residents who completed the survey said that staff are friendly, polite, patient and professional. Staff who were spoken with said that they feel supported so that they can provide a good level of care for residents. One member of staff who was spoken with said that they ‘really enjoyed working at the home and caring for residents’. Staff who completed surveys said that they are well supported and receive training to enable them to support residents. Staff are proud to work at Beaufort Lodge one member of staff said that they ‘always try to improve service to residents’. Relatives commented that staff have the required skills and experience to care for residents. One person said that ‘staff are very friendly and always available to speak to if there are any problems.’ The recruitment files for two members of staff who had been employed at the home since the last inspection were examined and one of these two members of staff was spoken with. Both files provided evidence of the checks carried out in respect of both individuals’ fitness and suitability to work in the home. Both candidates had provided detailed information about where they had worked previously and referee so that the manager could obtain references in respect of the person’s conduct in their previous jobs. Satisfactory references had been obtained for both candidates. Satisfactory identity verification, PoVA First checks and Criminal Records Bureau (CRB) disclosures had been obtained for both, and the manager had interviewed the candidates before they were offered employment. Both candidates had been provided with a job description and had undertaken a period of induction to the home, which included completing the nationally recognised Skills for Care Common Induction Standards. This helps to ensure that staff working at the home support residents in a consistent and effective way. The manager told us in the Annual Quality Assurance Assessment that staff working in the home are highly trained and undertake ongoing training and development. In the past twelve months two staff have completed National Vocational Qualification (NVQ) level 3 in care and ten staff have completed training to level 2. This helps to ensure that staff deliver care and support in accordance with nationally recognised standards and was confirmed through discussion with staff and examining staff training records. A copy of the staff training summary was made available for inspection. From these records it was noted that the majority of staff had undertaken training in respect of fire safety, food hygiene, safe moving and handling, safeguarding people, and the Control of Substances Hazardous to Health (COSHH). In addition some staff had undertaken training in health and safety, first aid, and managing dementia, challenging behaviour and diabetes. Records did not evidence that staff undertake periodic training updates so as to ensure that their skills and knowledge are updated. Beaufort Lodge DS0000063576.V368653.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Beaufort Lodge is well managed and residents’ views are regularly obtained so as to improve people’s experience of living in the home. EVIDENCE: Comments from residents, staff and relatives in relation to the home were very positive. The home’s manager was not present on the day of the inspection. The Area Manager for the company and the owner assisted with the inspection. Staff working in the home appeared confident and capable and there were clear lines of accountability. Staff who completed surveys commented that they are well supported and there was evidence that staff receive regular supervision so as to maintain and improve care practices. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 24 Resident’s views are sought through regular (quarterly meetings) and minutes from these were available. Residents and relatives views are obtained by way of a questionnaire so as to see where the home meets and exceeds expectations and where improvements to the service can be made. The most recent survey was carried out in January 2008, the results of which were available to the inspector. Comments made were positive and residents, relatives and staff who completed spoke with inspector and completed surveys as part of the inspection spoke very highly of staff and management. There is a policy in the home for safeguarding monies held by staff on behalf of residents. Monies are stored in a locked safe and regular checks are carried out so as to minimise the risk of error or mishandling. Records were assessed and noted to be in good order. As described throughout the report there were some issues identified which require the urgent attention of the home’s manager/ owner. There was evidence that equipment in the home such as hoists, chair lift, and gas and electrical systems are regularly serviced, maintained, repaired and replaced as required. Certificates were available in respect of checks carried out by the homes maintenance personnel and external professionals. The manager told us in the Annual Quality Assurance Assessment that as part of improving the service provided to people living in the home that there are plans to employ an activities coordinator so as to improver outcomes for residents in this area. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 25 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 X 3 Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2),Sch edule 3(3)(i), 12(2)(3) Timescale for action Medicines received into the home 20/08/08 must be stored in accordance with current regulations and guidelines. This refers to the storage of Controlled Drugs, which must be stored in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973 as amended. So as to prevent the mishandling of medicines in the home. This is a repeat requirement from the last two inspections and timescales of 31/10/06 & 02/11/07 have not been met. The arrangements for evacuation 30/08/08 of the premises in the event of a fire must be in line with current fire safety regulations so as to help ensure the safety of people living in the home. This is a repeat requirement from the last inspection and timescale of 02/11/07 has not been met All areas of the home to which 15/08/08 residents have access to must be maintained in a manner, which DS0000063576.V368653.R01.S.doc Version 5.2 Page 27 Requirement 2. OP19 24(4)(5) 3. OP19 13 (4) (a) Beaufort Lodge 4. OP21 23(2)(j) minimises risks to the individuals’ safety. This refers to ensuring that hot water temperatures in the home are regulated so as to minimise risk to residents. Bathing and showering facilities must be provided to meet the needs of people living in the home. This is a repeat requirement from the last inspection and timescale of 02/11/07 has not been met. 30/10/08 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 OP19 OP30 Good Practice Recommendations The manager should review access to the home and improve access for people who use wheelchairs. Staff should undertake periodic training updates to ensure that they maintain skills to best support residents. Beaufort Lodge DS0000063576.V368653.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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