Inspection on 23/05/07 for Beacher Hall Nursing Centre

This inspection was carried out on 23rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beacher Hall Nursing Centre 42 Bath Road Reading Berkshire RG1 6NG Lead Inspector Delia Styles Unannounced Inspection 23rd May 2007 10:55 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 DS0000069039.V333063.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. DS0000069039.V333063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beacher Hall Nursing Centre Address 42 Bath Road Reading Berkshire RG1 6NG 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) 01189 530600 01189 596213 whitmoch@bupa.com ANS Homes Limited Mrs Christine Carol Whitmore Care Home 70 Category(ies) of Old age, not falling within any other category registration, with number (70), Physical disability (40) of places DS0000069039.V333063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection New service Brief Description of the Service: Beacher Hall Nursing Centre opened in 1997 following a period of extensive building and renovation. The main entrance to the Centre and original part of the house is a listed building. It is set back from the road and surrounded by mature protected trees, and is on one of the main routes into Reading, about one mile from the centre of the town and the Oracle shopping complex. The Centre has 70 registered beds on three floors. There are 68 single and one double room: all have en-suite toilet and washbasins and are equipped with nurse call system, television and telephone points. There are 3 assisted bathrooms on each floor and a total of 7 shower facilities. Three lounges, 3 dining rooms and 2 quiet lounges provide a range of communal areas for residents to use. The second floor of the home is dedicated to the care of 20 more active younger disabled residents and the accommodation and facilities have been adapted to meet the varying needs of this client group. There is a large attractive enclosed courtyard garden with good access for residents to enjoy outside activities and functions. The current range of fees is between £528 and £2190 per week. DS0000069039.V333063.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’. Because there has been a change in the registered provider (a corporate owner) since the last inspection, this service is considered by the Commission to be a ‘new’ service. The inspector arrived at the service at 10.55 and was in the service for 7 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home manager. The inspector asked the views of the people who live here and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. A total of 9 comment cards were received from residents, 12 from relatives, carers or advocates, and one from a GP who provides medical care to residents. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The inspector looked around the building, examined samples of residents’ care plans, staff files, training records and other records required to be maintained in the home, for example the fire safety log and accident records, and the most recent quality assurance survey undertaken by the company that owns the home. The inspector discussed her overall impressions and assessments with the home manager at the end of the inspection. The inspector would like to thank all the residents, staff and visitors who shared their views about the home and the care provided, and all those who took the time to complete questionaires. The assistance of the Head of Nursing was much appreciated, especially as the inspector arrived on a day when the manager was very busy with a series of interviews. What the service does well: The home is very clean throughout and staff are welcoming and friendly. It is an attractive environment that provides comfortable and accessible personal and communal space for residents. The large courtyard garden and an activities room provide space for residents to enjoy a range of indoor and outdoor activities – gardening, handicrafts and art work. Some of the residents’ and relatives’ comments included: ‘Excellent conditions. Excellent staff’ ‘It’s the best home I have been in’ ‘Staff are friendly and helpful’ ‘All the staff are very welcoming, friendly and reassuring’. DS0000069039.V333063.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Overall, Beacher Hall Nursing Centre provides a good standard of care and services to residents. The company is introducing a new system of paperwork to record residents’ assessed care needs and the plans of care. The inspector recommends that staff should include information about people’s social and recreational care needs in the care plans and records. Care records should also include information about the extent to which the care staff have given has met the residents’ assessed needs. Several relatives felt that residents needed more entertainments and social activity to ‘break the monotony’; and ‘more care time per patient, including ‘chatting and listening’. The manager feels that this is being addressed and that the activities programme will be further improved because an additional activities worker has been appointed. From observations made at lunchtime with one group of residents, the inspector recommends that meal service and the ways in which staff assist residents could be improved, to make sure that residents can be encouraged to be as independent as possible. Many of the residents have specialist care needs and need a high level of staff help, and use of aids and equipment. Some recommendations are made about considering privacy and dignity of residents and making sure that in meeting their physical care needs, staff continue to respect the residents’ need to live in as homely and domestic environment as possible; for example, minimising the number of printed instructions about care and medicines displayed in residents’ rooms. Some bathrooms are used as storage areas for equipment such as hoists and this reduces the number of assisted bathrooms for residents’ use. The Centre should provide enough separate storage space for equipment. Recommendations are made for the service to review the staffing numbers and duty rotas, because many of the staff work long shifts in excess of their contracted hours and with insufficient rest time between consecutive day or night shifts. There is a risk that staff are at increased risk of injury and ill health if they are overtired and this could have a negative effect on residents’ care. DS0000069039.V333063.R01.S.doc Version 5.2 Page 7 Some of the residents and relatives’ feedback comments indicate that they are not as confident in the care staff’s knowledge and skills, because many of the overseas staff do not speak or understand English well enough. This was discussed with the manager. The home’s recruitment and screening process, induction, staff development and training programmes, should ensure that new staff have a good command of English and should help them to develop their skills in communication with residents. 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. DS0000069039.V333063.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 DS0000069039.V333063.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 and 3. Standard 6 does not apply, as the Centre does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether it is likely to be right for them. Personalised assessment of people’s diverse needs means that these are identified and planned for before they move into the home. EVIDENCE: The centre has clearly written information set out in the Statement of Purpose and Service Users Guide and a colour brochure. Residents and relatives felt that they had had good information about the Centre before they decided to live here. Welcome packs of information are left in a folder in each resident’s room. The manager or Head of Nursing assess all prospective resident’s care needs. BUPA has developed a comprehensive assessment document – QUEST – which is now being used in the home. DS0000069039.V333063.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems for the planning and delivery of care are good, with evidence that residents and their representatives are involved in the planning of care that affects their lifestyle and quality of life. More attention could be given to documenting the social and emotional care needs of residents, and evaluating whether the care given meets the resident’s needs and wishes. Physical health needs of residents are generally met. The policies and practices for managing medications are effective and protect residents from errors. EVIDENCE: The inspector looked at a sample of 6 resident’s care records. These included risk assessments – for example, of pressure area damage (pressure ulcers/’sores’), manual handling, nutrition (the Malnutrition Universal Screening Tool – MUST) and falls. Use of electric variable height beds, bed rails (to reduce the risk of residents falling out of bed) and lap straps (to reduce the risk of falls from wheelchairs). DS0000069039.V333063.R01.S.doc Version 5.2 Page 11 There was evidence of residents or their representative being involved in drawing up the care plans and signing the plans. One relative wrote that it was good that ‘they [staff] carry out all the objectives mentioned in the care plan’. The newer versions of BUPA paperwork also include a ‘map of life’ that helps staff to get to know more about the residents’ recreational and social preferences and needs. However, in the sample of care records looked at by the inspector, there were no specific care plans for how resident’s social and spiritual care needs will be addressed. The registered nursing staff write daily records of the residents’ care, based on the information given by care assistants and their own observations, but their comments largely addressed the physical needs of residents and were not linked to the care plans. There was little evaluation of the care given – i.e. to what extent had the care met the residents’ assessed needs. For example, it was not clear what action had been taken in response to a relative’s requests or suggestions about their loved one’s needs, although those requests had been documented. Relatives and residents’ comments were largely positive about the way in which the Centre meets residents’ physical health needs. Family and representatives of residents are kept up to date with important issues affecting their friend or relative. A GP’s comment card indicated no concerns with the way in which the home cares for residents. Relatives/carers and advocates survey responses to the question about whether care assistants have the ‘right skills and experience to look after people properly’ varied, with 5 responding that this is ‘always’ the case; 5 that this is ‘usually’ so; and 1 person ’sometimes’. Though positive about the ‘qualified nurses who work very professionally’ one relative wrote that ‘care staff sometimes lack experience to deal with the physical and emotional needs of the sick/elderly person’. The Centre has the appropriate equipment and aids to meet the needs of residents and access to specialist nursing and medical NHS staff for advice and treatment when necessary. A physiotherapist assesses all residents after admission to ensure that staff use safe moving and handling techniques. The systems for the ordering, storage, administration and disposal of medicines are sound, with regular internal audits of residents’ Medicine Administration Record (MAR) charts. The inspector noticed that several residents had notices prominently displayed in their rooms, listing particular medications, dietary restrictions or allergies. The inspector felt that this gave a somewhat institutional impression. The Head of Nursing explained that, although residents’ records and MAR charts also held this information, it was decided that more prominently displayed information was a safeguard for residents, especially if agency or new staff members were unfamiliar with DS0000069039.V333063.R01.S.doc Version 5.2 Page 12 residents’ health care needs because they were alerted to any ‘high risk’ aspects of residents’ care or treatment. The inspector recommends that some other aspects of privacy and dignity for residents should be improved: for example, the engaged/vacant signs on the assisted bath/shower rooms and toilets are difficult to see, so that if staff or residents do not lock the door when personal care is being carried out, there is a risk that other residents or staff can enter the room. There are no privacy curtains in the bath/shower rooms, so that residents could be exposed to view when the door is opened. A resident’s catheter bag and contents were not covered: the inspector recommends that some form of discreet and washable cover should be provided to avoid embarrassment to residents from having continence aids on view in this way. Relatives and residents comment cards indicated that they felt staff treated them well and with respect. Three out of 12 respondents felt that the service ‘always’ supports residents to live the life they choose; and a further 6 people answered that this was ‘usually’ the case. As is the case in many care homes and NHS health care facilities, there is a wider range of racial, ethnic and faith backgrounds represented within the staff group compared with the current residents. From the evidence seen by the inspector and comments received, the inspector considers that Beacher Hall Nursing Centre would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. However, there are indications that residents sometimes find that some care staff cannot communicate satisfactorily because English is not their first language: ‘some of them have a strong accent which X finds hard to understand, being fairly deaf’; ‘language is a great problem. They don’t understand me and I don’t understand them.’ DS0000069039.V333063.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range of activities within the home and community provide opportunities for most residents to participate in stimulating and motivating activities. The manager has recognises that there is further scope to develop and improve this aspect of care to meet the diverse needs of residents. The meals are good, offering both choice and variety and catering for special dietary needs. EVIDENCE: Residents’ comment cards returned to the inspector were all completed by younger disabled residents (18 to 65 years old) with the help of a carer or relative. Six out of 7 people who answered question 3 felt that they were able to make decisions about what they do each day how they spent their day and The same proportion felt that they could do what they wanted to each day, including weekends; though 1 person answered they could not (it may be that this person is severely disabled and unable to make independent choices). There was evidence that residents are able to choose what organised activities, if any, they join in. The Centre employs a full time activities organiser and has just appointed a second worker. The manager anticipates that the additional activities staff member will help to expand the range of individual and group DS0000069039.V333063.R01.S.doc Version 5.2 Page 14 activities available to residents. In answer to a question in the relatives/carer/advocates’ comment card about peoples’ views on how the home could improve, 4 out of 12 answered that more activities should be provided: ‘Social activity. We understand that most people are very ill. But it would be nice to break the monotony occasionally with some entertainment’. ‘A minibus to take patients out and about – especially wheelchair bound. It could be funded or maintained by relatives of patients’ ‘More activities and maybe some outings’ ‘More entertainment and if we can have a nice library’ A further suggestion was ‘More time per patient including ‘chatting and listening’. The manager said that the home does not have its own minibus, but residents have access to the Readibus service to enable residents who use wheelchairs to travel locally. There is a good public bus service to the town centre and the Oracle shopping complex. On the day of the inspection visit, many of the residents were enjoying sitting outside during the morning in the large courtyard garden, listening to music played over the loudspeaker. The courtyard has plenty of garden furniture and parasols, and an arbour to provide shade. The garden area is very attractive with flowerbeds, containers and sculpture and artwork created by residents. The greenhouse is used for residents to grow plants for use in the gardens or for sale. Residents spoken with were content with the activities provided. One person told the inspector that they chose not to go out on arranged outings but knew that they could if they wanted to. Another resident had recently enjoyed a holiday in France. Younger residents have access to several clubs that meet in Reading, for example PHAB. During the afternoon an entertainer sang and played guitar in the garden, inviting song requests from residents and their families. This was an enjoyable social event with visitors made welcome and offered tea and cake with residents. The activities organiser has a stock of videos, books and board games and other equipment. He also runs a weekly mobile shop for residents. Computer facilities have been installed for residents on the second floor. Weekly Activity planners were displayed on the notice board on each floor. DS0000069039.V333063.R01.S.doc Version 5.2 Page 15 All residents have a telephone point in their room and can pay to have their own phone line. The 4-week sample menus provided before the inspection visit showed that food is varied and nutritionally balanced. The inspector joined residents for lunch in the ground floor unit dining room. Meals are prepared and plated in the main kitchen and served from heated trolleys in the servery areas adjacent to each dining room. Residents were offered sherry, fruit juices or water with their meal. There is a choice of main course at lunch times, and one dessert. The main meal courses were pork casserole, mixed vegetables and potatoes or chilli and rice, followed by an instant whip dessert. One resident had fish and chips. One relative wrote that ‘M eats a largely vegetarian diet, but this is not always observed’. The dining room is attractively laid out, but with two tables seating up to six residents and one for 3, the space was limited for residents using wheelchairs and for staff assisting residents with their meals. Residents could choose to eat their meal in their own room if preferred. Ample time was given to residents to eat and the food smelled and looked appetising. The inspector considered that a resident with visual and hearing impairment could have managed more independently if a carer had described the meal and how the various foods were arranged on the plate. Dessert was served to residents whilst they were still eating their main course, so that those residents who were confused or unable to see their plates clearly, were eating from their dessert and savoury courses at the same time. These aspects of meal service and assistance should be improved. DS0000069039.V333063.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes complaints system is effective with evidence that residents feel that their views are listened to and acted upon. Residents feel safe and well supported by the organisation. EVIDENCE: Eight out of 9 resident comment card responses showed that people knew how to make a complaint and all were confident that they knew who to speak to if they were not happy. Nine out of 12 relatives/carers/advocates answered that they knew how to make a complaint; 2 did not and one ‘couldn’t remember’. Six of the sample said that the Centre staff ‘always’ responded appropriately if they or a resident has raised concerns and 5 that this was ‘usually’ the case. The complaints procedure is set out clearly in the information provided about the Centre and residents are invited to use the BUPA Care Homes suggestions and feedback forms provide in each resident’s Welcome Pack and in the reception area of the home. The completed pre-inspection questionnaire received from the manager indicated that a total of 38 complaints had been received in the last 12 months of which 22 were substantiated and 10 partially substantiated. One complaint involved verbal abuse of a resident by a qualified nurse, who was subsequently dismissed. The manager explained that the relatively high number of complaints recorded is because they treat all concerns and ‘grumbles’ as complaints. The manager reports all such complaints to BUPA head office and DS0000069039.V333063.R01.S.doc Version 5.2 Page 17 the cause and outcome are then analysed to ensure that any trends or frequent areas of concern are investigated and followed up appropriately. No complainant has contacted the Commission with information concerning a complaint made to the service. All new staff receive training in adult safeguarding issues and regular update sessions. Staff are given copies of the General Social Care Council Code of Conduct and have access to the local multi-agency codes of practice for the safeguarding of all vulnerable adults. DS0000069039.V333063.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a well-maintained and attractive environment equipped to meet the needs of the residents. It is clean and tidy and the homes policies and procedures reduce the risk of infection. EVIDENCE: The inspector toured the Centre and found all areas to be kept commendably clean and odour-free. There is an on-going programme of redecoration and refurbishment. Adaptations have been made to the second floor, for example laminate flooring, and a computer room, to meet the needs of more active younger disabled service users. Outside, the gardens are attractively laid out, with ramped access for people who used wheelchairs. Each floor has 3 assisted bathrooms, with a wheel-in shower facility as well as a bath in the larger bathrooms. The inspector noted that one bathroom on each floor is used for storage of hoists and other equipment, because there is insufficient space allocated to storage. This may reduce the ratio of bath DS0000069039.V333063.R01.S.doc Version 5.2 Page 19 facilities required for the number of residents accommodated. Consideration should be given to how more storage space for equipment can be achieved. The laundry, kitchen and staff room are located in the basement area. The laundry was clean, well organised and equipped. One relative’s comment card stated that the ‘laundry arrangements, particularly marking clothes and returning them after washing is haphazard’. There were no other adverse comments about the laundry service. There were 2 staff working in the laundry – a new laundry assistant has recently been appointed – and the manager said that with the additional staff member the service should address any problems. Staff have induction and further regular training in infection control, including the care of residents with specialist needs, such as tracheotomy and nutritional support/enteral feeding systems. DS0000069039.V333063.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are maintained at a satisfactory level, but there is evidence that not all residents receive a consistently high standard of care. The service has a good recruitment procedure that protects residents. The home recognises the importance of staff training; all staff receive relevant training focussed on improving and developing the standards of care for all residents. EVIDENCE: The inspector looked at a sample of the duty rotas provided pre- inspection and talked with the Head of Nursing about the staffing numbers available for care of residents. Though the numbers and skill mix of staff appear to be consistently maintained, several people who completed surveys were concerned about staff shortages and poor communication skills of some care staff, that were felt to impact on residents’ care because staff did not have the time or ability to have a chat or share a joke. However, there were also many very positive comments about the staff made in the survey responses – for example, ‘staff are friendly and helpful’; ‘all the staff are very welcoming, friendly and reassuring’; and ‘excellent staff’. Analysis of the duty rotas provided for March 2007 showed that a large proportion of staff, especially the registered nurses were working very much in DS0000069039.V333063.R01.S.doc Version 5.2 Page 21 excess of their contracted hours – for example, 3 staff had worked totals of 240, 252, and 276 respectively over a 31 day period. Twelve hours shifts are the norm, and most staff have split days off. One staff member had worked a total of 13 consecutive 12-hour night shifts. If staff work excessively long hours and without adequate rest periods between shifts, there is a risk to their own health and wellbeing, and to that of residents, because it is more likely that errors and accidents will happen if staff are overtired. The home should review its staffing patterns and adjust them accordingly to ensure there are always sufficient numbers and skill mix of staff to meet the residents’ needs and to cover for staff absences - holidays, job vacancies and training. The home had used agency staff to cover 9 shifts in March and April. The inspector spoke to a student nurse on placement in the home, who said that she had appreciated her time here and had learned a lot. One of the home’s registered nurses who act as a mentor to students had come in her day off to complete supervision documents with the student. A sample of 4 staff members’ files was examined. These showed that there is a consistent and thorough approach to recruitment and training of staff. All the information and documents in respect of new staff were available and demonstrate that the Centre’s procedures protect residents by not employing people who are unsuitable to work with vulnerable adults. All residents are allocated a member of care staff who acts as their ‘key worker’. Key workers are responsible for monitoring, reviewing and coordinating the care plans for all the residents to who they are allocated. They also are involved in gathering information for each resident’s review of care that is held at least monthly. The inspector spoke to one visitor who was not aware of the key worker involved in the resident’s care. The home manager said she would follow this up with the people concerned. The Centre has a commitment to staff training and development and there was evidence of a comprehensive programme of mandatory and specialist training sessions planned. The number of care staff with National Vocational Qualification (NVQ) Level 2 is below that recommended by the Commission: 31 of care staff currently have NVQ compared with the recommended 50 . Staff turnover accounts for the loss of some staff with NVQ, and the home manager is confident that the proportion of NVQ trained staff will soon meet the standard. DS0000069039.V333063.R01.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by the registered person and residents and their representatives are confident that the home is run in a way that supports the health and wellbeing of residents and staff. The home has sound policies and procedures and there are systems in place to monitor staff adherence to applying theory into practice. There are established quality assurance and monitoring processes in place to ensure that outcomes are good for residents. EVIDENCE: The Centre manager, Mrs Chrissie Whitmore, is a registered nurse and has worked in the independent care sector for 23 years. She has managed this service since 2000 and has extensive experience in her role. She is hoping to complete the Registered Manager’s Award in 2007. DS0000069039.V333063.R01.S.doc Version 5.2 Page 23 Residents and their families appreciate the manager’s leadership style and find her accessible and approachable. The Centre holds regular Resident/Relatives meetings to discuss improvements and suggestions about the way it is run. The managers operate an ‘open door’ policy that encourages residents, relatives and staff to raise any issues they may have. The BUPA internal quality assurance approach involves regular internal audit and analysis of all the aspects of care and facilities in the home. Residents and their families receive regular questionnaires about the home; the inspector looked at the most recent Resident Customer Survey (December 2006) analysis. The inspector discussed the arrangements for the safekeeping and management of residents’ personal allowances with the administrator. The systems in place comply with BUPA’s internal policies and procedures and provide a clear audit trail that safeguards residents from financial abuse. The fire safety logbook and training record was checked. This was up to date and in order, except that it was not clear whether required work to replace emergency lighting had been done: the manager confirmed that the work had been done and undertook to update the fire log/maintenance record. The sample of staff training records seen showed that staff receive mandatory induction and regular updates in health and safety topics, such as moving and handling (residents needs are assessed by a physiotherapist), food hygiene, health and safety, fire safety, and safe cleaning. DS0000069039.V333063.R01.S.doc Version 5.2 Page 24 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 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000069039.V333063.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action DS0000069039.V333063.R01.S.doc Version 5.2 Page 26 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. Refer to Standard OP7 Good Practice Recommendations * Written records of residents’ care should include evaluation of the care given, including how residents’ social and emotional care needs are addressed. * Daily record statements should be made more specific and be cross-referenced to the number care need/’problems’ identified in the care plans. * Review the use of notices displayed in residents rooms – their personal living space- as this gives an institutional impression. * Improve the privacy indicators on shared bathroom/shower/toilet facilities. * Provide some discreet means of concealing urinary catheter drainage systems where residents’ own clothing does not do this. * Provide screens/shower curtains to protect residents’ privacy and dignity when using shower and bath facilities in bathrooms with doors that open directly onto main corridors. Provide more storage space for equipment such as wheelchairs and hoists, so that bathrooms are not used for this purpose and the Centre can maintain the required ratio (1 bath/shower to 8 residents) of accessible bath/shower facilities for residents. * Review the staffing numbers and working patterns/shifts to ensure that staff are not working excessive hours and have sufficient rest periods between shifts. * Ensure that all staff have good communication skills in order to meet the assessed care needs of residents. 2. OP10 3. OP15 4. OP27 DS0000069039.V333063.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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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