CARE HOMES FOR OLDER PEOPLE
Beacon Court 4 Church Road Dartmouth Devon TQ6 9HQ Lead Inspector
Judy Cooper Announced 27 April 2005
th 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 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. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Beacon Court Address 4 Church Road, Dartmouth, Devon, TQ6 9HQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 832672 01803 832672 Thurlestone Court Limited Nigel John Harvey Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (34), Old age, not falling within any other category (34), Physical disability (34), Physical disability over 65 years of age (34) Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. PD from age 50 years. 2. To complete the NVQ qualification in Care and Management and/or the Registered Manager`s Award by 2005 Date of last inspection 5/10/04 Brief Description of the Service: Beacon Court is a large detached house situated on a hill in a quiet residential area, and on a bus route. Service users’ bedrooms are on four floors with sixteen registered single and three registered double rooms, most of them have en suite facilities. Many rooms have views over the town. Three of the floors are accessed via a shaft passenger lift and there is a stair lift to the lower ground floor (bottom floor). Two rooms on the first floor require a service user to be able to negotiate two steps to access the rooms. There are two lounges, a dining room, part of which easily converts to form a quiet craft area and a conservatory with a sun terrace, which has far reaching views over Dartmouth and the surrounding area. There is a garden area at the rear of the property and a car parking area at the front. The home has good, level access from the car park. The home cares for older people including those who are confused. The home can also offer care for service users, from the age of fifty years plus who are physically disabled. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day. No feedback forms were received prior to the inspection from residents, relatives of any other professional. The majority of those residents present during the inspection were spoken with, as was a visiting District Nurse. Opportunity was also taken to tour the premises, examine records and policies and talk with the Responsible Person’s representative, (who was present throughout the inspection), the home’s registered manager and staff on duty. What the service does well:
Beacon Court provides a comfortable, secure, well maintained environment, where residents’ individuality and residents’ rights, such as dignity, respect and privacy are upheld. Visitors are welcomed and encouraged and links maintained with the local community. The staff team is well trained and able to meet the needs of the residents. Some members of staff, including several night staff, have worked for a number of years at the home and are therefore well known and trusted by the residents. Residents are able to choose how they spend their time with some very individual lifestyles supported and maintained according to residents’ wishes. A particular strength of the home lies in the manager’s ability to communicate with the residents and staff, in such a manner as to encourage good, open communications generally throughout the home. The management of the Court Group, in turn, offer strong, regular support to the manager, visiting the home at least once a week and being available as required. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, (6 is not applicable). The admission process continues to be well managed with residents’ needs explored and known prior to admission to the home. EVIDENCE: The owner and manager continue to maintain the home’s statement of purpose and service user’s guide appropriately, with any updated details being forwarded to the Commission, for the home’s file as relevant changes occur. By looking at the records for a resident, who had recently been admitted to the home it was noted that a very full and detailed admission procedure was undertaken, which had ensured that Beacon Court was considered an appropriate home for the resident. The resident was able to confirm that they were comfortable at the home and their very individual needs were being met. Staff were also seen providing appropriate and thoughtful care to this resident. The home does not provide for intermediate care. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Residents are looked after well in respect of their health and personal care needs. The home’s medication systems are in order and the administration of medication fully accounted for, however staff involved in the administration of medication have not received accredited medication awareness training. Staff are aware of residents’ needs and meet these needs satisfactorily. Staff respect residents’ individuality and maintain their privacy as well as their independence. Staff continued to feel supported in their caring role by the management of the home. EVIDENCE: Care plans contained all relevant details in relation to an individual residents’ care. The care plans had been regularly reviewed with the resident and/or the resident’s relative/next of kin or by the home’s staff, as agreed by the resident. The home liaises with other professionals as required and a District Nurse was visiting on the day of inspection and was able to confirm that, in their opinion,
Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 11 the home is providing adequate care, in relation to current residents’ clinical needs. Two residents are currently using oxygen and it was noted that staff are aware of how to use the equipment and are made aware of any associated risks. The home’s medication cupboard and medication records were satisfactory. Suitable, approved training in the administration of medication has not been provided to all staff administering medication. The home’s accident reporting was seen to be in order. Daily records are kept for each resident and these were very informative and well written, clearly showing all care provided to individual residents. Some positive verbal comments received from residents during the inspection stated such things as “I love it here the carers are sweet ”, “I am exceptionally well looked after and the staff are lovely”. Staff were noted, during the inspection, as being considerate, gentle and caring, whilst respecting residents’ dignity. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Residents enjoy a pleasant and varied life at the home, with visitors encouraged and appropriate, regular entertainment provided. Links are maintained with the local community. Meals provided are well balanced and tailored to residents’ identified preferences. Residents are enabled and encouraged to maintain as much independence as possible and are supported with any individual choices they wish to make/maintain. Residents’ dignity is upheld at all times. EVIDENCE: Staff undertake group activities with residents twice a day and all can join in if they wish to. It was observed that the afternoon session was thoughtfully undertaken in an area aware from those that wished to have a quieter afternoon without a lot of noise or activity. A professional entertainer/therapist visits the home monthly and regular mini bus trips are provided. The home operates an open visiting policy and the visitor’s book clearly showed that the residents had many visitors at varying times throughout the day, however unfortunately only one visitor visited during the time of the
Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 13 inspection and the inspector was busy at the time talking to residents and so not able to speak with them. The routines within the home are flexible to ensure that residents can maintain individual lifestyles and choose how they spend their time. Residents are treated with respect and an example of this was noted when a carer was marking residents’ clothing discreetly and carefully, in accordance with instructions she had been give by the senior carer on duty. Residents are currently involved in deciding how to use their postal votes, which were received and distributed to individual residents during the inspection. There are regular residents and staff meetings with the minutes from both available on communal notice boards. The manager holds monies for several residents, as requested by the residents or their next of kin/advocate in a locked drawer, and there were detailed receipts etc in respect of these, ensuring that those residents that do use this service can be reassured that their monies are being handled and kept appropriately and securely. All residents spoken with, who were able to verbally respond, complimented the standard of food saying it was of a good standard. The cook was spoken with during the inspection and it was clear that she has an awareness of residents’ individual preferences and of elderly persons dietary requirements. In addition, specific dietary needs are also well catered for. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: The home’s complaint procedure was clear and was displayed in a prominent communal area of the home. It included the Commission’s name and address. The manager has previously dealt appropriately and efficiently with any complaint made (the CSCI has not received any official complaint within the past twelve months). The manager ensures that residents are kept aware of how to complain by going over the complaint policy during residents’ meetings. There are appropriate, updated adult protection policies which staff have easy access to. Staff training in this area is also provided during a staff member’s initial induction training within the home, followed by regular updated training sessions which ensures that staff are fully aware of how to identify and deal with any form of abuse. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 Beacon Court is comfortable, clean, warm and well maintained. EVIDENCE: The tour of the building showed that the home maintains its upgrading programme to allow the home to provide a high standard of accommodation. The accommodation presented as comfortable, well maintained, clean and welcoming. Bedrooms have been personalised as desired and residents can bring in personal items with them if they wish to. All rooms are being used for single occupancy (including the three registered double rooms). The responsible person stated that the home would provide a suitable lock if requested by a resident, but they are not provided as standard on admission. This is documented within the home’s statement of purpose. The lounge, sun lounge and dining areas are both spacious and well appointed. The manager and a designated member of staff, maintains the home’s fire precautions in line with the requirements of the local fire department. There is an infection control policy and all areas of the home were odour free. Staff have infection control training as part of the Court Group’s overall in house training package.
Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 16 The laundering needs of the residents are met appropriately. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staff at the home are well trained. They presented well in both appearance and manner. Staff are employed in sufficient numbers to meet the current resident groups’ needs. EVIDENCE: Staffing levels were seen to be in sufficient numbers to ensure that residents’ needs could be met during the day and night. Residents spoken to said that they felt well looked after and that staff were always available if needed. During the inspection it was noted that staff had the time to spend undertaking recreational pastimes with residents and attending to residents personal requirements, i.e. laundry marking, putting clothes away, talking to residents as well as attending to residents’ personal care needs. Training continues to be well planned and supports the staff in providing for the varied needs of the residents. Several staff, within the home, hold an NVQ training award (level 2,3 or 4) and their experience is reflected in some of the positive comments received from residents during the inspection. The owner has recently appointed two staff from overseas as part of the staff group. These staff are also to undertake NVQ training and were noted as being experienced within the care field within their country of origin. The staff file, in respect of the last two members of staff to be appointed at the home including one from overseas, was seen to contain a full and detailed staff
Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 18 recruitment programme which ensures that staff appointed are deemed suitable for the capacity they were employed within and residents therefore protected. Senior staff now make a record of any areas a member of staff may need to amend to ensure good care is always provided. A record is also kept of any good care practices noted by senior staff. This allows staff to monitor their own care giving and overall improve, and drive on, good care within the home. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,38 The home is managed efficiently and well. The home is providing a mostly safe environment for the residents, by ensuring the required health and safety standards are mostly met and maintained. However to ensure that residents are fully protected from the risk of sustaining a burn from hot surfaces, the programme already in place to cover all such surfaces, needs to be completed. Hot water, provided to residents’ facilities, should be regulated to a safe temperature where a resident has been assessed as being at risk of scalding if using non regulated hot water. EVIDENCE: Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 20 The manager has been in post for just under twelve months. Since his registration he has been successful in obtaining his N.V.Q level 4 in care and is continuing with the Registered Manager’s Award. The staff and residents spoke highly of the managers’ ability to manage the home and of his “kindness”. The home operates thorough internal quality monitoring systems with residents’ and relatives’ and visiting professionals’ feedback invited as part of the overall process. A representative from the management of the Court Group undertakes a monthly, in depth, quality audit visit where all aspects of the running of the home are examined and reported on, including consultations with the residents. This ensures that all practices within the home are regularly reviewed and that the care continues to be of a good standard and as residents would expect/want. The home had an annual development plan. The manger will look after monies for some residents as agreed with their families. In depth records of these transactions ensure that residents who use this service have their finances protected. Routine health and safety issues are well managed within the home with the required records being made available and all being seen to be up to date, which confirms that residents are cared for in a mostly safe and secure environment. Residents’ hot water to their washbasins is not regulated to a safe temperature. It is however regulated where there is full submersion bathing facilities and risk assessments are in place for any other areas. Some, but not all, hot surfaces have been protected throughout the home, although there are risk assessments in place in relation to those that have not yet been protected. Although these measures mostly ensure that residents are free from the risk of scalding or sustaining burns from hot surfaces, as some of the current resident group are both mentally and physically dependant, the manager needs to continually risk assess for any newly identified risks as residents’ needs either change or increase. This is due to the home being registered to, and offering, care for both physically and mentally frail residents, who could be considered to be at a higher risk of sustaining a scald/burn from non regulated hot water or non protected hot surfaces. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 4 x 3 x x 2 Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 22 YES 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 OP25 Regulation 15 Requirement The registered provider must continue to ensure that all pipe work and radiators to which service users have access must be risk assessed and guarded or have low temperature services.(This is a previous requirement with a previous timescale of 04/04/05). Timescale for action 27/04/06 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 OP9 OP25 Good Practice Recommendations Suitable, approved medication awareness training should be provided to all staff that are involved in the administration of medication within the home. The registered provider should continue to ensure that all water outlets, including hand basins within the home, are risk assessed and the hot water regulated to 43 degrees Centigrade as required 3. Beacon Court D54-D07 S51573 Beacon Court V210836 270405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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