Inspection on 09/11/09 for Beacon Edge Nursing Home

This inspection was carried out on 9th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beacon Edge Nursing Home 04/12/07

Beacon Edge Nursing Home 18/09/06

Beacon Edge Nursing Home 22/11/05

Beacon Edge Nursing Home 20/07/05

Beacon Edge Nursing Home 25/01/05

Beacon Edge Nursing Home 01/06/04

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

Key inspection report Care homes for older people Name: Address: Beacon Edge Nursing Home Beacon Edge Penrith Cumbria CA11 8BN     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Jinks     Date: 0 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Beacon Edge Nursing Home Beacon Edge Penrith Cumbria CA11 8BN 01768866885 01768210758 stokesw@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd care home 41 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following category: Dementia Code DE. The maximum number of service users who can be accommodated is: 41. Date of last inspection Brief description of the care home Care First Care Homes Limited, a subsidiary of BUPA, owns and runs Beacon Edge Nursing Home. Beacon Edge was originally a private house that has been altered and adapted for its current use and provides nursing care for 41 residents with dementia and 5 of these may be under 65 years of age. The home is on the outskirts of the market town of Penrith close to residential areas and overlooks the town; it is on local bus routes and is within a mile of local amenities. The residents bedrooms and communal areas are on the first and ground floors that residents can reach using a passenger lift. The home has three lounges/ dining areas, a conservatory for residents and a quieter area. The home has a kitchen on site and the homes laundry goes to another nearby BUPA Care Homes for Older People Page 4 of 37 Over 65 0 41 Brief description of the care home home to be done. Outside, the home has two small car parks for visitors and staff and well kept gardens. There is a sensory garden for residents. Fees payable are variable and are subject to the care needs assessment. There are additional charges for hairdressing, chiropody, newspapers and magazines and personal toiletries. The home makes information about its services available through its service user guide, welcome pack and statement of purpose. These documents and CQC inspection reports, are available in the home. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this service takes into account all of the information we have received since the last inspection. We sent surveys to some of the people that live and work at this home in order to obtain their views about Beacon Edge. We also asked some relatives to complete and return surveys, which they did. The inspection included a visit to the home by three inspectors, including a pharmacist who checked the medication arrangements in place at the home. During our visit we looked at a variety of the records that the home is required to maintain. We looked around the home to assess the general environment and living accommodation provided to people that use this service. We also carried out a Short Observational Framework Inspection (SOFI) during this visit to Beacon Edge. SOFI is a methodology we use to understand the quality of the experiences of people who use services who are unable to provide feedback due to Care Homes for Older People Page 6 of 37 their cognitive or communication impairments. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. We spoke to some of the people that live and work at Beacon Edge, including the manager and the responsible person. A manager and the provider completed an annual quality assurance assessment (AQAA) and returned this to us. The information recorded in the AQAA was incomplete but provided us with brief information about the service to help us to check the information we gather during the visit to the home. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The home is currently managed by an acting manager. The organisation must ensure that a manager is registered with CQC and an application must be made without any further delay. A registered manager is required by legislation and the home has been without one for at least 9 months. The processes in place for developing care plans should be reviewed. This will help ensure that initial plans are drawn up soon after a person is admitted to the home and ensure staff have some knowledge and information about the health and support needs of new residents. Care Homes for Older People Page 8 of 37 The manager must make sure that all records relating to medication are accurate to prevent errors that could cause harm. She must also ensure that ordering procedures are reviewed to prevent medicines running out. Care plans for complex and when required medication should be more detailed so that staff have clear guidance for managing these. Audit of medication should be more thorough so that concerns are identified and dealt with promptly to keep residents safe. Where issues are identified and indicate that health care professionals are required to intervene, this should be done without delay. Where advice and guidance is given, this should be recorded and monitored to ensure that staff are following these instructions and people are responding to treatment. Staff at the home should have training in the safeguarding of vulnerable adults so that they are clear about what constitutes abuse and when circumstances should be reported to social workers and to us, the Care Quality Commission (CQC). The manager must review the staffing levels, skills and experience to reflect the care and support needs of the people that live at Beacon Edge. Training needs should also be reviewed and addressed to ensure that staff have the necessary skills to meet the aims and objectives of the service. Improvements need to be made to the risk assessment processes at the home. Staff need to know what is recorded in them and follow the instructions given to ensure the safety of residents and themselves. We have made 12 requirements and 13 recommendations as a result of this inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service have their health and social care needs assessed prior to moving into Beacon Edge. This helps the provider to decide whether the home will be able to meet the needs and expectations of the people wishing to live there. Evidence: The home produces a statement of purpose, service user guide and a welcome pack for residents and prospective residents. The statement of purpose does not include sufficient information about the person designated as responsible for the service or of the acting managers skills and experience. We also found that this information is only available in one written format. Consideration should be given to producing it in alternative formats so that people using this service can access it more easily. People told us that they mostly received sufficient information about the home to help them make their decisions to use this service. One relative thought that this was an area where some improvements could be made. They told us; more detailed Care Homes for Older People Page 11 of 37 Evidence: information in writing to the family before the resident moves in would be an advantage, such as visiting, meals and any information that is needed from the persons family. Everything is explained when requested but it would make it easier for the staff and family. People using this service are provided with information about their terms and conditions of residency - a contract. This helps to ensure that people know what services they can expect whilst living at Beacon Edge. We looked at a sample of peoples care records. We found that people had their care and support needs assessed prior to moving into Beacon Edge. This process helps the acting manager to decide whether the home and the staff will be suitable and able to meet the needs and expectations of prospective residents. A relative said; the manager was very good and went to an assessment meeting prior to our relatives admission. The admission process was done quite quickly and it was a smooth process, except that some of her belongings have not been sent to Beacon Edge from her last home. The statement of purpose says that the home is able to provide specialist nursing care and support for people with dementia illnesses. We were told by the acting manager that one nurse at the home had recently undertaken some specialist training with the Alzheimers Society and would be the homes champion. The home currently has only one Registered Mental Nurse working there on night duty. General staff training records do not provide sufficient information to confirm that they have the specialist skills and knowledge to meet the aims and objectives of the service or meet the needs of the people that may live at Beacon Edge. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are gaps in the information recorded in peoples care plans. This means that people do not always receive the care and support they need nor are they always treated with respect and dignity. Evidence: One of the people that live at Beacon Edge told us that there are usually enough staff available and that they sometimes meet their needs. They said I think they do try hard to make a go of it. Relatives who returned surveys, indicated that there are usually enough staff with the right skills to meet the needs of the people living at Beacon Edge. During our visit to the home we looked at the personal care and support records of four people that use this service. They contain information about the care and support they need including, their personal care needs, nutrition, mobility, lifestyle and communication needs. We also undertook a SOFI exercise to help us assess the well being of people using Care Homes for Older People Page 13 of 37 Evidence: this service and to track whether the care and support they actually received, matched the needs recorded in their care plans. Our SOFI observation indicated that people experienced a neutral environment, for example just watching what was going on around them, or a positive state of well being. A high proportion of people were asleep during our time in the lounge. Staff interaction with residents was mostly positive. Most of the interaction between staff and residents was during the preparations for lunch and during lunch. One of the nursing staff told us that care plans are usually completed within 48 hours of a person moving into the home. Short term or interim care plans are not used and the nurse told us if there is something important about the persons care it will be recorded, but we usually have the care plan assessment from the social worker or hospital to look at too. Some of the care records we looked at were for a person who had recently been admitted to Beacon Edge. We found that an assessment had been carried out prior to their admission, although all of the information recorded was not as accurate as it could have been. Basic information had been recorded in some areas of the care plan. Many areas had not been completed, including plans to help the person settle into their new home, behaviour issues and how staff should manage them effectively, preferred routines and the correct use of sedative medication that is prescribed for when required. These omissions mean that this person may not be receiving the care and support they need with their daily life. Other care plans we looked at had been completed, kept under regular review and updated when necessary. Nutritional assessments and moving and handling assessments were included. Body weight and assessments of their skin condition are assessed and recorded. However, where problems have been identified, there is little evidence to demonstrate that advice is sought from specialised health care professionals to help ensure that people receive the care and support they need to maintain their health and well being. For example, where people have lost weight there are no food and fluid intake charts kept. One of the records we looked at did show that the person had been seen by a dietitian and advice had been provided. There was a care plan in place that had been recently updated but provided no information on how to increase calorific intake as recommended by the dietitian. The care plan of another person stated that they had poor eyesight and needed Care Homes for Older People Page 14 of 37 Evidence: assistance to wear the spectacles. This person did not have her glasses whilst in the lounge or during lunch and staff did not follow the communication care plan. We saw examples of care records where people had wounds or skin ulcers but there were no wound management or evaluation plans to help assess whether treatment was effective and that the wound was healing. We directly observed and read in daily notes, instances where staff clearly did not follow care plans and risk assessments, particularly where people were being supported with their mobility. This places people using this service at risk from harm or injury. We discussed this serious matter with the acting manager as it needs to be attended to swiftly. The pharmacist inspector examined the handling of medication by looking at relevant documents, storage and meeting with the acting manager, Sarah Hodges, and other staff. The inspection took nearly six hours. Feedback was given to the acting manager at the end of the inspection. Overall, we found that there were a number of areas that needed improvement in order to fully protect the health and well-being of residents. We looked at records for receipt, administration and disposal of medication. We found that some records for administration of medicines contained errors. Whilst most were pre-printed by the pharmacy some were hand-written by staff and contained errors such as missing doses or strengths of medication. This could place residents at risk of mistakes if medicines are not given as they are intended. Some records for the administration of creams, such as moisturisers and barrier creams, were sometimes incomplete and these should be improved. On occasions medicines were not given in the prescribed dosage or were omitted but the medicines administration records failed to explain why this was. We saw an instance when two doses of an antibiotic were not given but no reason was recorded for this. We also saw a pain-killer patch that must be replaced every 7 days that was not replaced until the eighth day. This could result in unnecessary pain. We saw many instances when medicines ran out, for example, laxatives, eye drops, dietary supplements and inhalers for people with breathing problems. This could cause serious harm to residents if they are not able to have the medication they need to keep them well. We examined a sample of residents files for information relating to changes to medication. Whilst most changes to medication were documented this was often done in various different places in the file. Some entries were very difficult to read and this could result in errors being made. This also meant that it was sometimes difficult to track clearly when and why changes had been made. It is advisable to have a standard system for recording this information for ease of reference. We also looked Care Homes for Older People Page 15 of 37 Evidence: at a sample of care plans for managing residents with complex or when required medication, in particular sedative medication. Some of these contained little guidance for staff to follow to ensure that the medication was managed safely and was given in a safe and effective manner with appropriate monitoring of effect. We checked the administration of when required sedatives and on occasions their use could not be justified from the records that were made at the time. Overall, the storage of medicines was in order. However, we checked medicines liable to misuse, called controlled drugs, and we found that the cabinet used for storage was not attached to the wall in accordance with the regulations. This must be addressed and will be checked again at the next visit. A requirement will then be made if this is does not then comply with the law. The acting manager told us that there were plans for further training of staff in the safe handling of medication. She also told us that she did monthly checks, or audits, of medication. We strongly recommend that these audits are done more thoroughly so that issues relating to medication can be identified and managed without delay to keep residents safe and to protect their health and well-being. Care Homes for Older People Page 16 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service have access to some social contact and leisure activities if they choose. This is limited for people who may have dementia or other cognitive impairments, which means that they may not be provided with suitable stimulation and choice in their social lives. Evidence: During our visit to Beacon Edge we observed that people were sometimes given choices in their daily lives. People were asked about what they would like to eat and drink and were supported to make these decisions. We also saw staff selecting different types of music in the communal lounge without asking residents if that is what they wanted. The acting manager told us that activities are led by individual interests and we did see in some care records where these had been recorded. We saw that the home had an activities programme on display and this included religious services such as holy communion, harvest festival and the Christmas service. Entertainers also visit the home and provide musical events. Information about the homes Nite Bite service is displayed on this notice board, this service provides residents with a choice of food and snacks between 6:30pm and 6.30am. Care Homes for Older People Page 17 of 37 Evidence: The residents we spoke to or who returned surveys to us, told us that there are usually activities for them to take part in if they wish and that people come to the home to provide entertainment. There are things going on and outings if people want to join in. Staff told us that the activities co-ordinator is very good but they would like to see more staff on duty so we could more often meet all needs - physical and psychological. We were also told that the activities co-ordinator maintains detailed records of the activities she provides and records who takes part in them. This helps her to tailor the activities programme to meet the needs and interests of the people that live at Beacon Edge. One person we spoke to was doing her knitting. She has lived at Beacon Edge for about a year and is quite happy. She told us the staff are fine. She also told us that she is a vegetarian and the cook is very good regarding dietary needs. Comments were also made about the meals by staff and visitors. They thought it would be better if; tea was served at 5pm instead of 4:30pm to leave more time between lunch and tea in the hope that residents will be better ready and enjoy their tea more. Another person thought that all meals should be served in the dining room not in the lounge on a plate. This would make it easier for some people to manage their food better. During the two hours of our SOFI observation we did not see any activities taking place and there was no 1:1 stimulation between residents and staff. We did see one resident who wanted to go out and became quite distressed. Eventually a member of staff did take them for a short walk and the person was much more relaxed on their return. A relative told us that there should be More opportunities to get out in the fresh air. We did not see any evidence during our visit to Beacon Edge to confirm that any specialist activities or services for people with dementia illnesses were included in the leisure activities programme. We did see some of the service of the lunchtime meal. The dining room is very dark and has poor lighting. This makes it difficult for older people to see what they are eating and drinking. We saw staff help people to the table and get ready for their lunch. Some residents Care Homes for Older People Page 18 of 37 Evidence: needed assistance with their meals and we saw that staff sat down beside them in order to help them with their lunch. Care Homes for Older People Page 19 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are not always protected from the risks of harm and abuse. This may result in them receiving injuries or unsuitable treatments. Evidence: The home has policies and procedures in place with regard to making complaints and comments and in respect of safeguarding vulnerable adults (abuse). The complaint process is included in the information and welcome packs that are give to residents and their families when they move into Beacon Edge. Most of the people who returned surveys to us, told us that they know about the complaint procedure and who to speak to if they are not happy about something. They added that concerns are usually dealt with appropriately. The person who completed the AQAA told us that the home had received one complaint and that this had been investigated, but not upheld. They told us that the home had received many compliments about the service provided. People using this service, or their relatives, have access to the acting manager or general manager on a regular basis via a clinic type arrangement. The managers office has been moved to a more accessible part of the home to help ensure that people using this service are able to speak to her more easily if they need to. Care Homes for Older People Page 20 of 37 Evidence: We looked at some of the records kept at the home, particularly the ones relating to accidents and incidents and some of the daily notes kept in individual care files. The person who completed the AQAA told us that there had been no incidents at the home that needed to be reported to social workers under safeguarding procedures. However, we saw from the records that there had been several incidents where people using this service have been at risk from harm or injury. These incidents should have been reported both to social workers and to us the Care Quality Commission. Some of the people that live at Beacon Edge, do at times present with challenging or aggressive behaviour. We found that care plans do not always provide staff with information or strategies to help prevent and manage this type of behaviour. This means that people using this service may not always be properly supported or protected from the risks of harm. We looked at staff training records. The acting manager has received training in safeguarding adults but she could not provide us with a record to confirm that other staff are provided with training in this subject. The AQAA identifies that this is an area where improvements could be made and states that the home will continue with training and development in the subjects of safeguarding and dealing with complaints. Care Homes for Older People Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Beacon Edge generally provides a warm and comfortable environment for the people that live there. Evidence: As part of our visit to Beacon Edge we looked around the home to check on the environmental standards and cleanliness. The home has recently undergone major refurbishment work, particularly to the decor and furnishings. Communal areas are identified by bright icon style signs to help people find their way around the home and access facilities. The communal areas of the home are generally clean, tidy and furnished to a good standard. The home employs domestic assistants to help maintain it in a clean and hygienic condition. At our last visit to Beacon Edge we made some recommendations in respect of the cleanliness and odours at the home. We did note some improvements in this area although there were still some areas with slightly unpleasant odours. The organisation has property and estates departments to help ensure the home is well maintained. Visits to the home by regional managers are said to focus on the standards of housekeeping. The home employs a maintenance person and a handyman who also provide a 24 hour on-call service to help ensure the home is maintained to a good and safe standard. Care Homes for Older People Page 22 of 37 Evidence: The home is equipped with fire fighting and fire detection equipment. These are maintained, tested and serviced regularly. We found that the dining room at the home is poorly lit and presents safety issues for people moving around in that room, besides the fact that people cannot properly see what they are eating and drinking. We found that bathrooms were not maintained as well as they could be. Shower and bath chairs were not properly cleaned and some bathrooms had clothing left on the floor and toiletries left out - all of which present potential hazards to the people who use this service. Toiletries should be safely stored in individual bedrooms and not left for communal use. Personal clothing should be treated with respect and cared for, not left on the floors of communal bathrooms. Not all bathrooms and toilets were equipped with suitable waste bins and this presents the home with infection control risks. Some bathrooms had liquid soap dispensers and alcohol hand gel, which is good hygiene practice, but others had bars of soap, again for communal use. Communal bathrooms, shower rooms and toilets are equipped with aids and adaptations to help people access these facilities. They also have emergency call bells, but the majority of these were not within easy reach of the people who may use these facilities. This makes it difficult for them to call for assistance if needed. Many of the bathrooms and toilets were not fitted with a lock for use when occupied. This does not promote the privacy and dignity of the people that live at Beacon Edge. People using this service all have their own private bedroom. People are able to personalise their rooms with photographs, ornaments, televisions, radios and small items of furniture. These things help to make their room familiar, more comfortable and homely. Outside each room is a glass frame containing photographs and mementos of the people that live in that room. The people returning surveys told us that the home is usually clean and fresh. One person said; my whole family have been impressed. The furnishings and decor are very welcoming and my mother said on the first day here that it was very comfortable. Care Homes for Older People Page 23 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some gaps in the training processes, which means that there may be times when staff do not have the skills and experience to deliver the services and care that the home offers to provide. Evidence: The home is staffed by care assistants and registered nurses. At the time of our visit there was only one specialist Registered Mental Nurse working there. A large proportion of the people that use this service suffer from dementia illnesses and require a considerable amount of specialist care and support from staff. Staff rotas show inconsistent staffing levels and that staff, at times may be attending training for some of their shift. There was no evidence to demonstrate that extra staff cover is provided for these times. Additionally, the home has covered a significant number of shifts with workers from their own bank of staff. The person completing the AQAA told us that the home has a good level of staff retention. We were told that 23 staff have left in the last year. This high figure is due to the way in which the organisation purges their staff recording system. From time to time records are cleared of staff who may have retired or cease to be on the list of bank staff. The way in which staff are employed at the home, particularly the high use of their bank staff, may impact on the consistency of care and support that people Care Homes for Older People Page 24 of 37 Evidence: living at Beacon Edge receive. Some of the staff told us that there are usually and sometimes enough staff on duty. One person said; Id like to see the legal quota of staff:residents so we could more often meet all needs, both physical and psychological needs. However, there is no legal quota. We would expect the manager to ensure that there were a sufficient number of suitably trained and experienced staff on duty in order to meet all the needs of the people that live at Beacon Edge. Another member of staff told us; Staffing levels have been an issue over the last few months. Agency staff and homes own staff have covered the work, but as a result our paperwork is not as up to date as it should be. One of the residents told us that they sometimes get the care and support they need and that there are usually enough staff available. A relative thought that the home could make improvements to the internal communication between care staff and staff shifts. The organisation produces staff recruitment and selection procedures for the home to follow. These help to ensure that only suitable staff are recruited. We looked at some of the recruitment records of recently employed staff. We found that the acting manager ensures prospective employees complete job application forms and provide details about their experience, skills and previous employments. Important checks such as references, criminal record bureau (CRB) and Safeguarding Vulnerable Adult (SOVA) lists are undertaken before the person starts to work at Beacon Edge. This process helps to make sure that people are protected from staff who may be unsuitable to work with vulnerable adults. We saw that recently recruited staff had undertaken induction training. Some of the staff also told us about this training and that it had covered everything that they needed to know about the job very well. Staff also told us that they receive some training to help them keep up to date with their skills and practice. The training records maintained at the home are not kept up to date and it is difficult to assess whether staff receive sufficient or relevant training and updates as they should. We looked at some of the staff training records. They show that staff have received basic training in moving and handling, fire safety, food hygiene, first aid, medication administration and dementia. Many of the dates recorded show that training took place some years ago and may need updating. Care Homes for Older People Page 25 of 37 Evidence: Some of the nurses have undertaken specialist training such as tissue viability and the management of pressure ulcers, blood glucose monitoring and the use of syringe drivers. One nurse was said to be completing an MA degree in dementia illnesses and care. He is the homes dementia champion and has also completed a dementia training course, which has been approved by Alzheimers Society. He is qualified to train staff in dementia care and acts as the dementia care role model at the home. Staff training is undertaken in a variety of ways including attending courses, watching training DVDs and completing questionnaires. The person completing the AQAA told us that 33 of the staff have completed National Vocational Qualifications (NVQ) in Care to at least level 2. The organisation plans to continue to support staff to gain the new qualification, which will replace the NVQ in the summer of 2010. Care Homes for Older People Page 26 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are gaps in the management systems, record keeping, staff training and supervision, which compromise the health, safety and welfare of people living in the home. Evidence: Beacon Edge does not have a manager that is registered with us, the Care Quality Commission. The acting manager at the home has been in post since February 2009. She is a qualified, registered general nurse and was previously the head of care at the home. During our visit to Beacon Edge the acting manager told us that she has recently registered to complete an National Vocational Qualification (NVQ) in management and is currently completing the BUPA management induction book. She has also undertaken some training in safeguarding vulnerable adults, the Mental Capacity Act and Deprivations of Liberty Safeguards. The acting manager of the home has been receiving guidance, support and training from the area General Manager. She told us that she did not complete the AQAA, this Care Homes for Older People Page 27 of 37 Evidence: was done by the General Manager. The AQAA provided us with brief information about the service and some sections of it had not been completed as required. The home carries out an annual quality assurance review of the service. Residents, their families and other interested stakeholders are involved in this. The acting manager is currently waiting for the report and the results to be published. Residents and relatives meetings are held at the home and the acting manager holds a regular clinic each week to help ensure people are able to raise issues or make comments about their experiences of Beacon Edge. We looked at the way in which staff working at the home are supported and supervised. The acting manager told us that the staff supervision was virtually up to date and that she carries out this task with the help of the other qualified nurses at the home. We looked at a selection of supervision records. The records did not confirm that staff are supervised as they should be. Comments in the surveys returned to us from staff indicate that the level of support they get from their manager is variable. The acting manager told us that the trained nursing staff had not been supervised since she took over. She also told us that she does not receive formal supervision but has frequent informal meetings and discussions with the General Manager and person responsible for the service. The organisation has provided a wide range of policies and procedures to help ensure the home is operated safely and in the best interests of the people that live there. From the information supplied by the manager in the AQAA, it is evident that these documents have not been reviewed or up dated for sometime. It is good practice to review such documents frequently to ensure they meet the requirements of any new legislation and are consistent with current good practice guidelines. During our visit to the home we looked at some of the records that the home is required to keep. Risk assessments have been carried out to help ensure people are safe in their bedrooms and these are monitored frequently. For example, window locks/restrictors and water temperatures are checked at least monthly. Wheelchairs and handling equipment are serviced and maintenance records are kept. Fire detection and warning systems, including emergency lighting and fire fighting equipment are checked regularly at the home and at least annually by an external contractor. Fire drills are carried out and staff receive training in fire prevention and fire evacuation procedures. Although all staff have undertaken this training, some staff do not have this training as often as they should. During our visit to the home we saw that a variety of health and safety risk Care Homes for Older People Page 28 of 37 Evidence: assessments are carried out, with records kept. We saw that staff had received some training regarding health and safety matters, but some of this needed to be up dated and refreshed. We saw staff using poor handling techniques when working with residents and clearly not following the instructions written in care plans and risk assessments. These practices place both residents and staff at risk of harm or injury. We looked at the way in which incidents and accidents are recorded and reported at the home. We found that some of the incidents recorded should have been reported to us and also to the social work team. The acting manager had not done this and this potentially places people at risk of further harm or injury. Care Homes for Older People Page 29 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 4 18 There must be a sufficient 08/03/2010 number of suitably qualified, competent and experienced people working at the home at all times. This will help ensure that the health and welfare of people using this service are properly supported and that the aims and objectives of the Statement of Purpose are met. 2 7 15 People using this service 31/01/2010 must have complete and up to date plans for all of their care and support needs. Clear instructions must be recorded of how those needs will be met. Care plans provide staff with the information they need to ensure people using this service receive the right care and support and are Care Homes for Older People Page 31 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action treated with respect and dignity at all times. 3 8 12 People using this service 31/12/2009 must have access to specialist healthcare professionals. Advice and guidance from such professionals must be clearly recorded in care plans and acted upon consistently. It is important to promote and maintain the health and well being of people using this service. 4 9 13 Ordering procedures for medication must be reviewed to prevent medicines from running out and to ensure residents always have the treatment they need. People must receive their medications as the doctor intended. 5 9 13 All records for administration 15/12/2009 of medication must be free from errors. This will help to protect residents from mistakes that could cause harm to their health and well-being. 6 18 13 There must be robust arrangements in place to ensure people using this 31/12/2009 04/12/2009 Care Homes for Older People Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action service are protected from the risks of harm or abuse. This must include, but is not limited to staff training, care planning and recording and a robust process for reporting matters of concern without delay. Staff must be clear about what action to take to prevent and protect people using this service from the risks of being harmed or suffering abuse. 7 20 23 A means of ensuring 31/12/2009 bathroom and toilet doors are secure when in use must be installed. The privacy and dignity of people using this service must be protected and promoted at all times. 8 22 23 Bathrooms, showers and toilet facilities must be kept in good working order, be clean, hygienic and free of hazards at all times. This will help to minimise the risks of cross infection or injury that they present to people living in the home. 31/01/2010 Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 9 27 18 There must be a sufficient number of experienced and suitably skilled staff working at the home at all times. Staffing levels must reflect the needs of the people using this service and take into account the aims and objectives of the home. 31/12/2009 10 30 18 Staff must be provided with training appropriate to the work they are to perform and to meet the aims and objectives of the service. Staff individually and collectively, must have the skills and experience to deliver the care and services which the home offers to provide. 28/02/2010 11 31 9 The service must be run and 31/01/2010 managed by a qualified, competent and experienced person who is registered with the CQC. People using this service must live in a home that is run in their best interests and by a suitably registered manager. 12 38 37 You must make sure that 14/12/2009 the Care Quality Commission are notified of any event that adversely affects the Care Homes for Older People Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action well-being or safety of any person using this service. The Care Homes Regulations require you to do this. This information helps us to judge the quality of the service provided and of the homes ability to ensure people using this service are safe and protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose should be reviewed to ensure it contains up to date and accurate details about the managers and responsible persons qualifications, skills and experience. Where the details for contacting other relevant organisations are listed, contact details should be updated and accurate. Consideration should be given to producing information about the home in alternative formats to help meet the communication needs of the people this service is aimed at. It is recommended that the manager undertake more thorough checks, or audits, of medication so that risks are identified and managed without delay to keep residents safe. It is highly recommended that care plans are more thorough and provide staff with clear guidance on managing residents with specific care needs for the administration of complex or when required medication so that they are managed safely and effectively. It is recommended that the manager implement a standard system for recording input from health care professionals and changes to medication so that these can be easily tracked. Page 35 of 37 2 9 3 9 4 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 5 9 It is highly recommended that care plans are more thorough and provide staff with clear guidance on managing residents with specific care needs for the administration of complex or when required medication so that they are managed safely and effectively. People using this service should be provided with opportunities to be involved in meaningful activities of their own choice and based on individual interests, needs and capabilities. Particular consideration should be given to the interests of people who may have dementia illnesses. Lighting in communal rooms should be sufficiently bright enough to facilitate activities such as eating, reading and moving around in safety. An accessible alarm/call system should be available in every room, including bathrooms and toilets. This will help ensure that people using this service are able to attract the attention of staff quickly, when needed. Personal toiletries should be kept in peoples own rooms to help avoid use by others and to minimise the risks of potential harm or cross infection. It is recommended that the arrangements for staff to obtain nationally recognised qualifications be reviewed. Staff need to have their skills and practice up to date to help ensure the specialist needs of people using this service are met appropriately. Accurate and detailed records should be maintained for each member of staff in relation to the training they have undertaken. This helps to identify any gaps in their knowledge or when training updates will be required. Policies, procedures and practices should be regularly reviewed to ensure they reflect current legislation and good practice advice. Staff should receive regular supervision and have their care practices monitored. This will help ensure that staff are working to the policies and procedures of the organisation and fulfilling the aims and objectives of the service. 6 12 7 20 8 22 9 26 10 28 11 30 12 33 13 36 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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