CARE HOMES FOR OLDER PEOPLE
Beacon Farm Care Centre Beacon Lane Cramlington Northumberland NE23 8AZ Lead Inspector
Sam Doku Key Unannounced Inspection 27 February & 20 March 2008 10:00 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 Beacon Farm Care Centre DS0000000546.V355511.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. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beacon Farm Care Centre Address Beacon Lane Cramlington Northumberland NE23 8AZ 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) 01670 - 715000 01670 590567 Beacon.Farm@fshc.co.uk Cotswold Spa Retirement Hotels Limited (wholly owned subsidiary of Four Seasons Healthcare Ltd) Judith Brown Care Home 55 Category(ies) of Dementia - over 65 years of age (55) registration, with number of places Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 11 residents receive Personal Care 43 residents receive Nursing Care The home is able to provide 3 places to named residents under the age of 65, should any of these residents leave the home the CSCI must be notified 16th April 2007 Date of last inspection Brief Description of the Service: Beacon Farm Care Centre is set in its own grounds with a secure garden area, situated on the outskirts of Cramlington, with pleasant views over surrounding countryside. Entry to the home is via a country type road. It is within easy reach of local shops, public transport and other useful amenities including a popular garden centre. The home is registered to provide mental health nursing and social care to an older client group who have dementia. The fees charged by the home range between £376.00 and £460.00 plus the free nursing care component. But do not include the following; hairdressing, chiropody and toiletries. Residents pay for these in addition to the basic fee. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes.
The inspection was unannounced and started on 27 February 2008 and completed on a second visit on the 20 March 2008. Before the visit the inspector looked at: Information we have received since the last key inspection visit on 16 April 2007; How the home dealt with any complaints & concerns since the last visit; • Any changes to how the home is run; • The provider’s view of how well they care for people, as highlighted in the details provided in the Annual Quality Assurance Assessment (AQUAA); • The views of the residents who use the service and their relatives. During the visits the inspector: • talked to the residents, the deputy manager, nursing and care staff; • looked at information about the residents and how well their needs are met; • looked at other records which must be kept; • checked that staff had the knowledge, skills & training to meet the needs of the residents; • looked around the building to make sure it was safe & secure; • checked what improvements had been made since the last visit; • the inspector told the provider what he found. All of these activities contributed to the inspection findings. What the service does well:
The home has a good system in place for accounting for personal allowances that are held for the residents. The home is generally clean and devoid of any unpleasant odours. Residents are encouraged to bring personal items into the home. This provides a familiar and comfortable environment for them. Residents described staff as “kind and helpful”.
Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Records relating to the day-to-day running of the home must be kept in ways that are easily accessible. The complaints record could not be traced and therefore it had not been possible to assess the way the home deals with complaint investigations. The home’s fire risk assessment could not be traced. The fire risk assessment must be kept and made available for inspection at all times. One of the mobile hoists in the home has been decommissioned but is located in one of the bathrooms. A notice should be placed on it to warn staff not to use it. Staff files are poorly organised and it was difficult to access information about employment, training and other personnel matters in a logical manner. The communication between one organisation that provides an “Enabler” support for one residents and the home is poor. Essential information about the eating habit of the resident has not been shared between the home and the agency to ensure that his dietary needs are accurately recorded and addressed. There was a serious lack of attention to the care needs of one service user. Instructions from his GP to monitor and record his weight and any swallowing difficulties were not carried out by the nursing staff as requested. Information in one care plan was very confusing. The care plan states Tuesdays, Thursdays and Fridays as the days he goes out with his “enabler” but the care plan evaluation records said he goes out on Mondays, Wednesdays and Fridays. Details in relation personal hygiene was lacking in two cases. One resident had long fingernails and were dirty with excrement. Another had badly stained cloths from the food and drinks he had at lunch time and these were still evident at 3:30pm when he and his relative spoke with the inspector.
Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 7 There were a number of residents with no shoes or slippers on their feet. A number of these residents were walking around with just socks on. In one case the sock on the resident’s foot was loose and was a trip hazard to her. A member of staff was observed to be walking alongside the lady and talking to her but failed to notice that the sock was loose on her feet and could potentially cause her to fall. This compromises both the safety and dignity of the residents. The staff moral is extremely low and they expressed the view that they feel unsupported and undervalued. Care staff expressed concerns about situations whereby the staff from the home are the first to be called upon whenever there are staff shortages in other homes. The current situation with the registered manager working in another home was cited as an example. The uncertainty about the role of the manager had been commented on by staff, relatives and also from comments in the service user survey. This points to a lack of effective communication with staff and relatives about the mangers position in the home. A number of situations were observed where the care staff were in the lounge with residents but they were not engaging the residents in discussions or in any meaningful social or recreational activities. Staff expressed the wish to have more time to talk to residents but on the numerous occasions that the inspector visited the lounges, staff were not communicating with the residents. The dining arrangements and practices in the basement dining room can only be described as institutional. Long before the residents arrive in the dining room, plastic bibs were placed on the back of every seat ready to be put on residents as they arrive. Some of the residents obviously did not need to have bibs on them but they were nonetheless fitted with one. The tables were not set for the residents. There were no cutleries, tablecloths, cups and saucer or napkins. The tables were bare and presented like a bingo hall. These practices seriously compromise the dignity and self esteem of the residents. There were no side plate provided and two residents were noticed to place their toasts on the bare table. In the other dining room, it was observed that on three occasions staff stood over residents while assisting them with their breakfast. In two of these cases, there was no communication between the staff and the residents while they were being assisted with their eating. One resident was hurriedly fed with her porridge in two and half minutes. Staff were wearing plastic gloves while assisting the residents with their food. The ramp into leading to the dining room and the kitchen must be re-assessed for health and safety reasons. Staff commented on the difficulties in transporting residents in special chairs into the dining room. Some complained of severe strain on their back when transporting items to and from the dining are. Two situations were observed where items fell off the food trolley when it
Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 8 was being transported along the ramp. Items also fell off the medicines trolley when it was being transported. These are serious health and safety issues that must be addressed as a matter of urgency. On the two visits to the home there was inadequate staffing in the kitchen. On the first visit, both the cook and the kitchen assistant were brought in from another home and are not entirely familiar with the arrangements in the kitchen although the cook had work in the home on the odd occasion. On the second visit, there was only the cook and had no kitchen assistant to help. Relatives expressed their concerns about their mother frequently wearing someone else’s cloths. There was no awareness amongst staff of their responsibilities under the Mental Capacity Act 2005. Records for one resident show that there has been no assessment made to determine if she has capacity to form personal relationships. Potentially her rights are being infringed upon by those who are caring for her by not involving her in such personal decisions. The staff room should be suitably decorated and furnished to provide pleasant and relaxing facility for them. However, it was later explained by the area manager that there is an alternative staff room in the building for staff to use. Staff complained about the poor lighting in the car park. Staff described tripping hazards, but more worrying to them is that the car park is dark at night and staff feel vulnerable when accessing their cars after work. The medication system is poor and lacks a professional approach to the drugs administration system. The concerns are:Case 1: Both bottle and MARR sheets said X3 a day but she only gets her tablets X2 a day. On the 1/2/08 she started to get X2 a day but there has been no change to the MARR sheet or the prescription on the bottle. Case 2: Diazepam: 26/06/07 record show that 28 tablets were received and the first one was given on 28/6/07. No records to show when the tablets were given and then 28 tablets were received 12/12/07. On Thursday 20/3/08 there was 16 tablets left in the bottle but no record of the 16 tablets that have been administered. Case 3: Codeine Phosphate 30 mg.: 100 tablets received on 2/1/08 and today (20/3/08) there is 24 tablets left. On the MARR sheet commencing 6/2/08 there was 31 tablets left in stock. From 6 to 12 Feb. the MARR sheet shows medication being given and signed for. Since then there has been no further record of medication being given and signed for. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 9 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. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 10 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 Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 11 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): 3, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care needs assessments and full assessments from the social worker or the nurse assessor generally ensure that the care needs are clearly identified, recorded and are met. However, this is not extended to all residents, and therefore compromises the welfare of the resident who had no assessments and care plans in place. The home supports and encourages pre-admission visits by prospective residents and or their relatives. This provides the opportunity for them to assess the home for themselves before making their decision about coming to live there. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 12 EVIDENCE: It is the home’s policy that full assessments are carried out by the social workers or nurse assessor and copies made available to the home as part of the admission process. The home also carries out their assessments of the individual in their own setting to make sure Beacon Farm Care Centre has the necessary skills and facilities to meet the needs of the prospective resident. However, in reviewing the files of one recently admitted resident it was noticed that baseline information was to be collected by the nursing staff and within a month this information was to be used to write her care plans. This information was not collected and as result the resident did not have a written care plan after being in the home for six weeks. The home encourages prospective residents and/or their relatives to visit before admission is arranged. This is the policy of the home and the nurse in charge stated that they always make the offer for people to visit the home to see the place for themselves before making up their minds about coming to live there. Two relatives said they found their visits to the home, before the admission date, helpful and said it made it easier for them to decide on the home. One service user stated that she visited the home with her daughter before coming to live there. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Personal and healthcare needs of the residents are generally met but the arrangements for meeting specific healthcare needs are poor and seriously compromise the health and welfare of the residents involved. Some of the practices in the home compromise the dignity of the residents. EVIDENCE: The residents’ files show evidence of visits by GPs and other healthcare professionals. The home maintains record of contacts with healthcare professionals, including GPs, psychiatrist, chiropody service, dentist, optician and other healthcare services. However, the way in which some aspects of the residents’ personal and healthcare needs are addressed showed a lack of proper care and attention.
Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 14 In one case the GP had asked for the home for specific observations to be made and recorded, to enable him to decide if the resident would require further medical investigation. This instructions from the GP was recorded in the home’s diary to remind the staff to follow this but the nursing staff failed to carry our this task. The resident, whose weight was causing concerns, was to be weighed weekly but he was only weighed twice in the period between 13/2/08 and 3/3/08. Other residents’ weights were not checked on the regular basis as stated in the individual care plans. Review and evaluation of care plans are not taking place as stated on the review sheets. For example, in one case the care plan relating to choking stated that the care plan was to be reviewed weekly but from the 20/12/07 to 8/2/08 the care plan was reviewed only twice. There is serious lack of communication between the home and another agency, which is involved in the care of a resident. This is in relation to a resident’s eating habit, which is causing great concern to the home and the GP. The nurse in charge described how the resident manages to avoid eating by claiming to have eaten in the home before going out with the other agency, or likewise, saying to the home that he had eaten while he was out with the other agency, when in fact this was not the case. There were no plans in place to address this communication issue between the home and the other agency and the result was that the resident continued to loose weight. The drugs administrative system is poorly managed and lacks a professional approach to the way the system is managed. Three random residents medication records were selected and in all three cases there were serious discrepancies. The recording sheets did not indicated when tablets were given and also tablets were missing and could not be accounted for. Some recording sheet could not be found so that the missing tablets could be traced. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The residents are supported to maintain contact with their families, friends and the local community. Such support promotes close relationship with relatives and the community in which they live. Residents also enjoy occasional social and recreational activities but some of the practices in the home do not reflect the lifestyle and culture of the service users. This compromises their sense of wellbeing and life satisfaction. The residents receive nutritious diets, which contributes to their health and wellbeing. However, the dietary needs of one resident has been seriously compromised by the lack of communication between the home and another agency involved with his care. EVIDENCE: Relatives are encouraged to visit as often as they wish and during the inspection visits, there were a number of relatives and friends visiting their family members.
Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 16 The staff, residents and relatives confirmed that activities are organised for the residents but these are infrequent and could be more regular so that the residents can enjoy a planned and sustained programme of activities. One resident’s care plan showed that he regularly went to church on Sundays. However, there was an entry in his evaluation notes that says “no longer goes to church on Sundays”. There was no reason given for this. The nurse in charge explained that the volunteers from the church who pick him up had stopped coming. There were no alternative arrangements made or possibilities explored to enable him to continue to attend church services. The care practices relating to lifestyle were, in some cases inappropriate and institutional in nature. In the basement dining room the tables were not set with tablecloths, cutlery, condiments or napkins. All the residents had plastic bibs on and these were laid out on the back of the chairs ready to be put on the residents as they arrived in the dining room. In two cases, there were no side plates provided and the residents put their toast on the bare table. In the other dining room the arrangements for assisting people with their food were poor. All those who were being assisted had plastic bibs on. The staff wore plastic gloves while assisting people with their meals. While people were being assisted with their meals, there was little or no conversation between the care staff and the residents. One resident was hurriedly fed with her porridge in two and half minutes. In one of the dining rooms there was a large notice on the hand paper towel dispenser to remind staff that one named resident prefers cornflakes for breakfast. A large number of residents were only wearing socks and in one case the resident was walking about with loose socks, which was a potential trip hazard. It was noticed that a carer was walking alongside the resident and talking to her but failed to notice the hazard that the loose socks posed to the resident. Although staff stated that they seldom had time to sit and talk to the residents due to staff shortages, it was noticed that on numerous occasions the staff had the opportunity to engage in constructive activities with residents or talk to them but on every occasion the inspector visited the lounge he noticed that the care staff were sitting with the residents and not talking to them. One resident’s clothes were heavily stained with food that they had for lunch. There were staff in the lounge all the time and at 3:30pm the staff had still not noticed this. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Relatives and friends are confident that any concerns they raise would be appropriately dealt with. This promotes the welfare of the residents. However, one service user’s rights are not fully protected by the practices in the home and potentially exposes some residents to abuse. EVIDENCE: The home has a complaints procedure and most of the staff said they have received training in safeguarding adults. Staff were able to explain the policies relating to safeguarding adults and demonstrated how they would apply the policy in their role as carers. Two relatives commented that they would know how to go about complaining if they have any concerns. One family said they have complained before but were not entirely happy with the outcome. Consequently the inspector wanted to examine the records relating to complaints. The nurse in charge could not find the complaints book. The inspector was therefore unable to assess the way in which complaints are managed by the home and the company. Examination of the records relating to residents personal allowance show that there are good recording and computerised system in place to account for
Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 18 people monies. Record of receipts for purchases on behalf of residents are kept in individual folders. The protection of the rights of one resident to make decisions for herself was seriously compromised by the lack of proper assessment to determine whether she has capacity to make decisions about forming and maintaining personal relationships. There were no records of her being consulted in a matter that is very personal to her and for her emotional well-being. The staff did not seem to understand their duty under the Mental Capacity Act 2005 in relation to this resident’s situation. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally clean and maintained to good standard but there are serious health and safety issues relating the ramp leading to the dining area. This compromises the safety and welfare of staff and residents. EVIDENCE: The home is clean and maintained to good standards. The home is free of offensive odours. Bedrooms were clean and personalised to reflect individual preferences. All the communal areas are appropriately furnished. The kitchen was noted to be clean and maintained to good standard. There is a cleaning rota showing how the domestic staff keep up with the cleaning activities in the kitchen.
Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 20 The laundry was found to be well ordered and appropriate COSSH notices are in place. The laundry machines are suitable for cleaning foul linen. The grounds and the gardens are well maintained. However, the lighting in the car park has been commented on by all staff as inadequate and that they feel vulnerable when using the car park in the dark. This is a genuine concern to staff and therefore the provider must take appropriate action to ensure the safety of the staff. There are serious health and safety issues relating to the ramp leading to the dining room and the kitchen. Staff commented on the difficulties in transporting residents in special chairs into the dining room. Some complained of severe strain on their back when transporting items to and from the dining are. Two situations were observed where items fell off the food trolley when it was being transported along the ramp. Items also fell off the medicines trolley when it was being transported. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing complements are inadequate particularly in relation to nurse cover on the floor. This compromises the safety and welfare of the residents. The company generally adheres to its recruitment practices, which safeguards the welfare of the residents. It also provides training for staff but some staff training need to be updated to ensure staff have up-to-date knowledge in best practice. However, the staff personnel file are poorly organised making it difficult to make proper assessment of the recruitment practices as described by the staff. EVIDENCE: The rotas show that the number of care staff on duty during the day are adequate to meet the needs of the residents. The night staff have concerns about there being only three staff, including the trained nurse, through the night. They cited examples whereby the design of the building and the high dependency of the residents made it at times difficult to maintain the safety and welfare of the residents. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 22 There were examples where residents had to go to hospital and the home had to ring a relative to accompany the resident, as staff were not able to do this, otherwise it this would seriously deplete the staff cover in the home. On these inspection visits, it was evident that the nurse in charge also happens to be the only nurse in the home. The nursing staff described the stress that they experience by managing the home while at the same time being the only trained nurse who is providing the clinical and nursing cover on the floor. The senior staff rota did not reflect the actual staffing levels. Although the manager is not based in the home and her duties have, until recently, been shared between two homes, the rota gives the impression that she is available in the home five days a week between 08:00 and 16:00. The nursing staff indicated that in practice this is not the case as the manager spends most of her time in the other home. The rotas must always reflect the actual staffing levels in the home. The company’s recruitment policies are followed. However, the staff files are poorly organised and this made it difficult to adequately assess the recruitment process and to determine the training that staff have received. The files that were examined showed that some of the staff would need to have an update on mandatory training, dementia awareness and the Mental Capacity Act 2005. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a serious lack of management oversight of the day-to-day management of the home, with poor practices and lack of direction leading to low moral amongst staff at all levels. This compromises the welfare of the residents. EVIDENCE: There is serious lack of management oversight of the day-to-day running of the home. There were anxieties amongst the staff about the role of the registered manager as she took on the additional management responsibility of another home, to the detriment of Beacon Farm.
Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 24 The staff feel unsupported and comments like “we are not important in this job”, “we are always made to fill-in for other homes when they are short of staff”, “all they are interested in is reduce the staffing to save money”, “they don’t care about the dependency levels we have to cope with”. The staff moral is extremely low and staff feel that they are not important. The staff room was cited as an example of how low the staff think the company thinks them. The staff room was shabby, unattractive and dirty. Staff are poorly supervised and practices which should have been spotted and addressed had been allowed to continue. Examples include the poor medication administrative system, poor maintenance of the care plans, poor care practices, such as standing over residents when being assisted with their meals, poor observational and communications skills. There were other examples of institutional practices mentioned in other parts of this report. The staffing situation in the kitchen was not entirely satisfactory neither. Care staff expressed concerns about them being asked to work in the kitchen whenever there was shortage there. Staff were concerned about food hygiene standards when after working on the floor, including toileting residents, they are told to go and help in the kitchen. The home has a good system in place for managing the personal allowances for the service users. Details of purchases and receipts are available for those whose monies are held by the home. The company’s Health and Safety policies remain in place. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). All the servicing records that were examined were up to date. These included servicing of hoists, water treatment, electrical installation and gas servicing. Up to date servicing and maintenance of these services and equipments ensure a safe environment for the service users and the staff who work there. Regular fire alarm testing, fire safety checks and record of fire instructions were kept. There are records in the home indicating fire drills and fire instructions with staff. The fire risk assessment for the home was not available in the home and therefore could not be assessed. Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 1 18 1 2 2 X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 X X 1 Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 OP4 Regulation 14(2)(a)( b) Requirement The needs of the residents must be assessed and appropriate care plans must be put in place to ensure that the care needs of the residents are fully met. Resident care plans must be written to address all of their individual needs. Relatives must be consulted about the care records. Reviews of care needs must be properly structured. All care records must be dated and signed. Outstanding. (30/06/07). Suitable arrangements must be made to ensure that the healthcare needs of the residents are fully met. The provider must take appropriate steps to ensure that the staff receive appropriate training in safe handling of medication. (17/04/07) The residents must be treated in ways that promote their lifestyle experiences and to uphold their dignity and choice, including their personal hygiene. Staff must receive training and
DS0000000546.V355511.R01.S.doc Timescale for action 30/04/08 2 OP7 15.1 30/04/08 3 OP8 12(1)(a) 30/04/08 4 OP9 15(2) 15/05/08 5 OP10 OP12 OP14 12(4)(a) 30/04/08 Beacon Farm Care Centre Version 5.2 Page 27 6 OP13 OP17 12(3) 7 OP15 16(2)(i) 8 OP16 22(3) 9 10 OP19 OP20 OP25 13(1)(a) 13(1)(a) 11 OP27 10(1) 12 OP27 18(1)(a) 13 OP28 10(1) 14 OP38 13(4)(a) supervision to ensure that this happens. Residents must be supported to make decisions about their live and staff must receive training in understanding their role in ensuring that the residents right to form relationships are respected. Residents identified as having dietary and fluid intake problems must have these care needs properly met. A record of what they have had must also be maintained. (30/06/07) All complaints to the home must be fully investigated with a full response of the findings given to the complainant. (30/04/07) The lighting in the car park must be improved to ensure safety of the staff, visitors and residents. The ramp to the kitchen and dining area must re-assess to safeguard the safety and welfare of the residents and staff. Suitable arrangements must be made to ensure that there is a competent person in charge for the day-to-day management of the home. The staffing arrangement in the kitchen must be reviewed to ensure that the kitchen is adequately staffed at all times. Some of the institutional practices are unsafe and compromise the welfare of the residents. Staff must be observant of dangers such as trips and act promptly to address them. Fire risk assessment must be carried out and a copy kept in the home at all times. 15/05/08 30/04/08 30/04/08 01/10/08 01/06/08 01/06/08 15/05/08 30/04/08 30/04/08 Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beacon Farm Care Centre DS0000000546.V355511.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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
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