Inspection on 16/08/06 for Beacon Hill Lodge Nursing Home

This inspection was carried out on 16th August 2006.

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

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

Other inspections for this house

Beacon Hill Lodge Nursing Home 15/09/08

Beacon Hill Lodge Nursing Home 28/06/07

Beacon Hill Lodge Nursing Home 23/01/07

Beacon Hill Lodge Nursing Home 07/11/05

Beacon Hill Lodge Nursing Home 31/05/05

Beacon Hill Lodge Nursing Home 06/09/04

Beacon Hill Lodge Nursing Home 27/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Beacon Hill Lodge Nursing Home 18 Beacon Hill The Downs Herne Bay Kent CT6 6BA Lead Inspector Mrs Susan Hall Unannounced Inspection 09:10 16 and 17 August 2006 th th 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 Hill Lodge Nursing Home DS0000026079.V301587.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 Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beacon Hill Lodge Nursing Home Address 18 Beacon Hill The Downs Herne Bay Kent CT6 6BA 01227 375536 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) Unique Help Group Limited Vacant Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the total of 30 beds 5 are also registered for Residential Care for Older People One (1) person with DE whose date of birth is 05/05/1944 Date of last inspection 23rd June 2006 Brief Description of the Service: Beacon Hill Lodge is a detached Victorian building, which faces the sea front at Herne Bay. It is close to the town centre, with it’s shops and other amenities. The home is owned by Unique Help Group, which itself is a part of Nicholas James Care Homes Limited. The Company own another 4 care homes with nursing, in this vicinity. The Home is registered for a total of thirty beds, most of which are for single use, and have en-suite facilities. There has been a change in the registration category this year, which now enables the home to take older people who have dementia and nursing needs, as well as older people with nursing. There is an understanding with CSCI that the home will consult with service users who do not have dementia on an ongoing basis, and will not admit dementia service users who may have disruptive behaviour. The Home has a large lounge and a separate dining room. There is easy access between the ground and first floors via a passenger lift. All rooms have a TV point, nurse call alarm and telephone point. The Home has parking space for guests at the front of the premises, and on road parking as well. The fee level is from £388.68 - £505.00. This information was given to the Inspector on the first day of the inspection visit. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection visit took place between 09.10 – 5.10 pm on the first day, and between 09.00-12.00 on the second day. The Inspector had carried out a random inspection in June 2006, to look specifically at nursing and wound care. There had been a number of concerns raised by relatives, District Nurses and care management between June – August 2006, and the Inspector assessed most of the National Minimum Standards to obtain a clear view of how the Home was functioning. Six requirements were given at the random inspection in June 2006. The ones for immediate attention had been met, and the other requirements were in the process of being met. As well as concerns voiced by different relatives and health professionals, there have been 2 referrals to the Kent County Council Adult Protection Team, which are currently under investigation. The Inspector was assisted during the 2 days of the visit by the company’s Group Manager, and by the Acting Manager from another of the company homes. He had been helping out with management over the previous few weeks, as the home is without a manager. The Inspector discussed this with a CSCI Regulation Manager after the inspection visit, and contacted the Group Manager and the Provider to ensure that this Acting Manager was enabled to return to concentrate on the home to which he is already allocated – as he cannot effectively manage both homes. The Inspector was concerned to find that the lack of management and leadership in the home had contributed to unrest amongst many of the staff. Nursing staff had not maintained effective leadership in the absence of a manager. This was affecting the quality of care being given to service users, and contributing to poor professional attitudes by some staff. Insufficient information to service users and staff had increased the difficulties. In the week following the inspection, a Deputy Manager moved to Beacon Hill Lodge from another group home to help bring some stability. However, the Inspector was pleased to find that Service Users were generally quite content, and one said “the staff look after her very well”, and another that “there are lots of changes, but the staff are always nice.” The Inspector talked with 11 staff (apart from the senior management), 2 relatives and 6 service users. She also met other service users, and obtained further feedback from 3 relatives, 3 health professionals and 4 care managers. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home needs a good manager in place to implement many of the necessary improvements. Some of these are: The medication room is very cluttered and has inadequate storage. There is insufficient evidence of staff training for mandatory subjects. Staff recruitment procedures need tightening up. There is no evidence of new staff having a proper induction. Quality Assurance procedures need implementing. There are no recent records of staff supervision. Health and safety procedures and risk assessments are incomplete. There are insufficient activities in place for the stimulation of service users with dementia. There is much redecoration and refurbishment needed to bring the premises up to a satisfactory level of maintenance. This includes: The redecoration of many corridors and bedrooms. Refurbishment of some of the bathrooms. New equipment – especially in respect of nursing beds, and some bed rails. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 7 A review of ancillary and maintenance staff is recommended, as there do not seem to be sufficient numbers for managing cleaning, laundry, kitchen duties, and general maintenance. 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. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 (Standard 6 does not apply in this home). The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Sufficient information is provided by the home to enable service users to make an informed choice. EVIDENCE: The statement of purpose includes all the information required in standard 1 and Schedule 1 of the Care Homes Regulations. The service users’ guide is set out in large print, and clearly specifies the fee levels, what is included and what is not included. It contains a sample of the contract of residency, the complaints procedure, and a copy of a service user satisfaction questionnaire. The company intend to set up a web site in due course, which will contain photographs of their different homes. This could be of particular help for service users with dementia, as they will be able to see where they are going to stay if they have been unable to visit beforehand. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 10 Pre-admission assessments were viewed for 3 service users, and had been well completed. The pre-admission assessment for the most recently admitted person was carried out by the previous Acting Manager. Service users are invited to visit the home before admission if possible, but as most come from hospital, and have high dependency levels, they mostly rely on relatives and care management to find a suitable placement. There is a trial period of 4 weeks, after which a review is held to see if the placement is considered suitable. The home has had an agreed change in registration since April 2006. This enables the admission of service users who are over 65 years and have dementia and nursing needs, as well as service users who do not have dementia. The service users’ guide states that the home will not admit service users with dementia who display “behaviour which may be disruptive to service users already resident in the home.” Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 The quality for this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans showed significant improvements for recording of wound care, and requirements given about this at the last inspection have been met. Medication trolleys have been re-organised; but the medication storage room must be sorted and re-organised to promote good practice. EVIDENCE: The Inspector read 3 care plans in detail, and looked at another 2 in reference to wound care. Two plans were noted to have tippex used on them. This should never be used on this documentation as it could enable staff to falsify records. The care plans are stored in individual folders and have the service user’s personal details and photograph at the front. Admission information was sufficiently detailed, and included topics such as next of kin, reason for admission, religion, allergies and likes and dislikes. Items of equipment needed were identified, such as “needs hoist; needs airwave mattress.” Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 12 There is a “life history” sheet, and some of these had been completed, but others had not, as these documents have only been recently introduced. The completed ones contained details of the person’s family history, working life, memories etc., and are particularly helpful for providing information for service users with dementia. One viewed had been completed with the help of a relative. Pressure areas are assessed on admission, and are now shown on a body map. Nursing observations were all recorded. Care plans included relevant assessments alongside the plans themselves, and were being reviewed each month. These included cognitive assessments, hygiene and dressing needs, mobility, skin integrity, diet, safety, social needs and general risk assessments. They included specific information such as “hoist for all transfers”, “ do not give any very hot drinks”, and “ may try to eat inedible items”. Consent for use of bedrails was obtained from service users themselves, or from relatives where the service user lacked capacity. There was good evidence of input from health professionals in the more recent weeks. These included visits from the Speech and Language Therapist, Community Physiotherapist, dentist, dietician, and GPs. Wound care documentation had been well completed since the requirements given in June 2006. Each dressing change was documented, and shows the state of the wound and the type of dressing used. The Inspector was informed that new documentation was being implemented, but not until discussions and training had been carried out with all the nursing staff. Nurses complete daily records, and these were properly timed and dated. Care staff are allocated with specific service users to care for at each shift, and are informed of changes at handovers. They give written feedback to the nurses for any concerns or changes that they observe during that time. Care staff write their own daily reports for the service users they have been caring for. The Inspector noted that these were detailed accounts, and showed how the service users were feeling, as well as what they had been doing. Fluid balance charts are maintained for those who are ill. These had been well completed, and added up after each 12 hours. This was an improvement since the random inspection. The medication is stored in a clinical room. The two trolleys were in good order, but the room itself was very cluttered, untidy and disorganised. There is insufficient storage space, but it is unclear how much storage space is needed until the cupboards and shelves have been cleared of unnecessary items. The Controlled Drugs cupboard appeared to meet specifications. A contract was in the process of being arranged for the disposal of unwanted controlled drugs. Medication room and drugs fridge temperatures are recorded daily. The drugs fridge was running at 8 degrees, which is the highest acceptable level, and so this needs keeping under review. The contents of all cupboards and both Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 13 trolleys were examined. Creams and lotions are correctly stored separately. Some items had been prescribed over a year ago, but not used, and so were evidently not needed. Medication Administration Records (MAR charts) were inspected, and showed the receipt of medication on the charts. Each MAR chart had a photo of the service user. Each drug entry was signed by 2 nurses. Analgesia specified if one or two tablets were given. The MAR charts had an old list of staff signatures at the front, ongoing since 2003. Many of these signatures were for nurses who no longer work at the home, and the list was unclear and difficult to follow. It needs updating. The Inspector observed care staff treating service users with respect, and with attention to their privacy for personal care. On several occasions the Inspector observed service users trying to rise from their chairs, and seemed restless. These were service users who were unable to communicate their needs clearly. There did not seem to be a proactive approach from staff to find out if these service users were looking for something, or wanted the toilet. The staff lacked the leadership of a manager trained in dementia care. Care plans record any given preferences around death and dying, such as “ call relatives day or night”; a specific undertaker required, or choice of burial or cremation. Care staff will sit with service users if a relative is not available. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The quality for this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs to review the activities available, and make more provision for activities for all service users – those with dementia, and those without dementia. There is little contact with the community, but there are plans to improve this. The employment of kitchen assistants could increase the choices for service users at tea times. EVIDENCE: The home employs an activities co-ordinator for 2 hours on week day afternoons. She does not have a prepared list of activities, but tries to assess what service users want to do each day. This does not enable alert service users to have specific things to look forward to. There is a variety of board games, quizzes, bingo and some craft activities. These are carried out in the dining room after lunch. One service user said there “used to be exercises but they don’t have them any more” (i.e. armchair exercises to music), and another said they would “like more singing”. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 15 The Inspector observed service users who had poor communication abilities sitting in a lounge mostly unattended, and with no stimulation. The Group Manager said that they are intending to implement activities for service users with dementia, and to arrange trips out in a minibus. The company have 6 minibuses between the local homes, and some of the maintenance men have been checked and registered as suitable drivers. A co-ordinator at one of the other homes is starting to organise trips out for service users between the homes. Relatives and friends are able to visit at any time, but the front bell system is poor, and people are kept waiting outside for entry. This does not give a good first impression of the home. On the second day of the visit, the entrance hall was cluttered with wheelchairs, and this does not appear welcoming either. There is a keypad system to leave the home, and the front door sticks – so it is difficult to get out too. One relative said they had been offered drinks and meals when visiting, but another said they had visited many times and never been offered anything. Some improvements could be made with maintaining good relationships with visitors, and making them feel welcomed. Advocacy services are made available for anyone who requires this. Service users are encouraged to maintain their own finances if possible, and to make choices about their lifestyles where they can. They are able to bring in personal possessions, and many bedrooms were personalised. The Inspector visited the kitchen, and noted the cook had to go to the library room next door for one of the fridges, as the kitchen was not big enough. The cook carries out the cleaning processes, and had good cleaning rotas and lists in place. Food and fridge/freezer temperatures are recorded and graphed. The cook has completed City and Guilds chef training to NVQ level 2, and showed good knowledge of food hazards, and keeps excellent records. Daily records are kept for what service users eat each day, and this is also put on graphs so that a pattern can easily be seen for how well service users are eating. The cook prepares the menus, and ensures there is plenty of fresh fruit and vegetables. Each lunch has a starter, main course and dessert, and there are choices for each course. Meals and drinks are fortified with butter, cream or resource drinks for service users who are struggling to maintain their weight. Homemade soup is made every day, and fresh fruit smoothies are frequently offered. There is currently no kitchen assistant, and the cook does all the cleaning and other kitchen tasks. She prepares and gives out breakfasts, but teatimes are prepared and given out by care staff. The Inspector did not consider this good practice, as some of the care staff cook better than others, and sometimes the choice is minimal. A supper cook, or a kitchen assistant, dedicated to the task would enable the service users to have consistent quality, and increased choice. Some of the service users said it depended on which carer was doing Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 16 the teas as to whether it was all right or not, but “the cook is very good, and what she serves at lunch times is very nice”. Beacon Hill Lodge Nursing Home DS0000026079.V301587.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. The quality for this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff need training in the initial documenting of complaints. A complaints log system, and auditing, need to be implemented. There is insufficient evidence to show if all staff have received training in the protection of vulnerable adults. There are currently 2 adult protection investigations being carried out. EVIDENCE: The complaints procedure had been recently amended to provide the correct details. It clearly states that complainants will be responded to within 28 days, and includes details to enable complainants to access senior management, Social Services, or CSCI. Complaints were being documented in a notebook, and one complaint made to the home since the previous inspection had been appropriately dealt with by the previous Acting Manager. The CSCI Inspector received phone calls or letters of concern from 9 different sources since June 2006. Most of these centred around the callers’ perception of inadequate nursing care. Two referrals had been made to the Adult Protection department, and investigations are ongoing at the time of the report. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 18 Staff recruitment procedures include taking a POVA First check, applying for a CRB (Criminal Record Bureau) check, and taking 2 written references. One new staff member had confirmation of POVA First on her file, but other files checked did not. CRB checks are held centrally at Head Office and there was no list of reference numbers available to view. There was evidence of staff training in the recognition and prevention of abuse, but the Inspector could not confirm that all staff had received this training, as there is no staff training matrix in place. Certificates were not evidenced in all staff files viewed either. Beacon Hill Lodge Nursing Home DS0000026079.V301587.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 The quality for this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home needs much refurbishment to bring it up to a satisfactory standard. EVIDENCE: The Inspector viewed all areas of the home, including most bedrooms. Most corridors, and many bedrooms, need redecorating and re-carpeting. The communal areas could be improved with redecoration, but were not in such a poor state of repair as some areas. General redecorating of skirting boards, window sills, doors etc. is needed in most areas of the home. The group of homes have a team of maintenance men who carry out maintenance as directed by a maintenance manager. The Inspector talked with 2 maintenance men who were carrying out minor repairs. One said that they Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 20 were “ due to redecorate and re-carpet this home, and some new beds have been ordered”. Each home is visited weekly by a maintenance person, but the perception of 2 service users was that “they always have to wait for things to be done”. If something breaks on e.g. a Thursday, and the maintenance man does not call until the next Wednesday, this can be very frustrating. The Inspector discussed the system with the Group Manager, who said the system may be reviewed in the future. Most bathrooms and some en-suite toilet areas need refurbishment. The kitchen is too small for the amount of equipment needed, as a fridge is stored in a library room next door. This is not very satisfactory if service users (and their relatives) wish to be quiet in there. Some equipment needs replacing, and this includes some beds, head boards, commodes and bed rails. Many sets of bed rails looked old, and “bumpers” for the bed rails were thin and worn. As use of poorly fitting bed rails can contribute to dangerous risks for older people, it is important that all sets of bed rails are risk assessed, and are checked to ensure that they fit the beds properly. The home is equipped with a passenger lift for access between floors, and has sluicing facilities on each floor. One of these includes a sluicing disinfector. Staff said that the numbers of hoists were satisfactory, and these had been serviced in March 2006. No communication signs were seen - to assist service users with dementia with orientation. Radiators are fitted with guards, except that one guard was seen to be broken. The Inspector did not confirm if hot water temperatures are checked regularly, but noted that there was a list of bath temperatures recorded in one bathroom. The laundry area was viewed on day 2. This is a separate outbuilding at the rear of the property. All the laundering for the home is carried out here, and this laundry is also used for the washing of bed linen and towels from another large home within the group. There is one Laundry Assistant each day from Monday to Fridays, and a second Laundry Assistant on Mondays and Tuesdays. There is no Laundry Assistant at weekends. There are 3 large commercial washing machines, (with sluice facility), and 2 commercial tumble dryers. A red alginate bag is used for soiled items. Clothes are labelled by relatives or staff, and there is a name tag system in use which is easy to affix to clothing. The home employs 2 housekeepers for cleaning from Mondays to Thursdays; 1 housekeeper on Fridays, and none at weekends. It is a very large building. If a housekeeper is on leave or off sick, this leaves 1 or none for the whole building. The cleaning staff said that they do not have the time to pay attention to details as they would like. They try to keep the carpets clean, but most of them are “past it” now. The Inspector viewed the carpet cleaner which is a small domestic one. It had a broken section of tubing so would not Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 21 function properly. It was stored up a flight of stairs which is a health and safety hazard to carry it down from there (this is referred to in Standard 38). The housekeepers said that sometimes the maintenance men will come in with a large carpet cleaning machine. Some of the cleaning products had been changed, and they did not think these were as effective as previous ones. The home did not smell of urine on the 2 days of the visit, and this was a credit to their hard work. The rear garden has been paved, and there is a seating area. Some service users were enjoying sitting outside. The surrounding flower beds and tubs were over run with weeds. The Group Manager said that new gardeners had just been employed; the gardens will be much more enjoyable when these areas have been tidied up. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 The quality for this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Staffing levels have been satisfactorily maintained since July 2006. Staff recruitment files must be checked to ensure they contain all required information. Staff induction training must be fully implemented. EVIDENCE: Staffing levels had improved since the random inspection in June 2006. the home is registered with an agency for any emergency cover of staff. Current staffing levels are 1-2 nurses in the mornings, and 1 nurse on duty at all other times. There are 5 care staff in the mornings, 4 in the afternoons/evenings, and 2 at night. However, one of the care staff is allocated in the mornings to help in the kitchen, and to give out drinks, lay tables etc., and one of the care staff in the afternoons is allocated to cook the teas. So this effectively leaves 4 care staff in the mornings, and 3 in the afternoons and evenings – with a 4th to help with care when the food is cleared. The Inspector recommends that this system is reviewed. If kitchen assistants/ supper cooks were employed, this would enable the care staff to concentrate on caring. These staffing levels were for the current numbers of 20 service users, and the Group Manager said that staffing levels would be increased in line with more admissions. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 23 The home has 6 out of 16 care staff who have completed NVQ 2 or 3 training, and this equates to 37.5 . There are also 3 nurses from abroad who are completing adaptation training (not included in the percentage). The Inspector viewed 4 staffing files. These contained most of the required documentation, including completed application forms, health questionnaire, 2 written references, proof of identity, confirmation of POVA first check, and confirmation of training certificates. However, one did not contain a photograph, and one file for a staff member from abroad did not have a work history. Confirmation of employment for this person had been given before references were received. The Group Manager said that CRB (Criminal Record Bureau) checks are held centrally at the Head Office, so the Inspector was unable to verify that all these had been completed. There was no list of reference numbers available for inspection. The most recently recruited staff member had a note on file with the POVA first confirmation, stating the date when the CRB check was sent for. The Inspector discussed the process with the Group Manager, as this means that a Manager would not be able to view returned CRB checks. This would not be good practice, as a Manager should be aware of any previous convictions, and what for. Nurses’ NMC “PIN” numbers were checked prior to confirmation of employment. The Company have obtained the “Learn to Care” induction programme, but this had not yet been implemented, and new staff were not being given a proper induction. The home has a staff training file set up in alphabetical order, and this contains evidence of staff training courses during the past year. However, there is no staff training matrix, and without this, it is not possible to confirm that all staff have had the required mandatory training. There was also evidence of ongoing training, with courses booked for basic food hygiene, first aid, health and safety, moving and handling, and pressure sore prevention. One of the nurse’s files included training in venepuncture, adult protection, and an enteral feeding study day. The Inspector recommends that a separate list is kept of updated training carried out by nurses, so that their skills and competencies can be verified. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31- 38 The quality for this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home needs a registered manager who can bring leadership to the staff, and promote good working relationships. Health and safety processes need attention in some areas. EVIDENCE: The home has been without a manager since the beginning of June 2006. The Company had asked an Acting Manager from another home to assist with management in the meantime, but this left the other home without effective cover. The Company are actively recruiting a new manager. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 25 Lack of management and a clear lead to staff was evident in the home. Some staff had poor professional attitudes, which were affecting other staff who were trying to maintain good care. A lack of information to staff and service users was not improving the situation. Some staff meetings were taking place, but staff still felt uninformed. Quality assurance processes are ready to be implemented, but are not properly in place yet. Service user questionnaires are available and ready to be distributed and audited when a manager is appointed. There are no service user/relatives meetings at present. The Group Manager is carrying out monthly (Regulation 26) visits. The Inspector was informed that the home is due to be redecorated, recarpeted and refurbished; and this would encourage the Inspector to think that the home is financially viable. Service users’ pocket monies are stored safely in a locked area. Records are made in a hardback notebook. Two signatures are made for each credit/debit entry. Pocket monies are stored individually. When the account is closed it is signed for by the next of kin as well as the nurse on duty. The home does not act as an appointee for anyone. Staff supervision is not currently happening, although forms are in place ready to implement this. The Group Manager has ensured that she is available to staff while the home is without a manager. Policies and procedures had been reviewed by the Company at the beginning of the year. Other documentation (staff supervision, complaints log etc.) has already been identified as out of date. Maintenance files were viewed, and included an indexed fire safety folder. Action had been taken in response to a Fire Officer’s advice, and a Fire Service report in December 2005 confirmed that the action taken was satisfactory. The fire safety log book and staff register for fire drills needs updating. Fire alarm tests and emergency lighting were up to date. Other maintenance records for gas, electricity, appliances and passenger lift were all up to date. The Inspector drew the attention of the Group Manager to the dangerous practice of expecting domestic staff to carry a heavy carpet cleaning machine down a flight of stairs, and a new storage place must be located. The machine was also faulty, and needs repairing or replacing. Accident records were viewed and had been well completed. The Inspector recommends that an auditing process is established. Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 2 1 3 2 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 3 3 1 2 1 Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15 Requirement The provider must ensure that care plans are completed accurately, and without the use of “tippex”, which could enable staff to falsify records. To ensure that there is sufficient and suitable storage space in the medication room, for safe storage of medicines. To update the signatures list and PIN numbers of staff who administer medication; and to obtain an up to date BNF (British National Formulary) reference book. To review the activities currently available, and ensure that there are suitable activities provided for service users with dementia, and service users without dementia. To implement a complaints log and auditing system. Timescale for action 16/09/06 2 OP9 13 (2) 01/10/06 3 OP9 13 (2) 01/10/06 4 OP12 12 (1-3) and 16 (2) (n) 01/12/06 5 OP16 22 (8) 01/10/06 Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 28 6 OP18 13 (6) and 18 (1) (c) 23 (2) (b,d) To ensure that all staff have training in the Protection of Vulnerable Adults, and that records confirm this training. To provide the CSCI Inspector with an action plan for the redecoration and re-carpeting of corridors and bedrooms, where applicable. To review the state of the bathrooms, and provide an action plan for their refurbishment where indicated. To review the kitchen space, and provide an action plan for increasing this; or for altering equipment and storage so that the kitchen does not impinge on communal areas for service users. To ensure that the external grounds are safe for service users, and are appropriately maintained. To review equipment available in the home, and ensure that it is fit for purpose. This is with particular reference to nursing beds and bed rails, which must be replaced where necessary. To ensure that staffing recruitment files contain all the required information; and for CRB checks/reference numbers to be available for inspection. To ensure that all staff complete a recognised induction programme. To implement a staff training matrix so that mandatory DS0000026079.V301587.R01.S.doc 01/12/06 7 OP19 01/11/06 8 OP19 23 (2) (b,d) 01/12/06 9 OP19 23 (20 (a) 01/12/06 10 OP19 23 (2) (o) 01/12/06 11 OP22 23 (2) (c) and 13 (4) (c) 01/12/06 12 OP29 19 and Schedule 2 01/12/06 13 OP30 18 (1) (c) 01/12/06 14 OP30 18 (1) (c) 01/12/06 Page 29 Beacon Hill Lodge Nursing Home Version 5.2 training can be verified for all staff. 15 16 17 OP31 OP33 OP36 8 12 (2,3) 18 (2) To appoint a registered manager. To implement quality assurance processes. To implement formal staff supervision for all staff members. To ensure that the carpet cleaning machine is in proper working order. 01/01/07 01/12/06 01/12/06 18 OP38 23 (2) (c) 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP13 OP15 Good Practice Recommendations To review the system for visitors entering and leaving the home, so that visitors feel welcomed. To employ kitchen assistants or supper cooks to prepare teatimes, so that more choice is provided for service users at this meal. To review the numbers of laundry and domestic staff employed in the home, ensuring there are sufficient staff to keep the premises clean, and to keep laundry processes up to date. To implement a record for trained staff updates, skills and competencies. To ensure other relevant legislation is complied with – e.g. the Health and Safety at Work Act 1974. Equipment such as the carpet cleaning machine should be accessible without staff endangering their health. DS0000026079.V301587.R01.S.doc Version 5.2 Page 30 3 OP26 4 5 OP30 OP38 Beacon Hill Lodge Nursing Home Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beacon Hill Lodge Nursing Home DS0000026079.V301587.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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