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Inspection on 23/01/07 for Beacon Hill Lodge Nursing Home

Also see our care home review for Beacon Hill Lodge Nursing Home for more information

This inspection was carried out on 23rd January 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home continues to provide good quality food, with a varied and nutritious diet. The cook is highly motivated to ensure service users receive the best possible individualised diets. The domestic staff have been doing an outstanding job in keeping the home so clean during large scale refurbishment work to the property. The home`s own surveys included comments from service users and relatives praising the warm atmosphere, clean environment, and caring staff. There is a clear commitment by the manager and staff to meet the national minimum standards, and to ensure that care for service users continues to improve. Care staff showed a genuinely caring attitude towards meeting service users` needs. There is a proactive approach to acting quickly to get things done. For example: the manager assessed a need for another high quality airflow mattress for pressure relief, and the provider immediately purchased another two. The management also noted the changed legislation, which entails carrying a out a new fire risk assessment for the Regulatory Reform (Fire Safety) Order, and this had already been carried out.

What has improved since the last inspection?

The Inspector was pleased to note many improvements since the previous inspection. These include: Improved care planning. Improved medication management. New auditing systems already being carried out by the new manager. A more welcoming atmosphere in the home. Implementation of an activities programme, so service users can decide if they wish to join in. Implementation of a complaints log and improved handling of complaints. Many improvements to the internal environment, such as refurbished lounge, dining room, corridors, two bathrooms, visitors` toilet and some bedrooms. Better recruitment procedures, and recruitment to increase care staffing levels. Co-operation between the management and staff to bring about improvements. Implementation of a staff training matrix, and increased opportunities for staff training. Commencement of formal staff supervision.

What the care home could do better:

The Inspector noticed that there are no communication signs to assist service users with dementia in understanding where they are going to next. However, this could be a sensitive issue, as service users without dementia said they were feeling increasingly isolated, and there were less service users with whom they could hold meaningful conversations. The home intends to manage the integration of service users with and without dementia, and consideration may need to be given for an area where service users without dementia can choose to meet together if they wish to do so. Continued discussion with service users is very important in this respect. Care staff expressed their frustration with insufficient time to carry out all their tasks. This especially impacts on mealtimes, as they do not want to rush service users who need assistance. The Inspector was informed that recruitment of more care staff was under way. Staffing levels must be reassessed; especially as service users with increasingly high dependency needs take more time to care for. The company have employed gardeners for the group of homes, but the flowerbeds at the rear of the property looked untidy and unattractive. Although the inspection took place in Winter months, much could be done to improve the outlook of this area. Consideration should be given for how to brighten up this area, so that it encourages service users to go outside in warmer weather. Other areas where improvements have been started, need to show continued progress.

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 Key Unannounced Inspection 23rd January 2007 09:30 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.V328273.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.V328273.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 Post 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.V328273.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the total of 30 beds 5 are also registered for Residential Care for Older People 16th August 2006 Date of last inspection 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 in the last 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 £403.21 - £588.00. This information was given to the Inspector as part of pre-inspection information. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a second Key Inspection in this inspection year, which included assessing most of the national minimum standards for a second time since April 2006. The last Key Inspection was carried out in August 2006, and showed that the home was not running smoothly at that time, and that most of the minimum standards were not being met. Eighteen requirements, and five recommendations were given. The Inspector used information collated since that time, as well as a visit to the home, to carry out this inspection. She was pleased to note that the company have worked hard towards meeting standards, and many improvements have been made. This has brought about a better morale amongst staff, and a determination to see better standards of care maintained. A new manager had been appointed a week prior to the inspection, and she already showed an awareness of things that need to be done in order to continue the improvement to the service. The previous acting manager is now working for another home within the same group. The Inspector was contacted by three sources (including relatives and care managers) regarding concerns about the home, and used this information as part of her investigations at the inspection visit. No complaints had been forwarded to CSCI, and five complaints made to the home had been dealt with appropriately. An allegation, which was forwarded to the Kent Social Services Adult Protection (AP) team, was not substantiated. Two referrals made to the AP team last July are still under investigation. The Inspector talked with five service users, and observed how staff were interacting with other service users. She also had conversations with seven staff (apart from the manager), including a nurse, care staff, kitchen and domestic staff. The group of homes have a maintenance team to manage upkeep, and they were much in evidence, and working hard to carry out improvements to the internal décor. Conversations with two of the maintenance team confirmed that they are carrying out extensive work, which includes refurbishing bathrooms, bedrooms, communal areas and corridors. Work which had already been completed was seen to be of a high standard. Service users said that they were pleased to see the changes being made, although “it will be nice when the work is all finished!” They generally expressed their satisfaction with the standards of care, with comments like “the girls are all good and very nice – and very helpful”; and “they look after me very well, and the food is really good.” Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The Inspector was pleased to note many improvements since the previous inspection. These include: Improved care planning. Improved medication management. New auditing systems already being carried out by the new manager. A more welcoming atmosphere in the home. Implementation of an activities programme, so service users can decide if they wish to join in. Implementation of a complaints log and improved handling of complaints. Many improvements to the internal environment, such as refurbished lounge, dining room, corridors, two bathrooms, visitors’ toilet and some bedrooms. Better recruitment procedures, and recruitment to increase care staffing levels. Co-operation between the management and staff to bring about improvements. Implementation of a staff training matrix, and increased opportunities for staff training. Commencement of formal staff supervision. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 7 What they could do better: 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 Hill Lodge Nursing Home DS0000026079.V328273.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.V328273.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 Quality in 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 company had already updated the Statement of Purpose and the Service Users’ Guide with the relevant information for the new manager. Apart from this, these documents were not inspected again, as they were seen at the last inspection to be well produced and have sufficient information. A specimen contract of residency is included in the service users’ guide, and is clearly set out, with details of insurance cover, and terms regarding a possible Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 10 stay in hospital. The guide contains a copy of the complaints procedure, and a copy of the service users’ satisfaction questionnaire. There had been no recent new admissions. The manager stated that she will carry out pre-admission assessments herself, and when she has a deputy manager, she will train this member of staff to do these as well. Previously viewed pre-admission assessments had been well completed, and showed a detailed assessment process. The manager stated that she will carefully assess prospective service users to see if they will fit in with the current life of the home. This includes ensuring that any service users who have dementia as well as nursing needs are not likely to be disruptive to other service users, or to have challenging behaviour. The company will need to keep under review how well the categories of service users interact with each other. The Inspector has already noted in the summary that some service users without dementia were finding the placement increasingly difficult. Service users are invited to visit the home prior to admission if possible. As most are admitted from hospital, and have high dependency nursing needs, they rely on their relatives or care managers to arrange for a suitable placement. There is a trial period of four weeks, after which a review is held to check if the placement is suitable. Beacon Hill Lodge Nursing Home DS0000026079.V328273.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff work well together to ensure that service users’ personal and health care needs are being met. EVIDENCE: The Inspector viewed three care plans, and noted that these had sufficient health care information. The care plans had been compiled into a new format during the past two months, so information was not seen prior to that time, except for some daily records. The plans are well laid out, enabling easy access of information. They showed monthly reviews of assessments. There was some evidence of service users (or authorised next of kin) being involved in the care planning. The plans will benefit from the inclusion of additional information during the coming months, but all the necessary information to provide care was available in the files viewed. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 12 The Inspector viewed some turn charts and fluid charts. Some of these were completed better than others, showing good evidence of repositioning and toileting service users at night, but not throughout the day. The Inspector had a brief discussion with care staff about completing the turn charts accurately, and it was clear from speaking to them that they comply with policies regarding two-three hourly toileting and pressure relief, but this could not always be evidenced on turn charts. Care staff expressed some frustration at not being able to spend as much time with service users as they feel they need to. The care plans showed clear details for personal healthcare provision, such as “likes to have a bath each day between 08.30-09.00, and needs assistance”; and details regarding chiropody, denture care, risk of falls, and the ability to use the call bells. Risk assessments were generally well completed, with suitable thought put into preventive care. Health care professionals are contacted as needed, and there was evidence of recent visits from an occupational therapist, a speech therapist, GPs, and a physiotherapist. Wound care was well documented, with a separate record for each time a wound was dressed. The new manager had already carried out a full audit of all wounds, bruises and pressure areas, and how these were being treated. The medication room was much better organised than at the previous visit, and medication documentation was placed in this room for easy reference. The cupboards and medicine trolleys were mostly in good order, including the controlled drugs cupboard. The drugs fridge was clean and in good order, and the temperatures of the fridge and the room were satisfactory. These are recorded daily. Eye drops and liquid medication had been dated on opening. The home has good records for all receipt and disposal of medication, and a contract is in place for the disposal of waste medication. Medication administration records (MAR charts) were examined and had been well completed. They include a photograph of each service user. Some handwritten entries had not been signed by two nurses, and there is a recommendation to ensure this is always carried out. Service users said that the staff treat them courteously and with respect, and that their privacy is protected. They are free to spend time in their own rooms if they wish, and some have had their own telephones fitted. The care plans include an assessment for service users regarding their views or requests when dying. Some of these were not fully completed yet, or service users did not wish to discuss this. The manager said that she was hoping to arrange some specific training for staff in care of the dying, and palliative care. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is taking steps to improve the range and quality of activities for service users with and without dementia; and there is a more welcoming atmosphere for visitors. The home provides good quality food for service users, which is suitably prepared and presented. EVIDENCE: The home has an activities co-ordinator for 2 hours per day, Mondays to Fridays, and she had previously been carrying out activities according to who was present in the dining room in the afternoons. This meant that it was mostly the same few people and the same activities. The new manager had discussed with her how to move ahead with arranging more meaningful activities, and the need to put a programme into place so that there is something for service users to look forward to. This will also enable them to decide if they want to join in that day or not. The activities co-ordinator had already drawn up a rough programme and pinned this to the notice board in the foyer. Forward planning will also enable relatives to join in if they wish. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 14 Activities include reminiscence sessions, singing, video afternoons, games and cards. The activities co-ordinator is also due to commence armchair exercises, after receiving the relevant training to do this. The company have another activities co-ordinator who works between the homes, and who organises outings. She is particularly good with service users who have dementia, and is working with the home’s co-ordinator to discuss how to involve them more fully. There is an activities folder, which has a separate section for each service user, showing their likes and dislikes, and if they like to join in or not. Service users who prefer to stay in their rooms will be visited for one to one chats/games/crosswords etc. by the co-ordinator as applicable. The home was providing a more welcoming atmosphere to visitors, and the reception and front hall area are much improved by redecoration. Some new carpet was being laid in the front porch area on the day of the inspection. Service users are encouraged to retain independency where possible, and to personalise their bedrooms according to choice. Menus were viewed, and were seen to provide a nutritious and varied diet. The cook has an excellent record of kitchen management, and has completed City & Guilds NVQ 2 training some years ago. The Environmental Health Officer (who had visited the home in the preceding week), recommended that she studies for an intermediate certificate. The cook ensures that service users have the right diets, and provides fortified meals and drinks for service users with low weights. Weights are recorded monthly, and the cook keeps a record of these, and discusses appropriate diets with the manager and nursing staff. The kitchen was seen to be clean and well organised. Care staff were finding it difficult to manage the number of service users who need assistance with eating and drinking, and showed their concern that service users are given sufficient time to have drinks during the day, and time to be assisted without rushing at meal times. Care staff were also being required to take it in turns to act as a kitchen assistant in the mornings, and the manager had provisionally offered employment to a kitchen assistant, so that care staff would no longer be needed to help in the kitchen. This is very important, as their time needs to be spent on carrying out care duties. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 15 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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously by the home, and are properly investigated and recorded. Staff have awareness about the protection of vulnerable adults, but the home’s records need to be updated to confirm training in this area. EVIDENCE: A complaints log has been implemented, and showed that five complaints had been made to the home since November 2006. The records showed that two complaints were fully substantiated, and three were partially substantiated. Complaints are separately documented, and show the action taken, and how this has been communicated back to the complainants. The Inspector noted the improvement in ensuring that complaints are now properly documented and audited, and complainants are given due consideration. Service users said that the new manager is quickly picking up on things which need to be attended to. They also said that the care staff are quick to pass on any concerns to the manager, and “see that things get sorted”. The home has an ongoing adult protection investigation regarding two service users, which was commenced in July 2006. A separate allegation was made in Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 16 September 2006, and the subsequent investigation showed that it was unfounded. The Group Manager stated that staff have been given training in the recognition and prevention of abuse, and staff showed their understanding of this. However, the training was only clearly evidenced on the staff training matrix for six staff (and only four of those in 2006), so the company need to be able to verify that this training has taken place for all staff. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 17 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): 19-26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The company have worked very hard to improve the appearance and upkeep of the home. There is still much to be done, but the work is well under way. EVIDENCE: The general environment was vastly improved from the previous inspection, and the provider and maintenance team are to be commended for such a noted difference to the premises. The front entrance hall and corridors, and the main lounge and dining room, have been thoroughly redecorated, and new armchairs and tables and chairs had been purchased. All of these areas have been re-carpeted, with the same carpeting, to provide continuity throughout the home. Redecoration has been carried out with light colours, which improves the overall appeal of the building. Maintenance men were carrying Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 18 out work to completely renovate the quiet library room next to the kitchen, and informed the Inspector that the Provider has plans to redecorate and re-fit the kitchen. The manager’s office has been redecorated, and new cupboards/shelving were under discussion. Some bedrooms have been redecorated, and there is an ongoing programme to redecorate all rooms where needed, with the agreement of the service user in that room. Service users can ask for alternative colours for décor for their own rooms if they wish. One service user was having a new carpet fitted in his room on the day of the inspection. The Provider has also purchased new bedroom furniture - including wardrobes and chests of drawers; some nursing beds; new airflow pressure-relieving mattresses and cushions; and new bedrails. The home has a sufficient number of mobile hoists, and these had been serviced during the past year. The Inspector saw one of the bathrooms on the ground floor had been completely re-fitted, and another one was being tiled on the day of the inspection, and waiting for new fitments. There is an ongoing programme to refurbish bathrooms on the first floor as well, with the possibility of fitting one of these up as a shower room. One service user said this would be excellent, as they would be able to shower unaided, which would be appreciated. The visitors’ toilet on the ground floor had been completely refurbished. Radiators throughout the home are fitted with radiator guards. Bath temperatures are checked by care staff prior to use. The manager has responsibility for checking that hot water temperatures stay at the right levels, and the maintenance team will deal with any thermostats that are failing. Sluices were seen to be clean and tidy. The home has a sluicing disinfector. The laundry area was fully inspected at the last visit, and was running satisfactorily. There have been fewer concerns voiced about clothing. The home was generally clean throughout, and a credit to the cleaning staff. The home is much dustier with all the alterations going on, and the cleaning staff are working hard to keep areas clean during this time. One service user said they are doing a “marvellous job” but it will be a relief when it’s all finished. The home now has two cleaning staff on duty each day, and one at weekends. This is an improvement from previously. An additional cleaner may still be needed once or twice per week to carry out the extra duties such as cleaning behind beds, cleaning skirting boards, and cleaning inside windows (where they are in reach). A service user asked if the home could get a window cleaner, as the outside windows have very rarely been cleaned. The company have employed gardeners between the homes, but the garden areas at the rear still need lots of attention. At this time of year there was little to see, but weeds were still in evidence. The garden borders will benefit if they Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 19 are sorted and replanted as appropriate in the Spring/Summer, so that service users have a garden area where they can enjoy sitting/walking. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care staffing numbers are low and need to be increased in line with dependency levels. Staff recruitment procedures are generally satisfactory, and staff training is being addressed. EVIDENCE: The staff rota showed some evidence of additional staffing from the previous inspection, with more domestic staff than previously. However, there were only 1 nurse and 4 care staff on duty in the mornings for 21 service users, many of whom have high dependency levels. This would probably be sufficient, except that 1 carer was still being required to go into the kitchen during the mornings to act as a kitchen assistant – so there are only effectively 3 care staff in the mornings. The Inspector was informed that a kitchen assistant had been offered a post, and the company were waiting for a satisfactory CRB check before this employee commenced work. Care staff have the motivation to work hard and to provide good care, but are hampered by having to cope with continually low levels of staffing. Afternoon and evening shifts are covered by 1 nurse and 3 care staff, and they get very tired by late afternoon as most work long day shifts. This does not seem to be Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 21 the best arrangement for either the staff or the service users. The inspector was pleased to note that there was active recruitment taking place for care staff, and several applicants had already been offered jobs. The service users said that the staff work hard, and are genuinely caring. There is a requirement to ensure the numbers of care staff on each shift are sufficient to meet the dependency levels of service users. The home is registered with an agency if the need arises. The home has an increased number of care staff with NVQ 2 or 3 training, and the manager stated that there were two care staff currently studying for level 3, and one for level 2. Another four care staff were waiting to commence level 2. The company pay for staff to study for level 2, and subsidise them for level 3. The percentage has increased but is still below 50 . Satisfactory recruitment procedures are in place, but some files for existing staff need to be updated. The manager stated that she would carry out a complete audit of all staff files in the next few months, and ensure all documentation – including a recent photograph – is on file. Criminal Record Bureau checks (CRBs) are currently sent off by one of the group’s managers. The current system for managing these in the group is due to be altered, so that the manager for each home will review them before they are filed at Head Office. This will enable the managers to make final decisions about employment. A staff training matrix has been implemented and showed that most staff had completed mandatory training. Updates that were due had been noted, and highlighted. The company have a training programme for the year, covering much of the mandatory training, and some other training needs (e.g. ongoing training in dementia care). The Inspector highlighted the need for confirmation of adult protection training (which has already been referred to in the section for “Complaints and Protection”). Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager shows an aptitude and commitment to work with the staff to raise the overall standard of care. There were noted improvements with the implementation of quality control audits and staff supervision. EVIDENCE: The manager had been in post as manager for one week, after two weeks working with the previous acting manager for a handover. She is RGN, and has previous experience as a manager in residential settings, and as a deputy manager for a nursing home. She has completed most of the Registered Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 23 Managers’ Award – just having two modules to complete. The managers for this group meet together once per month to make decisions about new processes, and for mutual support. The manager had already recognised much of what needs to be done to bring this home up to a higher standard, and was looking forward to meeting the challenge. She was already working to build up relationships with the staff and service users, and knew service users by their given names. Staff expressed gratitude for her manner towards them, and that she wishes to lead the way by working alongside them where possible, and being a familiar presence on the “floor”. Formal staff meetings, and service user/relatives meetings, had not yet commenced, but the staff obtain ongoing feedback from service users which they feed back to the manager. A quality control audit was carried out in December 2006, and showed some very positive comments, such as: “I like the peace of mind of being looked after. Staff are genuinely helpful.” (From a service user); and “Wonderful care, great staff” (from a relative). Monthly visits are carried out by the group manager, and are currently forwarded to the Inspector at her request, so that she can see the progress which is being made. The manager stated that the same procedures were in place for managing service users’ pocket monies, which are safely stored in a locked area. Records are currently written in a hardback notebook. All details are itemised, and two signatures are recorded for each transaction. Pocket monies are stored individually. When an account is closed, the next of kin signs for the amount taken, as well as the manager or nurse on duty. Photocopies can be made of the individual records if requested. No staff act as appointee for anyone. Formal staff supervision has been implemented, but is not fully implemented, as senior staff need to have the necessary training first. A satisfactory yearly appraisal format is in place. Policies and procedures were reviewed in November 2006, and are added to or amended as needed. The Inspector noted that health and safety procedures for ongoing maintenance work were effective, and were not impeding service users who wished to keep walking around. Staff on the maintenance team are allocated to carry out ongoing repairs in each home. The fire records and other maintenance files which were checked, were seen to be up to date. A new fire risk assessment in compliance with the Regulatory Fire Order had been carried out in December 2006. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 2 2 2 3 2 3 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 3 3 2 2 3 Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 25 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 2 Standard OP7 OP15 Regulation 15 (2) 12 (1) (a) Requirement To ensure that all care plans are brought up to date. To ensure that mealtimes are unhurried, with service users being given sufficient time to eat. This includes ensuring that there are sufficient staff throughout the day to assist service users with food and drink. To ensure that all staff have training in the Protection of Vulnerable Adults, and that records confirm this training. Previous requirement with new timescale. 4 OP19 23 (2) (o) To ensure that the external grounds are safe for service users, and are appropriately maintained. Previous requirement with new timescale. 30/04/07 Timescale for action 31/03/07 28/02/07 3 OP18 13 (6) and 18 (1) (c) 31/03/07 Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 26 5 OP19 23 (2) (a,b,d) To complete the ongoing improvements for the internal refurbishment of the premises (excluding the kitchen). To inform the Inspector in writing of the dates for the proposed plan to re-fit the kitchen. The Registered Provider must ensure that there are suitable numbers of care staff on duty for every shift, so that service users’ needs are fully met. 30/06/07 6 OP19 39 (h) 28/02/07 7 OP27 18 (1) (a) 23/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP4 Good Practice Recommendations To review the processes of assessment by which service users with or without dementia are assessed as able to interact together. To ensure that turn/toileting charts clearly show the evidence of repositioning and toileting throughout the 24 hour day. To ensure that all handwritten entries on medication administration charts are checked and signed by two nurses. To employ kitchen assistants or supper cooks to prepare teatimes, so that more choice is provided for service users at this meal. To ensure that sufficient numbers of domestic staff are employed to enable all the cleaning duties to be carried DS0000026079.V328273.R01.S.doc Version 5.2 Page 27 2 OP8 3 OP9 4 OP15 5 OP27 Beacon Hill Lodge Nursing Home out. 6 OP29 To complete an audit for all existing staff files, ensuring that all required information is included. Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beacon Hill Lodge Nursing Home DS0000026079.V328273.R01.S.doc Version 5.2 Page 29 - 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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