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Inspection on 28/06/07 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 28th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

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

Residents were unanimous in their praise for the standard of food, which they said is "always of a high standard" and "the choices of meals is excellent". The cooks are familiar with their likes and dislikes, ensure there is always fresh fruit available, and provide good quality home-cooked food. The home is kept very clean, and relatives said the "the home is always clean and fresh". There were no offensive odours on the day of the inspection visit, and the Inspector was impressed with the high standard of cleanliness.The home has good quality assurance procedures in place, and staff respond positively to the views of residents and relatives. Relatives are made welcome in the home, and are encouraged to join in with activities and special occasions.

What has improved since the last inspection?

What the care home could do better:

The Company needs to keep numbers of staff (especially care staff) under review, to ensure consistency of staffing levels. Residents said that the carers are very good, but sometimes there are not enough of them, and this means that residents have to wait for personal care needs to be met. The Inspector recommended that the manager should liaise with the staff to assess if this is related to particular times of the day, or if it is generally a problem throughout the day. Staffing numbers should then be adjusted accordingly. A bathroom on the top floor was seen to be in very poor condition, with an old, stained bath, and poor quality integral hoist. The Group manager asked the maintenance manager to review this during the day of the inspection, and it was proposed that this bathroom should be altered to provide a disabled shower room. The maintenance manager expected to start work on this during the next week. The kitchen was reviewed by the Environmental Health Officer during January 2007, and the officer gave a recommendation to refurbish the kitchen. The Provider has already stated his intention for a complete kitchen refurbishment, and the Inspector was informed that he is planning how to carry this out with the least possible disruption for residents.

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 28th June 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.V340150.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.V340150.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) Nicholas James Care Homes 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.V340150.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 23rd January 2007 Date of last inspection Brief Description of the Service: Beacon Hill Lodge Nursing Home is a detached Victorian building, which faces the sea front at Herne Bay. It is close to the town centre, with its shops and other amenities. The home was purchased by Nicholas James Care Homes Limited during 2006. The Company own another four care homes with nursing, in this vicinity. This enables the managers to train together and support each other. 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 no separation of facilities in the home for these different categories of care. There is an understanding with CSCI that the home will consult with residents who do not have dementia on an ongoing basis, and will not admit residents with dementia 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 £312 per week (residential placements), to £700 (for people with high nursing needs). Fees are according to the assessed needs for individual residents. This information was provided during the inspection visit. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector carried out a full “Key Inspection”, which included assessing the key standards, and most of the other National Minimum Standards as well. The last inspection had been carried out in January 2007, after a previous inspection in August 2006, when the home had not been operating well. The inspection in January showed some marked improvements, and the Inspector was pleased to see at this inspection that further planned improvements had been made, and that the home is now operating at a much better level. The manager has been in post since January, and has brought a new level of stability and leadership to the home. Improvements have been reflected in fewer complaints, with only two complaints during the last six months. One of these was substantiated, and one was not. There have been no referrals to the Social Services Adult Protection department. The inspection process includes information gathered about the service since January; a visit to the service; and survey forms from residents, relatives and health professionals. Survey forms included positive comments such as “My relative is very happy, and I am relieved she is so well looked after”; and “They make relatives feel welcome and aim to include them in all decisions regarding outings, and any other matters. The home is clean and warm.” Some other comments expressed concerns about occasional shortage of staff, resulting in residents having to wait longer than usual for personal care needs to be met. The Inspector talked with 9 residents and 1 relative during the visit, 1 health professional, and 5 staff; in addition to the manager and Group manager, who were present throughout the day. What the service does well: Residents were unanimous in their praise for the standard of food, which they said is “always of a high standard” and “the choices of meals is excellent”. The cooks are familiar with their likes and dislikes, ensure there is always fresh fruit available, and provide good quality home-cooked food. The home is kept very clean, and relatives said the “the home is always clean and fresh”. There were no offensive odours on the day of the inspection visit, and the Inspector was impressed with the high standard of cleanliness. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 6 The home has good quality assurance procedures in place, and staff respond positively to the views of residents and relatives. Relatives are made welcome in the home, and are encouraged to join in with activities and special occasions. What has improved since the last inspection? What they could do better: The Company needs to keep numbers of staff (especially care staff) under review, to ensure consistency of staffing levels. Residents said that the carers are very good, but sometimes there are not enough of them, and this means that residents have to wait for personal care needs to be met. The Inspector recommended that the manager should liaise with the staff to assess if this is related to particular times of the day, or if it is generally a problem throughout the day. Staffing numbers should then be adjusted accordingly. A bathroom on the top floor was seen to be in very poor condition, with an old, stained bath, and poor quality integral hoist. The Group manager asked the maintenance manager to review this during the day of the inspection, and it was proposed that this bathroom should be altered to provide a disabled shower room. The maintenance manager expected to start work on this during the next week. The kitchen was reviewed by the Environmental Health Officer during January 2007, and the officer gave a recommendation to refurbish the kitchen. The Provider has already stated his intention for a complete kitchen refurbishment, and the Inspector was informed that he is planning how to carry this out with the least possible disruption for residents. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 7 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.V340150.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.V340150.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 (Standard 6 does not apply in this home). People who use the service experience good quality outcomes in this area. The home provides good information for prospective residents. Pre-admission assessments are carried out to determine if the home can meet the individual needs of each person. EVIDENCE: The Statement of Purpose is well set out with all the required details (as per Schedule 1 of the Care Homes Regulations). It had recently been amended to show the details of the deputy manager, who had commenced her post a few weeks previously. The document includes details such as the style of accommodation, activities available, the complaints procedure and advocacy services. It clearly states that the home is for older people with nursing needs, and for older people with nursing needs and dementia. These are integrated into the life of the home together, with no separation for different categories of residents. The manager assesses residents with dementia to ensure they will fit in with other residents, and do not present disruptive behaviour. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 10 The Service Users’ Guide is in large print, and had been updated to reflect recent changes in staffing. The Guide includes the details for what is included in the fees, and what is not included (e.g. dry cleaning, hairdressing, chiropody). A sample contract is included, and a sample resident questionnaire form. All residents (or the person acting on their behalf) are provided with a contract, and a signed copy is retained on file. A completed contract was viewed. A copy of the most recent inspection report is available by the visitors’ book in the front entrance hall, along with a copy of the service users’ guide, the complaints procedure, and the home’s latest newsletter. The Inspector recommended that the home should include some of the residents’ views about the home as a part of the information available. The manager said that she could include a copy of the audited results from their recent questionnaire survey. Pre-admission assessments are carried out by the manager. These are well completed, with all relevant information, such as medical history, moving and handling needs, nutrition, pressure areas audit, medication, and dependency levels. Residents and relatives are encouraged to visit prior to making a decision about moving into the home. As many are admitted from hospital, it is often their relatives who make decisions for them. Admissions are for a trial period of 4 weeks, with a review at the end of this time to check the suitability of the placement, and to see if the resident has settled in well. Beacon Hill Lodge Nursing Home DS0000026079.V340150.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 People who use the service experience good quality outcomes in this area. All care plans have been brought up to date since the last inspection. They are very detailed, and show evidence of meeting residents’ care and medical needs effectively. EVIDENCE: The Inspector viewed three care plans, including two for recently admitted residents. These are very comprehensive files, with clear details about medical and nursing care, and include well completed risk assessments, daily reports, and records of visits from other health professionals. They are set out with an index, so that it is easy to find the required information. The files are divided into different sections for different aspects of care – for example: the section for checking that the environment is safe for the resident includes a check for if bed rails are needed, and if the person can use a call bell. Risk assessments also include a falls risk, and how to prevent falls occurring; a minimum hourly check for residents who are unable to use their call bell; a Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 12 detailed person centred care plan, and details of any accident forms – with the action taken, and any further follow up indicated. Assessments and care plans are reviewed every month, and there is some evidence of discussing care plans with the resident/next of kin. The Inspector viewed detailed records for different aspects of nursing care – e.g. someone with a long term indwelling catheter – with details of fluid intake, catheter changes, and input from different health professionals. Wound care is well documented, with a separate sheet for each individual wound, clear details of the wound progress at each dressing change, and details such as if pain relief is needed prior to a dressing change. Appropriate referrals are made to the dietician, speech therapist, physiotherapist, GP etc. and the manager will quickly access other sources if she feels additional advice is needed. The manager ensures that nurses and care staff are informed of specific needs for newly admitted residents, relevant to individual medical needs, such as if the person has had a “stroke”, or has Parkinson’s Disease. The manager is hoping to give additional training to care staff (in time), about different illnesses associated with older people. Nutritional needs are well documented, and weights are recorded weekly or monthly as appropriate. Medication is stored in a small clinical room which was seen to be tidy and well organised. Room and fridge temperatures are recorded to show they meet storage requirements. The cupboards and two medication trolleys were in good order, and showed good stock rotation. No out of date medication was seen. Medication is receipted into the home by the manager or deputy, and written clearly on the medication administration records (MAR charts). The Inspector examined all of the MAR charts, and these were well completed. Handwritten entries are signed by two nurses. The controlled drugs cupboard meets specifications, and the register is neatly completed. Residents said that they are well looked after. One said “This is the best place I could possibly be”. Others said that the nurses and carers are very good, and attend to details such as getting their hair done and helping them to choose their own clothes. Several stated that there are times when they have to wait too long for the toilet. The Inspector passed these comments back to the manager, who said she would assess if this happened at any specific time of day, and if it indicated insufficient staff at certain times of the day. The Inspector also talked with a care manager who had just completed a review with an associate. She had received the same comments about residents having to wait for the toilet. Residents have care plans and assessments in respect of death and dying. These form part of the admission process, so that residents can quickly have the opportunity to discuss any particular fears, preferences about staying in Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 13 the home or admission to hospital (where indicated); and any special arrangements such as particular relatives to sit with them or ministers to visit, and any chosen funeral arrangements. Beacon Hill Lodge Nursing Home DS0000026079.V340150.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People who use the service experience good quality outcomes in this area. The range of activities and outings has been improved since the last inspection. Food is of a high quality, and is well prepared and presented. EVIDENCE: The home has increased the programme of activities, and there is a weekly planner displayed on a notice board in the front entrance hall. The activities co-ordinator works for two hours every afternoon (Monday to Fridays), and spends the first hour carrying out a group activity, and the second hour giving one to one time with residents in their own rooms. Care staff try to provide some activities during the weekends, such as putting on a video, playing games, or taking someone out for a walk. Two of the residents said that they really valued the activities, as they are a “welcome break in the day”. Another said that “it is good to be able to go out sometimes”. Minibus outings are now organised weekly, and residents have enjoyed going to visit Ramsgate and Broadstairs. The minibus can take approximately 3-4 ambulant residents, and 2 who are confined to wheelchairs. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 15 The activities co-ordinator keeps records for each resident of their preferences, their previous hobbies and lifestyle, and the sort of things they like to take part in. The home has recently started to produce a small newsletter (written by one of the staff), and this includes items such as birthdays, and details of forthcoming events. The home was in the process of organising a summer fete and the manager said that many relatives were taking part in helping with this. Any money raised will go into the residents’ fund for further activities and entertainment. Residents had enjoyed a singer coming into the home on the previous day, and entertainment is organised when possible. There is a recognition that the residents would benefit from more activities, and the company are looking at the possibility of recruiting an additional person for extra hours. Visitors said that they are made welcome in the home, and are usually offered hot drinks etc. Kitchen staff always present these very nicely, with a tray of tea/coffee etc. – not just a cup. The home has a welcoming and friendly atmosphere. Residents are enabled to bring in personal possessions, and rooms were seen to be personalised. A property list is retained in care plans for any specific items. Residents said that they are able to go where they wish, or stay in their own rooms. They do not feel pressurised to go to the lounge etc. All residents spoke highly of the quality of the food, and said there was plenty of choice, and meals are well cooked. Lunches were seen to be attractively presented, and well prepared. The cook is very concerned to ensure that residents’ meals suit their individual preferences, and their specific diets. Menus had been altered to include summer fruit and vegetables. The cooks are familiar with preparing pureed foods, and fortify soups and foods for residents who are under weight. Soups are usually home made, and home made cakes are offered every day. There are currently two cooks in the home, working opposite each other. A kitchen assistant helps them in the mornings. This is an improvement from the last inspection, when a carer had to help in the kitchen in the mornings. Evening meals are still prepared by care staff, and those assisting have completed basic food hygiene training, and have sufficient interest and ability to manage the food at teatimes. They work solely in the kitchen until all food is cleared away, and the kitchen is cleaned at the end of the day. If there is sufficient time, they may change out of kitchen uniform into care uniform, and assist with putting residents to bed. The Inspector expressed concern that while this is a help in the evenings, the home could benefit from having another carer in the afternoons, so it would be good practice to recruit kitchen assistants to carry out the teatime meals. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 16 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 People who use the service experience good quality outcomes in this area. Residents are not afraid to complain, and know who to speak to. Complaints are appropriately handled and investigated. Residents are protected from abuse. EVIDENCE: The home had received two complaints since the last inspection. One of these was forwarded from an anonymous source via CSCI. This was in respect of care practices, and was thoroughly investigated. The Inspector was shown the details of the investigation. The points raised were not substantiated. The other complaint was given directly to the staff on duty and forwarded to the manager, and was also about care practices. This complaint was upheld. The manager stated that there had been an emergency in the home on that morning, and staff had been diverted away from other residents. Both complaints had been properly investigated, and had had appropriate action taken. The complaints procedure is available in the entrance hall, and is clearly set out with the details for anyone to access. The staff training matrix showed that staff are trained in the protection of vulnerable adults. They receive in-house training from another manager in the Company, who is trained as a trainer in this subject. The home has a whistleblowing policy in place. Recruitment practices include waiting for POVA First checks and Criminal Record Bureau checks to be completed prior to confirming employment. Beacon Hill Lodge Nursing Home DS0000026079.V340150.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 People who use the service experience good quality outcomes in this area. The home is pleasantly decorated and furnished, and provides a comfortable and homely atmosphere. EVIDENCE: The Inspector viewed all areas of the home. It has been redecorated and recarpeted throughout, in the past year, and provides a light and homely environment. It is a large building, and requires a lot of upkeep. The maintenance team have worked very hard to bring the building up to a high standard of accommodation, and the housekeepers work hard to provide good standards of cleanliness. There were no offensive smells in any areas. Visitors commented on the high standards with remarks such as “The home is clean and warm”; and “My relative’s bedroom and bathroom are cleaned as well as I would expect it in my own home”. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 18 There are three communal rooms including a lounge, a large dining room, and a quiet room. The dining room has new tables and chairs, and tables were nicely laid with clean tablecloths and flowers. The quiet lounge can be used by visitors as well as residents. New furniture has been purchased in many areas, and new nursing beds. The manager has purchased new bed linen. Some soft furnishings still need updating,(e.g. curtains), but in other rooms there are matching armchairs, curtains, and bed covers. The home has a sufficient number of bathroom and toilet facilities. 23 of the rooms have en-suite facilities. These are still in the process of being upgraded, but are currently acceptable. The bathroom on the top floor was seen to be in very poor condition, with a damaged bath, and an old and stained hoisting facility. This was not being used. During the day of the inspection, the Group Manager asked the maintenance manager to view it. They proposed to alter this into a disabled shower room, and this will provide residents with a choice of bath or shower. The alterations were due to commence the next week, so the Inspector has given a recommendation to carry this work out as scheduled. The home has sufficient equipment such as hoists, pressurerelieving mattresses, raised toilet seats and grab rails. Wheelchair maintenance is carried out monthly by the maintenance team, and there are weekly tyre checks. Hoists are stored in a wide area at the back of the entrance hall. The manager would like to screen this off, or have a separate storage area, and is working out the best scenario for this. The manager’s office needs some more shelves or cupboards for storage of care plans and other documents. The Environmental Health Officer viewed the kitchen in January, and a refurbishment was recommended. The Inspector was informed that the Provider intends to carry out this work, and is working out the best possible management for this upgrade, with the least disruption for residents. The Group Manager stated that CSCI would be informed of the timescale for this work when it has been decided. The gardens were better maintained than at the last inspection, and there is a paved walking area at the rear of the building, and an outside table and chairs under a gazebo, so that people can sit outside. The front of the home has a very pleasant outlook over the sea. The laundry service is managed in a separate building at the rear. Residents and relatives expressed their satisfaction with the laundry service, with comments such as: “The laundry is quickly done and returned to my relative”. The laundry area is well provided with equipment. There is a Laundry Assistant from Mondays to Fridays, with an additional Assistant for Mondays and Tuesdays, so as to assist with the extra work from the weekend. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 19 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 People who use the service experience good quality outcomes in this area. Staffing levels are satisfactory, and staff recruitment and training are well managed. EVIDENCE: There has been some improvement in staffing levels since the last inspection. This includes the recruitment of Kitchen Assistants in the mornings, so that care staff can now concentrate on caring at this busy time. The home is staffed with 1 nurse throughout the 24 hour period, and the manager (who is also nurse trained) is on duty until 5.30 pm on week days, and can assist with nursing duties if needed. There are 4 care assistants in the mornings, and currently 3 to care in the afternoons. A 4th carer acts as kitchen assistant and prepares evening meals. The care staff who carry out this work have completed basic food hygiene training, and have sufficient expertise and knowledge to prepare residents’ meals. After the meals are concluded, and the kitchen has been cleaned, the carer may then change uniform and work as a carer for the last hour or two of the shift. Night duties are covered by 1 nurse and 2 carers. The care staff are assisted by a good team of ancillary staff. This includes a cook every day, two domestic cleaning staff from Monday to Friday, and one domestic staff at weekends. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 20 An activities co-ordinator is employed for two hours from Monday to Friday afternoons. There are two Laundry Assistants on Mondays and Tuesday mornings, one from Weds-Fridays, and none at weekends. Care staff are expected to keep laundry duties going over the weekends, and carry out some activities. This may be possible on a smooth running weekend, but additional staffing may be needed for some weekends to oversee these duties. The home currently had an occupancy of 24 residents, and staffing levels will need to be kept under review and adjusted as the home increases numbers of residents. The home promotes NVQ training for care staff, and there are three who have completed NVQ level 3, and three who have completed NVQ level 2. Several other care staff had commenced NVQ training, and will increase the percentage to 50 when this training is successfully completed. Recruitment files were viewed for three staff. The files were in good order, and well maintained. They included requirements for a photograph of the staff member, proof of identity, POVA First and CRB checks, and two written references. Work permits had been obtained where necessary. Nurses “PIN” numbers are checked. The application forms have been altered to ensure that a full employment history is obtained. The manager has implemented a staff training matrix, and some of this was displayed on the wall of the office. The matrix shows that staff have completed mandatory training, and there is ongoing training scheduled for updates. Basic training in the home includes training in POVA (Protection of Vulnerable Adults) and dementia, as well as other mandatory subjects. Nurses are encouraged to develop their own skills and abilities. Some were applying to train in venepuncture, which is currently carried out by the District Nurses. The nurses were in the process of completing an ASET medication course to update their medication training. The manager and deputy were booked to attend a tissue viability training course, and the deputy already has good training in wound care. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 21 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): 31-33 and 35-38 People who use the service experience good quality outcomes in this area. The manager has instigated changes to provide effective management and running of the home. EVIDENCE: The manager has been in post since January 2007, and has brought about stability to the home, and clear leadership for other staff. She is a level 1 nurse, and has previous experience of caring for older people. She is in the process of applying to CSCI for registration. She sometimes works at weekends, and has carried out some night duties, so that she gets to know all the staff and how they work. She is promoting a greater understanding and awareness amongst the staff in regards to illnesses that are common amongst older people (e.g. strokes, Parkinson’s disease). The Inspector noted that staff were working well together, and supporting each other in their different roles. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 22 The manager has recently employed a deputy manager, and this means that there is usually the manager or deputy in the home on most days. The manager has instigated good quality monitoring systems, including a questionnaire for residents and relatives. This had been distributed in the home in the preceding months, and the results had been clearly audited. The Inspector recommended that the audit is made available for residents and relatives to view, as it shows their perception of how things are going (see standard 1).The outcomes were mostly very positive, with most residents stating that their privacy and dignity is maintained, the care is good, and the food is good. Several had asked for more social events, and the manager was taking action on this. The manager has good auditing systems in place for different aspects of the home, and this helps with the quality monitoring. Monthly visits are carried out by senior management. One of the staff had recently commenced a newsletter. This is well presented, and contains current news and changes, and notice of forthcoming events. Residents’ money is not managed by the home except for a few “pocket monies.” These are stored individually, and records are retained for all transactions. There are occasionally residents who do not have anyone to act for them, and there was good evidence for one where the GP, a financial adviser, and solicitors had been involved in arranging a power of attorney for this person, who was becoming increasingly confused, and no longer able to manage their own finances. Staff files showed good records for staff supervision, which has been implemented for all staff. This is carried out on a one to one basis every two months, providing staff with individual opportunities to discuss progress, training, and developments in the home. Records are generally well maintained and kept up to date. This includes care plans, medication charts, maintenance files and staff files. Care plans are kept in the manager’s office, where they are available for staff, but are not properly stored. There is a recommendation to provide shelves or cupboards for better storage. Other maintenance records viewed included legionella checks, hoist servicing, gas certificate, lift servicing, and PAT testing. These were all up to date. The insurance certificate is on display and is in date. Chemicals are stored safely in accordance with COSHH requirements. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 23 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 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 3 3 Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP1 OP10 Good Practice Recommendations To include residents’ views of the home with the Service Users’ Guide. To ensure that residents’ dignity is not compromised by having to wait long periods for personal care to be given (with particular reference to toileting). To carry out the proposed plan to increase the range of activities and outings. To carry out the proposed alteration to the bathroom on the top floor, and refurbishing it so that it can be used for residents. To keep numbers of care staff under review, in line with the assessed needs and numbers of residents; and increasing staff in accordance with assessed levels. DS0000026079.V340150.R01.S.doc Version 5.2 Page 25 3 4 OP12 OP21 5 OP27 Beacon Hill Lodge Nursing Home 6 7 8 OP28 OP31 OP37 To keep promoting NVQ training for care staff, in order to increase the percentage of staff with level 2 training. To ensure the manager applies to CSCI for registration. To provide suitable storage for care plans e.g. cupboards or shelving. Beacon Hill Lodge Nursing Home DS0000026079.V340150.R01.S.doc Version 5.2 Page 26 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. 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