Inspection on 14/09/06 for Beaconsfield Care Home

This inspection was carried out on 14th September 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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beaconsfield Care Home 29/07/08

Beaconsfield Care Home 28/01/08

Beaconsfield Care Home 28/06/07

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Beaconsfield Care Home 13 Nelson Road Southsea Portsmouth Hampshire PO5 2AS Lead Inspector Mark Sims Unannounced Inspection 14th September 2006 10:00 Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 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 Beaconsfield Care Home DS0000066435.V303858.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 Adults 18-65. 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. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beaconsfield Care Home Address 13 Nelson Road Southsea Portsmouth Hampshire PO5 2AS 0189 5678 770 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) Beaconsfield Care Limited Mr Rajendra Mahadeo Care Home 21 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (21) of places Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users admitted within the LD category must also have a mental health diagnosis. NA Date of last inspection Brief Description of the Service: The current proprietary company has only been registered in respect of the property since February 2006, when the Commission was in the process of taking enforcement action against the previous proprietor and he decided to sell the home. The premises is an end of terrace, period property that has three floors, a converted basement and an extension giving it 21 registered places, within the categories of Learning Disability (LD) and Mental Disorder (DE). Whilst parking is restricted to road side only, public transport to and around the Southsea area is good and the home is situated only a short walk from the main shopping area of Southsea, in addition to the main shopping precinct a number of local convenience stores are accessible to the clients and their visitors. Within the home access to all floors is only possible if the client is able bodied and fully mobile, although the annex does provide some ground floor accommodation, although to access the communal areas clients do still need to be mobile enough to negotiate a small flight of stairs. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first ‘Key Inspection’ for Beaconsfield Care Home, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the core and/or key national minimum standards. The fieldwork visit, the actual visit to the site of the home, was conducted over two days, where in addition to any paperwork that required reviewing the inspectors met with service users, staff and undertook a tour of the premises to gauge its fitness for purpose. The inspection process also involves far more pre fieldwork visit activity, with the inspector gathering information from a variety of professional sources, the Commission’s database, pre-inspection information provided by the service and linking with previous inspectors who had visited the home. The new process is intended to reflect the service delivered at Beaconsfield Care Home, since its purchase as opposed to a snapshot in time. What the service does well: What has improved since the last inspection? This inspection is the first for the service since it was purchased by Beaconsfield Care Limited in February and whilst significant work has been undertaken by the new proprietary company, the managing director and his business partner are the first to acknowledge that a great deal of work is still to be completed if the home is to meet the national minimum standards. The following is an indication of the areas where the service has improved its performance to date: • • • • • Newly equipped laundry Redecoration and refurbishment of the food storage area Updated care planning process New ethos of care and the promotion of independence Introduction of Keyworker system Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 6 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. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 2 Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. New service users are admitted following a lengthy pre-admission assessment and visit to the service, although the documentation available should be updated. EVIDENCE: The evidence indicates that the home is managing the admission of new service users well and that people are supported throughout the process of deciding whether the home can meet their needs or not, as demonstrated by: • Discussion with the managing director: In discussion with Mr Mahadeo it was established that only one person has been admitted to the home since the company purchased the service and that the pre-admission assessment tool used during the assessment phase of the process had been that inherited from the previous regime. The assessment tool, seen during the second fieldwork visit day, is perhaps not the most comprehensive pre-admission assessment available, however it is a functional document, which at least provides the user with a baseline judgement of the person’s needs and abilities. As the management team is in the process of introducing new care plans to the home, it is worthwhile considering updating the assessment Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 9 tool, as there should be a clear and obvious link between the information gathered during the assessment and the care plans developed. • The assessment tool: As indicated above the pre-admission assessment tool is limited, although it is functional and does give a reasonable indication as to a person’s needs and abilities, although this is at a very basic level. Trial Visits/Stays: It was understood that the last client admitted to the home had, in addition to undergoing a pre-admission assessment, been invited to the home for tea and an overnight stay, although due to time restrictions the latter visit did not occur. In conversation with the managing director it was established that the client came for lunch, this statement supported by a diary entry confirming attendance to the home, where the individual was given the opportunity to socialise with the other clients, meet some of the staff and tour the premises. In conversation with the client it was established that he was happy at the home and had found settling in relatively straightforward. • Service user comment cards: 10 comment cards were returned to the Commission, as part of the inspection process: 4 confirmed that sufficient information had been provided to them prior to admission: 5 stated insufficient information was available and 1 person could not recall the build up to their admission. It should be pointed out at this stage that people’s comments are largely reflective of the admission process experienced under the previous owners and not the current providers, although it is understood that new contracts, etc., are being drafted for all existing clients. • Professional assessments: Several of the care planning files were noted to contain information from social workers, either involved in the initial placement arrangements for the service user or subsequently during placement reviews. These however, at times, were noted to be historic documents, as many of the service users are no longer actively involved with a care manager, although several of the people spoken with raised concerns over the lack of support they feel they receive from the local social services department. • Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 6, 7 & 9 Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. Each service user has an individualised plan of care. The service users are fully enabled and encouraged to make decisions for themselves and to take reasonable risks within their day-to-day lives. EVIDENCE: The evidence indicates that each service user has an individualised care plan and that following the last inspection work on improving the structure and content of the files has been undertaken. • Five service user plans were reviewed during the fieldwork visits and found generally to be informative documents, although some care planning issues identified during assessments or documented within additional records were not being transferred across to a plan of care. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 11 The managing director also provided the inspector with sight of the proposed new care planning package/system, which he and his business partner are preparing for use within the home. Whilst these documents may in time prove to be more appropriate and better structured than the current plans and documents, the inspector did note that the focus of the plans seemed very formal and medicalised and perhaps did not give sufficient credence to the fact that the aim and purpose of the home is to be a caring environment and the residents have care related issues and not acute psychological / psychiatric needs. • Team meetings: The record for the staff meeting dated 07/07/06 documents that the managing director raised the subject of care planning with the staff and records his intention to ‘work on the existing plans to shorten them and make clear what actions staff should take’, the latter referring to the support staff should provide to clients. A professional comment card: a comment card returned by a care manager indicates that her clients have care plans and that these are regularly reviewed and updated. All three professional comment cards returned establish that the professionals are ‘satisfied with the overall care provided to the service users’, statements that are repeated within the four relative comment cards returned. However, further developmental work is both required and planned for the care planning system, as the current system lacks consistency and clarity, this statement meaning to convey to the home that they need to concentrate on the care element of the service they provide, as they are not an acute setting. Work is also needed on developing the risk assessment tools, which to date do not clearly differentiate between the: ‘Action’ – ‘Risk’ – ‘Severity of the Risk’ and ‘The Plan to Manage the Risk Identified’. They would also help to establish and support the decision-making process and/or agreements reached with service users, over how any anti-social behaviours are to be managed and the consequential actions if persistent antisocial behaviour is demonstrated. However, given the competing priorities facing the new owners it is acknowledged that this work might take some time, as their focus is given to more pressing issues. The evidence indicates that the service users are supported and encouraged to exercise their rights to freedom, self-expression and self-determination, whilst Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 12 • acknowledging and accepting that they live within a communal setting and that persistent anti-social behaviour will not be tolerated if it is detrimental to their fellow residents, as demonstrated by: • Discussion with service users: one of the service users specifically sought time alone with the inspector to discuss the agreement he has with the home, regards the repercussions if he becomes anti-social following the consumption of alcohol. During the discussion it was established that the person can become difficult if too much drink is consumed and that the agreement does not prevent him drinking or drinking too much but rather is an agreement whereby his limited funds are distributed evenly across the days of the week and that if he spends more than the allocated amount on any given day this reduces the amount of money he has to spend the following day. Whilst this at times appears to cause difficulties for the client, he conceded that it does help him manage his finances and that whilst on occasions he might binge he generally manages to control his drinking and the subsequent behaviours. In discussion with the managing director it was established, as alluded to above, that the home has no risk assessment framework to support this decision-making process and agreement and that regardless of whether the original agreement was put into place by themselves or other bodies the home had a duty to assess the impact on the service user and respond accordingly. • Observations: Throughout both fieldwork visit days the service users were noticed to be coming and going as they pleased and to be involved in a multitude of activities within the home, both socially and individually. Again it is complicit upon the home to properly and/or appropriately riskassess people’s abilities to go out safely and securely and to consider agreeing with them plans on how their safety and wellbeing can be best ensured when out independently. The inspector also observed the managing director taking a client out to the local shops/supermarket, the client liking to shop for himself and both appreciating and enjoying the chance to visit local amenities. • Service user comment cards: The comment cards returned by the service users indicate that people generally feel able to make decisions about what they do each day with five people ticking ‘Always’ in response to this question, whilst five others responding ‘Usually’. DS0000066435.V303858.R01.S.doc Version 5.2 Page 13 Beaconsfield Care Home People adding remarks such as ‘I am free to come and go as I please – I go for short walks several times a day’. During a conversation, the service user mentioned above discussed his shopping trips and how he really enjoys the opportunity to go to the supermarket. The same client also discussed how daily he walks round to Southsea Shopping precinct and buys items for both himself, other clients and staff, which is his preference, as he establishes before going out if anyone requires anything. • Relatives: One visiting relative, during a conversation with the inspector, discussed how her son goes out to the local church, mainly to the coffee mornings, and how he is supported in house with his fascination with astronomy, the relative discussing how the new managing director has provided transport to a local planetarium. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 12, 13, 15, 16 & 17. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. Service users receive supported when accessing appropriate age, peer and culturally based activities and are active members of the local community. The service users are supported in the development of personal relationships/friendships and maintaining family contacts. The rights of service users are respected and their daily responsibilities acknowledged. All meals are freshly prepared, individually portioned and enjoyed by the service users. EVIDENCE: The evidence indicates that the service users are active members of the local community and that a range of age specific, cultural and religious events / activities are accessed on an individualised basis. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 15 • Dataset Information: the dataset information returned to the Commission in the build-up to the fieldwork visits establishes that service users are involved in/with a number of external organisations: 1. 2. 3. 4. Salvation Army Drop in centre Havelock centre Portsmouth Interaction The dataset also indicates that people use many of the local attractions and amenities: 1. 2. 3. 4. Shops Cinema Planetarium Library The latter facility also referred to by a relative during a conversation, as reported within the ‘Needs & Choice’ section of this report. • Conversations: As indicated above the Salvation Army is a local organisation visited by the service users, with one particular resident attending meetings and assembles on a regular basis. During a conversation it was established that this particular person has been involved with the Salvation Army for a number of years and that she finds the experience of going to meetings, etc. rewarding and enjoyable. Whilst another service user discussed his association with a local member of the clergy, although it was unclear whether the service user attended church or just called upon the priest for philosophical and spiritual guidance and/or debate. • Observation: As reported above, within the ‘Needs and Choice’ section of the report a service user was observed going out with the manager to make use of the local shops. Other service users were noted to be coming and going as they pleased throughout both fieldwork visit days, many returning with items they had purchased whilst out. • Keyworkers: In discussion with one keyworker and the service user for whom they act, it was established that this person has poetic talent and that the keyworker is supporting the client to research and/or source local recital groups that he may be able to access/attend, although DS0000066435.V303858.R01.S.doc Version 5.2 Page 16 Beaconsfield Care Home consideration of some behavioural issues is required, as acknowledged by the resident during the conversation. The evidence indicates that the service users have developed internal relationships with both the staff and each other and that wider community based relationships are supported by the home, as is the maintenance of contacts with families where possible/practical. • Relative Contacts: Four relative comment cards were returned prior to the fieldwork visits taking place, all four comment cards returned confirming that: ‘The staff/owners welcome you into the home at any time’ ‘You can visit your relative in private’. A relative, already referred to within the report, was observed being entertained by her next of kin within the home’s quiet lounge and during conversation she confirmed that she is always made welcome in the home and visits at time convenient to both her and her next of kin. The issue of privacy and meeting people in private was also acknowledged by the professional who responded to the Commission via the comment card system, all three cards stating that they can see their clients/patients in private when they visit. • Conversations/Observations: As indicated within the last two sections of the report a service user was observed entertaining his relatives when they visited the home. Whilst another service user was observed returning to the home following a visit/trip to see his partner, the service user later discussing his experience of travelling to see his partner and the activities undertaken during their visit. • Visitors Book: On arrival at and departure from the home visitors are expected to sign or amend the visitors book, this providing a degree of security and keeping track of the people in the home in the event of fire, etc. However, such logs also provide evidence of the visitors to the home and the type of people undertaking the visits, relatives, friends or professionals, etc. Scrutiny of the home’s log demonstrated that few visitors sign in, although where people had the picture created was a mix of social and Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 17 professional visitor, although with improved use of the log a far better view of the people visiting the home could be created. The evidence indicates that the service users enjoy the meals provided and feel that they meet their needs and preferences. • Dataset: Information contained within the dataset establishes that: 1. 2. 3. 4. • Breakfast is served between 08.30 & 09.00 hours. Lunch is served between 12.30 & 13.00 hours Evening Meal is served between 18.00 & 19.00 hours Supper is available between 22.00 & 22.30 hours. In response to the following questions, posed within the dataset the managing/director responded ‘Yes’: 1. ‘Do service users have a choice of menu’ 2. ‘Are the dietary needs and wishes of the people from minority ethnic groups catered for’ 3. ‘Are special diets provided’ 4. Are their facilities for service users to make drinks and snacks’ Included within the dataset information were copies of the preceding two week’s menus. These records providing evidence of the range and variety of meals served, although it was noted that only one daily main meal option is available. • Observations: observations indicate that mealtimes are social occasions, with service users and staff eating together within the home’s dining room, although people can opt to take meals in other parts of the home if they require. Service users were also noted to participate in the clearing of tables and tidying of the dining room, one service user even hoovering the dining room once everyone else had vacated the area, although this appeared to be more of a routine practice encouraged by the staff than a preferred task voluntarily entered into by the client, although this was never clarified with the service user directly, as he appeared more interested in the versatility of the new vacuum when approached later. It was also noticed and/or felt that all of the service users enjoyed their meals, as all of the plates were returned to the kitchen virtually empty and everyone ate a good size dinner, including a pudding. Just off of the main kitchen is a kitchenette or servery, where the residents are able to make hot and cold drinks and where a variety of Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 18 snack: biscuits, bread, fruit, etc., are available to people should they require them. Throughout the day the inspector observed people making use of this area and even discussed its use with three service users, whilst they prepared themselves drinks after dinner. • Conversation: in conversation with some of the service users it was apparent that the meals provided at the home were enjoyed and that snacks and drinks, as mentioned above are available throughout the day. Activities: a client who obviously loves his cooking and described on several occasions how he learnt to cook and the meals he enjoys preparing, was noticed to be in the kitchen supported by a carer, the pair involved in baking cakes for the other residents to consume with their afternoon tea and/or evening meal. Tour of the premises: During the tour of the premises the inspector noted that in several of the bedrooms visited the clients had their own tea and coffee making facilities, cups, kettle, etc. This in itself causes no immediate concerns for the inspector, as the management has no doubt undertaken mental risk assessments, balancing the potential benefits against the potential hazards. However, as indicated within the ‘Needs and Choice’ section of the report the home’s documented risk assessments are inadequate and whilst mentally the management may have addressed these issues, it remains necessary to cover such arrangements using a documented processed to. • Catering staff: in discussion with the chef it was established that he has a long history of involvement in catering and previously had been employed at several local authority premises. The chef discussed how the meals are based on the known likes and dislikes of the service users and that daily he makes himself accessible to the clients, as he likes direct feedback on the meals served. The chef also felt that the menu changes introduced by the new owners had been an improvement on that previously available under the old proprietor, a view shared by at least one service user during a conversation; and that the food stocks were good. During our conversation the chef discussed how he was currently reviewing the menus, to reflect the changing seasons and variation in seasonal vegetables available, etc. • • Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 18, 19, 20. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. Personal care and support is provided in accordance with the needs and wishes of the service users. Service users have access to both physical and emotional health care support. The home’s medication policies are adequate for the purpose of supporting the service users, although storage and procedural practices require attention. EVIDENCE: The evidence indicates that the service users are appropriately supported with regards to their health and personal care needs and that they are happy that their individual preferences/choices are taken into consideration. • Comment Cards: six service user comment cards indicate that staff ‘Always’ treat the service users well and listen and act on what they say, two other comment cards respond ‘usually’ to both questions, with the remaining two comment cards responding ‘always’ to the question ‘do staff treat you well’ and ‘usually’ to ‘do the carers listen and act on what you say’. DS0000066435.V303858.R01.S.doc Version 5.2 Page 20 Beaconsfield Care Home • Care plans: the care plans as mentioned in the ‘Needs & Choices’ section of the report, are informative if poorly constructed documents, which provide evidence of the support provided to and required by the service users. Observations & Discussions: During the fieldwork visits the inspector witnessed various personal care strategies being employed by the staff to support the service users to meet and manage their personal care needs, elements of their behaviours posing challenges. One such challenge involves a service user who is prone to damaging and/or destroying his personal clothing if left in his bedroom, the resident confirming this during an earlier discussion with him, when he discussed the difficulties he had accessing public services, i.e. a library, as often when home he feels compelled to damage the reading material, etc. he’s brought home. In order to manage this particular problem an agreed plan of care has been established, whereby the resident’s clothing is retained in the carers’ office and each morning before he baths or washes, etc. he collects his clothing from the staff on duty, this plan was observed in operation and seemed to be acceptable to the service user. • • Conversations: During conversations with the service users it was ascertained that they receive a wide variety of support from the care staff, bathing, guidance, assistance with using the laundry, etc. In conversation with one client he stated that he needed ‘reminding to change his clothing’, whilst another person commented on ‘I receive help cleaning my room, I collected books and these on occasions really build up’, a statement supported by his relative during a meeting with them. The evidence also indicates that service users receive appropriate health care support, although concerns were raised over the poor level of service people receive from the local authority, several people commenting on their disappointment and not having a regular care manager or having no care management support at all. • Comment cards: two professional comment cards were returned in the build up to the visit, by general practitioners both indicating that they were ’satisfied with the care provided at the home’, ‘that staff are knowledgeable about the needs of the service user’, ‘residents are seen in private’ and that ‘specialist instructions are incorporated into peoples care plans’. One of the two general practitioners to respond also added: ‘You may express to the home, directly, that I am grateful that our less accessible Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 21 patients, with more severe mental health problems, are so well looked after and that contacts/requests to GPs have been so often timely, appropriate and not driven, ever, by defensive or ignorant staff, I’m impressed’. • The dataset: the dataset information contains an extensive list of health and social care services with whom many of the service users are involved, many of these professional sources were approached seeking their views of the service, however, as indicated within the report only three people opted to reply, it is assumed that the people who did not respond have no concerns or observations. Appointments: In discussion with the managing director and senior staff members it was ascertained that all appointments to be attended by the service users are documented, although this does not mean the person is accompanied, the purpose of the diary system being to remind people of their forthcoming appointments and arrange support if required. On scanning through the afore mentioned document it was easy to pick out where entries had been made confirming that people’s appointments are logged and monitored. • Observations: During the second fieldwork visit day the inspector witnessed an optician arriving at the home and undertaking a consultation with one of the service users, the optician making use of the quiet lounge for the purposes of his visit. The optician was also heard speaking to another service user, confirming that he had an appointment scheduled with her for later in the month and that this particular visit had been arranged just to see the person he was with. This conversation however, going some way to confirm the service users’ involvement with health and social care professionals. The evidence suggests that service users are reasonably well supported by the home’s medication practices, although some procedural anomalies were detected. • Records: Details of the clients’ medications are documented within their care plans on admission to the home and is part of the information gathered pre-admission. The medication administration records, the home’s accounting for medicines arriving at the home and sent for disposal and the controlled drugs registered were all found to be being appropriately maintained and accurate. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 22 • Work, as mentioned throughout this report, is required to the risk assessment documents of the home, which should include those used when assessing people and their abilities to self-medicate. • Observations: A tour of the home’s medication storage facilities evidenced that whilst the arrangements are safe and secure they do not comply with European and/or British Standards, as defined within the ‘Safe Custody Regulations’. However, it is important to point out that these regulations are not enforceable within a residential unit and therefore it is the inspector’s recommendation that when the medication arrangements are upgraded next at the home consideration be given to complying with the regulations as this would be best practice. • Procedural Observations: Whilst discussing the home’s medication practice with a senior member of the staff team it became apparent that the staff are in the habit of secondarily dispensing service users medications. This meaning that one staff member is dispensing the medication from its original container into a second container for another member of staff to administer later. This particular practice is no longer recommended as good practice and it is important that the management take steps to address the issue as soon as possible. • Professional Views/Comments: As recorded above two general practitioners responded to the Commission, via the comment card system, both making positive comments about the staff and the support provided to service users with their medications, etc. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 22 & 23 Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The service users feel they are listened to and can approach the staff and management with concerns. The service users are a vocally able group, although improvements in the training of the staff might further ensure their safety and wellbeing. EVIDENCE: The evidence indicates that generally the service users and/or their relatives are happy to raise concerns or complaints with the home and confident that the issues will be appropriately handled and addressed. • Comment Cards: Ten service users comment cards were returned, nine confirming/ticked ‘always’ in response to the question ‘do you know how to make a complaint’ and one no. The four relative comment cards also indicating that they knew how to make a complaint, all four also confirming that they had never needed to use the process. The three professional comment cards also established that they had never received a complaint about the home. • Dataset: Details of the home’s complaints process were included in the dataset information provided to the Commission, along with a summary of the home’s complaints activity over the last eight months: DS0000066435.V303858.R01.S.doc Version 5.2 Page 24 Beaconsfield Care Home 1. No complaints have been recorded at the home • Commission Records: The records maintained by the Commission indicate that no complaints have been received or referred to the Commission in the last eight months or since the new company purchased the home. The evidence indicates that the service users are aware of their rights to live without being subject of abuse, etc. and that steps to safeguard their welfare is promoted. However, training opportunities for staff appear limited and this does impact on the overall ability of the staff to protect people from abuse, and the lack of appropriate risk assessments, etc. is an issue that should be addressed. • Comments: It is evident throughout the report that service users feel able to voice their opinions around the service they receive, and appear to be are a group of individuals who are able to express themselves openly. However, discussions with the staff suggest that the service users, whilst generally are a group of people who are aware of their rights to a good level of care, etc., they remain vulnerable in other aspects of their lives, for example: being exploited by other service users, etc. It was pleasing to note how much the staff know about the individuals residing at the home and about their characters and particular conditions, some of the conditions making people more malleable than others. This was perhaps best demonstrated during a conversation about a client who exerts influence over another service user in order to get him to beg (in the street, etc.) for money. This is now closely monitored by the staff, as is work to ensure the vulnerable client is provided with the resources and opportunities to discuss such issues and be suitably empowered to say no. However, again the documentation around this problem and the risk assessment documentation is not as good as it could be, nor is it sufficiently detailed or meticulous as it might be. • Professional Comments: As already stated within the ‘Personal and Healthcare Support’ section of this report the doctors find staff knowledgeable about the needs of their clients, which supports some of the above observations. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 25 • Relatives: As already mentioned within the body of the report, relatives feel the home is meeting the needs of their next of kin and no concerns regards their safety or wellbeing were identified. Observations: observations demonstrated or supported the belief that people feel happy and safe within the home, service users and staff interacting well throughout the fieldwork visits. The dataset also provides a clear statement of the fact that the staff are provided with access to an adult protection policy and procedure and that within the last eight months no adult protection incidents have been referred. Commission Database: The above remark/observation is also supported by the Commission’s records, which indicate that no ‘Adult Protection’ referrals have been forwarded to the Commission or brought to our attention. Training: The dataset does, however, establish that training around adult protection issues has not been provided under the current proprietary company, a fact supported when reading through the training records for staff during the fieldwork visit. In discussion with the managing director it was ascertained that work is in progress to attend to staff training needs and develop an in house training and development programme, although this is not a priority, given some of the other issues to be addressed, therefore training is focusing on core training and development events at this time. • • • • Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 26 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 24 & 30. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The premises is in need of redecoration and refurbishment, as communal areas appear tired and shabby and remedial works to make the home remain habitable over the longer-term. The hygiene or cleanliness of the property was generally good, although in need of attention in some areas where build-ups of dust and cobwebs were visible. EVIDENCE: The evidence indicates that significant time and effort is being invested in the property and that work is being undertaken to address the poor maintenance and rundown appearance of the home. • Discussions: The managing director showed to the inspector a ‘Pinder’ report (a report on the viability of the premises), which considered the condition of the building and highlighted for the proprietary company the huge number of structural defects and remedial jobs that required attention. DS0000066435.V303858.R01.S.doc Version 5.2 Page 27 Beaconsfield Care Home The managing director stated that many of the smaller items had been attended to already, however, he was in the process of negotiating with a building firm to commence work of the entire premises, addressing the remainder of the structural jobs and undertaking the redecoration and refurbishment internally, the managing director explaining that this had been delayed as local firms had been reluctant to get involved with a specialist care facility. • Tour of the premises: During the tour of the home it was possible to see much of the work that required attention, as well as additional works not originally covered in the ‘Pinders’ report, this including: 1. The replacement of a bathroom ceiling, which has come down. 2. The repair of the roof, which was leaking during the first fieldwork visit day. 3. Improved lighting throughout the home. 4. General décor and replacement of carpets The home does boast a new laundry facility with commercial washers and driers and the loft space and rear gardens have been cleared of debris and junk, however little else can visibly be seen to show where improvements to the premises have been achieved and the proprietors run the risk of becoming disillusioned if they do not attend to some of the jobs that have tangible and identifiable outcomes. • Plan/schedule: The inspector never saw a plan for the redevelopment of the service and is of the impression that the managing director and his partner (business) may not yet have drafted an action plan. Service users: The service users in direct conversation with the inspector, impressed upon him their satisfaction with life at the home, several people opening up their bedrooms to the inspector to show him how they had stamped their individual mark/character on the layout, etc. Relative’s Comments: The relatives of a service user provided further evidence of how much the residents enjoyed / appreciated living at the home and discussed how her next of kin had his bedroom set out how he liked it, although staff were in the process of helping him with his hording tendencies, a fact confirmed by the managing director, who stated that if you left the person with an empty box, etc.he was willing to sort through his belongings and dispose of those he no longer required. • • The evidence indicates that insufficient domestic staffing hours are available for a home the size of Beaconsfield. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 28 • • Dataset: The dataset establishes that no one is currently employed at the home to undertake domestic staff duties. Observations: The care staff were involved in general cleaning duties on both days of the fieldwork visits, although these seemed to be general cleaning jobs and mainly concentrated around the communal areas of the home. Tour of the premises: The inspector noted that in general the cleanliness of the home was good, although high dusting appeared to be an issue in places, cobwebs in corners and dust on light/lampshades, etc. It was also noted that the bathroom/toilets were often unclean and soiled, although staff did explain that they had not had time to tidy those areas due to the inspector’s visit and due in part to some unsocial habits exhibited by people. • • Discussions: in discussion with the staff it was established that the staffing numbers for the home are reduced at the moment, although the managing director has interviewed new staff and appointed at least one new carer, although this person has yet to commence work. The staff also explained how currently they were undertaking extra hours, etc. to cover and that on top of the care work they undertook a degree of domestic type work. • Managing director: In discussion with the managing director it was acknowledged that the home needed to recruit a dedicated domestic staff and that staff shortages have been experienced, although it is envisaged that this will end soon with new staff having been recruited, although their individual checks to work have yet to be returned. Service users: In discussion with the service users it was clear that they felt the home was clean and tidy and met their needs, several of the service users discussed becoming involved in or their responsibility for ensuring their personal bedrooms remained tidy and several others have taken on extra roles, cleaning tables and hoovering the dining room floor post meals, etc. During the tour of the premises it was also established that service users have access to and use of the laundry, although to date very few people launder their own clothing preferring to leave this to the staff. • • Comment Cards: All ten service user comment cards returned to the Commission in the build up to the visit, were ticked ‘Always’ in response Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 29 to the question is the home ‘fresh and clean?’ supporting the information gathered during personal conversations with people. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 30 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 31, 32, 34 & 35. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The information provided tends to indicate that the home is currently not meeting the 50 ratio of staff trained to National Vocational Qualification level 2. The use of the recruitment and selection process is limited and therefore should be considered to afford the service users’ safety, security and protection. Training opportunities are limited, although they would appear to address core training and development needs. EVIDENCE: The evidence indicates that the company is currently attempting to recruit new staff and maintaining adequate staffing numbers to meet the needs of service users. • Dataset: Copies of the staffing rosters, supplied as part of the dataset information, indicate that the home is appropriately staffed and that sufficient care staff are available, across the twenty-four hour period. DS0000066435.V303858.R01.S.doc Version 5.2 Page 31 Beaconsfield Care Home • Observations: The fieldwork visits days provided further evidence of the fact that adequate staff are available to meet people’s health and social care needs, although, as reported this is often due to staff good will at this time, whilst new carers are recruited. In discussion with staff it was established that carers work as a team and that there is no allocation of jobs, etc. each day with carers responding to the demands or preferences of the service users. The staff also discussed the introduction of the keyworker system, although this is unlikely to work as it is intended until a full staff complement are available and in post. • • Relative comment cards: Service users’ relatives generally consider there to be sufficient staff available with all four comment cards returned recording that ‘in my opinion there are always sufficient numbers of staff on duty’. Professional comments would also appear to support the fact that sufficient and appropriate staff levels are maintained, people’s testimonies indicating that: ‘there is always a senior member of staff to confer with’ and that people are ‘satisfied with the overall care provided to the service users’. • The evidence indicates that staff training and development is not a high priority for the new proprietary company, although there is an acknowledgement that core-training needs must be addressed and that plans must be laid down for future improvement. • Dataset: the dataset information provided by the managing director included details of the training attended by staff over the last eight months: Mandatory: • • • • • Food Hygiene Fire safety Manual Handling First Aid Health and Safety Non-mandatory: • • Control of Substances Hazardous to Health (COSHH). Keyworker Training. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 32 • Discussions: In discussion with staff it was established that training is available at Beaconsfield and that people recalled the recent ‘Keyworker Training’ provided by the managing director. It was also apparent that staff understand the problems being faced by the proprietary company and that wider training and development opportunities may not, in the short-term, be readily available. • Dataset: The dataset establishes that 3 out of the 14 care staff possess a National Vocational Qualifications (NVQ) level 2, which is 20 of the care staff working at the home. In discussion with the managing director it was also ascertained that these staff possessed the qualification prior to working for Beaconsfield Limited and that presently no one, as of yet, has been put through this training by the company. The evidence, whilst limited, indicates that the home’s recruitment and selection process should ensure the safety and wellbeing of the service users. • Observation: At this visit the file of one (the only new recruit employed by the new company) staff member was reviewed and found to contain the following information: 1. An application form, which might need expanding upon given the 2004 amended regulations 2. Contracts 3. In house induction information, which should reflect the new ‘Common Induction Standards). 4. Employment correspondents 5. Two References 6. Protection of Vulnerable Adults clearance 7. Criminal Records Check outcome 8. Supporting identification and documents. • Discussion: The managing director discussed how he and his business partner have entered into a contract with ‘Peninsular’ for all of their employment needs and support and that all newly updated documentation, policies and procedures and guidance/advice is provided by this management consultancy firm. Dataset: The dataset establishes that employment policies and procedures are available and that the company has a full set of recruitment and selection guideline available if required. • Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 33 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 37, 39, 42. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The manager is professionally qualified, although does not yet possess a management qualification and is relatively inexperienced within social care. The service users feel they are able to comment on the future direction of the service and that staff listen to their concerns and/or observations. The health, safety and welfare of the service users is not being appropriately promoted. EVIDENCE: The evidence indicates that the home is well run and managed and that the service users, their relatives and staff are appropriately protected from harm and injury. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 34 • Commission Database: Information contained within the Commission’s Registration Report (a report produced prior to the manager being registered by the Commission) indicates that the manager possesses a Nursing Qualification but no formal management qualification, although a clear undertaking to complete the required qualification is given. In addition to the registered manager (also a director, as commented upon throughout the report), the second company director is also very involved with the service and provides both additional management support and stability to the home. In discussion with the second director it was established that she has worked within the National Health Service within a middle management/professional nurse specialist role for sometime and is intent on bringing her skills and knowledge to the home. • • Comments: A relative of the service user, spoken with during the fieldwork visits indicated that the managing director is both approachable and supportive. Professional Comments: A professional comment card also addressed the overall management of the home, as reported earlier within the ‘Personal and Healthcare Support’ section of the report. All three professional comment cards and all four relative comment cards remarking how, overall, they are satisfied with the level of care provided at the home. • The evidence indicates that the service users are given a voice within the home, although this is at an informal level, currently other pressures have meant the new company has been unable to arrange residents’ meetings or forums, etc. • The new proprietary company has introduced a ‘Keyworker’ system to the home, as discussed within the ‘Staffing’ section of this report. The benefit of the introduction of this system, in addition to ensuring hotel style issues are addressed, tidying of rooms, provision of personal toiletries, etc., is that it has provided the service user with an identified contact within the home who they can approach if they have concerns or issues to address, although due to the staff shortages this system cannot operated as intended. Comments: The service user comment cards, returned in the build-up to the fieldwork visits, indicate that service users feel listened to within the home and feel staff respond appropriately to their requests, etc., as reported within the ‘Personal & Healthcare Support’ section of this report. • Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 35 • Discussions / Observations: Throughout both fieldwork visit days the inspector had the opportunity to both observe resident – staff interactions and to talk to service users about the home and the care provided. It was quickly ascertained that the service users are happy at the home, several people very concerned that the purpose of the inspector’s visits was to close their home, ‘reassurance that this was not the purpose of the visits was given’. In discussion the people spoken to confirmed that whilst they do not have formalised meetings and do not think there would be a benefit of such a meeting in the home, they do feel able to speak to any of the staff and the managing director if they have concerns about any element of the service. It was also apparent through discussions with the chef that this approach was also being operated by non care staff, as the catering staff were spending time with the service users establishing whether meals met their expectations and if their were any preferences or oppositions they might like included on the menu, etc. • Discussion: In conversation with the managing director it was ascertained that the long-term aim of the home is to introduce service user meetings and to improve the overall quality auditing systems of the home, although again these are not the most pressing issues facing the company as they attempt to redevelop the service. The evidence indicates that health and safety is not being properly addressed and/or managed within the home. • Tour of the Premises: Whilst the building requires extensive improvement no immediate health and safety concerns were identified, although some issues should be reviewed, i.e. the use of individualised and environmental risk assessments and the leaking roof should be checked to ensure that long-term exposure to water has not caused structural damage, which might effect the strength of beams, etc. Dataset: Health and safety training is being made available to staff, the dataset evidencing that staff complete first aid, moving and handling and food hygiene over the last eight months. Tour of the premises: Access to paper towels and liquid soaps within bathrooms and toilets are indicators of attention to infection control, as is the availability of a specific infection control policy, as listed within the dataset. The non-managerial director is also an infection control nurse specialist, who during discussion is preparing to provide in house training to the Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 36 • • staff and will obviously be able to use her skills to review and update policies, monitor practice and develop in house practices. • Observations: The availability of a maintenance person, seen on site attending to minor/routine repairs is a benefit to the home, as this ensures that the general fabric of the environment is kept up together. Comment Cards: The service users’ comments should also be considered as evidence, the home described as ‘clean and fresh’, etc. as reported within the ‘Environment’ section of the report. • Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 37 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 38 N/A Are there any outstanding requirements from the last inspection? 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 YA9 Regulation Requirement Timescale for action 11/11/06 2 YA24 3 YA35 YA32 Regulation The home’s risk assessment 13 documentation requires reviewing and updating to ensure all risks to the service users are easily identifiable and plans to manage these risks clear and concise. Regulation The management must forward 23 to the Commission details of its plan for the repair, redecoration and refurbishment of the premises, the initial plan covering the immediate 12 months, following this inspection and the work scheduled. Regulation The management must review 18 the training needs of the staff and produce a plan to address those needs, including NVQs and service specific training (mental health / Learning disabilities). 11/12/06 11/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 39 No. 1 Refer to Standard YA2 Good Practice Recommendations The management team should review the current assessment documentation to ensure it gathers all of the necessary information for determining someone’s suitability for accommodation at Beaconsfield. When refurbishing the medication storage facility the management should consider upgrading all medication cabinets in accordance with the guidelines within the ‘Safe Custody’ Regulations. As part of the home’s review of staff training and development, considerations on how to improve and update staff awareness of current adult protection practice/advice should be given. The management should seek to recruit a dedicated domestic staff and ensure sufficient time is available to address all cleaning issues. The manager should consider his own development needs and managerial growth. 2 YA20 3 YA23 4 5 YA30 YA37 Beaconsfield Care Home DS0000066435.V303858.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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. 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