Inspection on 28/01/08 for Beaconsfield Care Home

This inspection was carried out on 28th January 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 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 28/06/07

Beaconsfield Care Home 14/09/06

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 Mick Gough Unannounced Inspection 28th January 2008 10:30 Beaconsfield Care Home DS0000066435.V357922.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.V357922.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.V357922.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 02392824094 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) triniraj@sky.com 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.V357922.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. 28th June 2007 Date of last inspection Brief Description of the Service: Beaconsfield is an end of terrace, period property that has three floors, a converted basement and an extension giving it 21 registered places for residents within the categories of Learning Disability (LD) and Mental Disorder (DE). Access to all of the floors is via stairs and the home is suitable for residents who are fully mobile. There is no parking at the premises, however parking is available on the street and public transport in the area is good. The home is situated only a short walk from the main shopping area of Southsea, in addition a number of local convenience stores are accessible to the residents and their visitors. One of the registered owners is also the registered manager of the home. The current scale of charges is from £332.57 to £500.01 per week - this includes the cost of care, food and laundry. Residents pay for their own toiletries, chiropody, hairdressing etc. Some of the residents have travel tokens or bus passes. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This report details the evaluation of the quality of the service provided at Beaconsfield and takes into account the accumulated evidence of the activity at the home since the last inspection, which was carried out in June 2007. The inspection took into account; the previous key inspection report, relevant information from other organisations and what other people have told us about the service. Comment cards were received from 1 relative, 1 member of staff, a care manager and 1 health care professional. Included in the inspection was an unannounced site visit to the home, which took place on the 28 January 2008. Evidence for this report was obtained from reading and inspecting records, touring the home and from observing the interaction between staff and users of the service. It was also possible to speak with 6 people who live in the home, 2 members of staff, a senior support worker, the administrator and the homes manager who assisted the inspector throughout the visit. The home is registered to provide support for 21 residents and at the time of the inspection there were 20 people living at the home. What the service does well: From talking with residents and from the comments received it was clear that residents were happy living at the home and that staff and residents got on well together. Care staff at the home know the residents well and were aware of individual likes and dislikes. Comments received from residents included “I like living here” and “I am very happy” one resident commented “I don’t know what I would do if I had to leave, this is my home” another commented “they all know me well and look after me” It was evident from observation and from talking to staff that they care about the residents and those staff spoken to were aware of residents needs and knew how individuals liked to be supported. A care manager commented, “I have good communication from the staff at Beaconsfield and any concerns have always been dealt with appropriately. Visitors to the home are made welcome and there is a flexible visiting routine. Residents are offered choice as much as possible and are encouraged to make their own decisions about how they spend their time. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Since the last inspection a number of improvements have been made and the following improvements were noted: • There have been some changes to the medication procedures and policies have been put in place with regard to the safe handling and administration of medication and staff at the home have received training with regard to medication. However these changes are not sufficient and more work is required to ensure full compliance. Staff has received training with regard to safeguarding and the protection of adults. Bathrooms and toilets have been repaired and hand-washing facilities are available in all bathrooms. A new shower room has been put in place New carpets have been laid in the downstairs hallway and lounge and new flooring has been laid in the kitchen and dining area. All new staff at the home has suitable recruitment checks carried out before they commence work at the home. A quality assurance system has been put in place to obtain the views of residents and stakeholders. Suitable notifications have been forwarded to the CSCI, in line with the regulations. A fire risk assessment for the building has been put in place and the home has complied with recommendations made by the fire officer. • • • • • • • • What they could do better: There were 5 requirements made as a result of this visit and other points, which need to be addressed to help improve the service provided for residents are contained within the main body of the report. General observations were: The home needs to develop their assessment procedure to include their own assessment so that they do not rely totally on assessments from outside agencies, this will help ensure that the home and residents can be confident that the home can meet their needs. Care plans are in place for all residents and these provide basic information for staff, however these require reviewing and updating to give staff clear information on the support that residents require and they need to inform staff how and when residents would like their support to be given. The daily recording in care plans does not always show what care has been given or how residents have been supported and the recording needs to be improved to show that staff are providing residents with the care and support they need. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 7 The reviews of care plans do not give any information on how the care plan is working for the individual and does not provide any information of who has been involved in the review process. More detailed recording would provide evidence of any progress made and of specific areas of support that may be required. There is a lack of clear risk assessments in place and staff do not have the information they need to manage risks and this is not in the best interests of the people who use the service. The lack of clear risk assessments has been an outstanding requirement from the previous two inspection of the home and is a cause for concern. The Commission has issued a Statutory Enforcement Notice to the home and failure to comply is likely to lead to prosecution or other enforcement action, which could include a proposal to cancel registration. Medication procedures at the home have improved since the last visit, however the procedure for administering “when required” medication needs to be improved and the home must provide clear guidance for staff on the procedures to be followed when administering any “when required” medication in order to protect residents. Currently there was no training recorded or planned for staff in mental health or learning disability. These are relevant to the client group being supported at the home and the manager needs to provide staff with training that is relevant to the residents that staff are expected to support. The record keeping systems in the home do not always support what staff and management are saying takes place in the home, residents are happy with the care they receive, however In order to provide clear evidence the home should provide training for staff so they know what is expected of them and the home needs to develop the recording processes in the home. The manager of the home is spending more time at the home and has made improvements since the last inspection. He carries out both management and care duties, however in order to move the service forward the manager needs to concentrate on dedicated management duties in order to get care plans, risk assessments, medication, residents finances and recording issues sorted out and he also needs to define the roles of the senior carers. 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. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 8 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.V357922.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New residents have their needs assessed before they move into the home, however the home needs to develop the assessment procedure to include their own assessment so that they do not rely totally on assessments from outside agencies. EVIDENCE: The majority of residents in the home have all been admitted through social service referral and we were informed by the manager and senior carer that potential new residents are admitted with the support of a care manager. Residents are invited to visit the home prior to moving in and social service and relevant health care professional assessments are obtained. 3 care files seen all contained local authority assessments and we were told that the decision on whether the home could meet the residents needs were initially based on this assessment. We were informed that the home has its own needs assessment form but this was not in place in the 3 files seen. The home does not use its own assessment tool to help them decide if they can meet prospective residents needs and the information provided buy other agencies is used on its own. We were told that care managers visit new residents regularly in the first few weeks of their stay, however these visits are not recorded and the home did not have records of the home reviewing the placement to see if it was suitable. Residents spoken with said that they were very happy with the way there move to the home was handled and said that Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 10 the staff were very supportive and that they were able to discuss any problems with staff and sort out any problems they may have quickly. Staff members spoken with said that they took time to get to know new residents and were careful not to be too intrusive so that the new residents felt comfortable. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans are in place for all residents and these provide basic information for staff, however these require reviewing and updating to give staff clear information on the support that residents require. It is not clear if resident’s needs are met because the recording and review systems used in care plans does not provide evidence of care delivery. Residents are supported to make informed choices. There is a lack of clear risk assessments in place and staff do not have the information they need to manage risks and this is not in the best interests of the people who use the service. EVIDENCE: Care plans were seen for 3 residents and these had a pen picture with photograph and this gave good information on the resident’s history. The care plan itself gave only basic information, the plans were mainly statements of the care needs and did not give staff any information on what actual support was required and how this support should be given. There was information in one plan that the resident lacked skills to maintain his personal hygiene and Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 12 appearance, but there was no information on how to support the resident or how this should be done. The level of information meant that staff could not evidence that there was a consistent approach for the care of residents. Another care plan provided more information on the care needs of the individual but it did not give staff any information on how the resident wanted their support to be given or what level of support was needed. Recording in care plans took place at the end of each shift and this gave basic information on how the resident had been, information recorded was “fine today” “had a good night” or “seems fine” there was little information on what care had been given or evidence of care delivery. We were informed by the manager and senior carer that reviews take place monthly, this was recorded in care plans but the review did not provide any evaluation on how the care plan was working for the individual or provide any information if any progress had been made nor was there any information to show that the resident had been involved in the review. We were informed that all residents now have a care manager and this has not always been the case. We were also informed that the home is planning to have full reviews for all the residents on an annual basis. All residents spoken to were aware of their plan of care and those spoken with were happy with the care they receive, they were full of praise for the staff and all felt that they were well looked after. Care staff spoken with were aware of the residents needs and were seen to respect residents wishes. The home recognises the right of the residents to make their own decisions and choices and residents were free to move freely around the home and were able to be involved as much or as little as they liked. Those residents spoken to said that they were able to make their own decisions but were able to get support from staff if they wanted it. The last 2 inspection reports have identified the need for the home to review and update its risk assessment process so that any risks to residents are easily identified and that plans are in place to manage these risks. We looked at the risk assessments in the 3 plans viewed. There were risk forms in place to indicate if there was any risk identified, however these were not risk assessments, there was no information on what the actual risk was nor was there any information for staff on how the risk could be minimised or reduced. One care plan clearly identified that the person was at risk from alcohol abuse and a strategy had been put in place to help him with this problem, however there was no risk assessment in place. We spent some time discussing risk assessments with the manager and one senior care worker and explained the need to have risk assessments in place so that where a risk had been identified, there were measures in place to manage the risk. When speaking to staff it was clear that they were aware of the risks involved to residents but the lack of a clear risk assessment did not give clear guidance for staff on what they should be doing or provide for a consistent approach, this also meant that there was no way of knowing what was effective in keeping identified risks to a minimum. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 13 The lack of clear risk assessments has been an outstanding requirement from the previous two inspection of the home and is a cause for concern. The Commission has issued a Statutory Enforcement Notice to the home and failure to comply is likely to lead to prosecution or other enforcement action, which could include a proposal to cancel registration. Beaconsfield Care Home DS0000066435.V357922.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to access the local community and are encouraged to take part and be involved in appropriate activities. They are offered support to maintain social contacts and daily routines at the home respect resident’s rights and responsibilities and meals at the home are flexible and residents benefit from a balanced diet. EVIDENCE: Residents at the home are supported to undertake education and occupation if their skills allow and they wish to do so. One resident attends a local college for literacy classes and the home supports him in this, however none of the other residents are interested in undertaking any educational activities. We spoke with a number of residents who all stated that they did not wish to undertake any form of education or employment, however one resident has expressed an interest in trying to find some form of employment in the future and the home has said that they will support the resident in this and have raised this issue with his care manager. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 15 5 residents at the home take advantage of a befriender service and have people who call to see them at the home and go out with them into the community, this service is run by a local organisation and all relevant checks are carried out on the befrienders by the organisation who support it. 3 residents have regular family involvement and a number of residents access the community independently. Whilst speaking with residents it was clear that they are able to come and go as they wish and they are free to take part in activities if they wish, a number stated that they preferred their own company and either spent time in their rooms or went out on their own. Visitors are welcome at any time and there are no restrictions on visitors as long as staff are aware and that they sign in the visitors book. Daily routines are flexible and residents are encouraged to be involved as much as possible, some residents help with tidying their own room, some do their own laundry with staff support, others hep out in the dining room whilst others do not get involved at all. Residents are offered a choice at meal times and all residents spoken to said that the food was good, lunch on the day of the inspection was shepherds pie, with fresh vegetables with Burgers for those who did not want the main choice, this was followed by cheesecake. The kitchen and dining area had new flooring laid and this was easy to clean. There is an area of the kitchen where residents can make their own hot drinks throughout the day and night. The home purchases fresh fruit and vegetables 3 days per week and the manager does shopping from local supermarkets and from cash and carry on a weekly basis. Fresh milk is delivered to the home. We looked at the fridges, freezers and storerooms and these were well stoked with good rotation of food to ensure that the most recent purchases were at the back so those with the shortest shelf life were used first. There was a record kept of all food consumed and the cook spoke with us and said that equipment was in a good state of repair and that any problems were quickly resolved. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not always receive personal support in the way they prefer, this is hindered by poor care plans and this does not always ensure that their health care needs are met. Medication procedures at the home have improved since the last visit, however the procedure for administering “when required” medication needs to be improved and a new controlled drugs cabinet needs to be provided. EVIDENCE: Personal support to residents is given in private and residents are able to state what support they require but care plans do not give staff clear information on the level of support residents need. Most of the residents are able to attend to their own personal care needs, although staff need to prompt residents to maintain their own personal hygiene. Staff spoken with were aware of what support individual residents needed and they were seen to be encouraging residents to close their bedroom doors when getting dressed to maintain their privacy and dignity. All residents at the home are registered with a number of different GP surgeries and they are able to keep their own GP if they wish. Dental checks Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 17 are arranged through a local health centre or with a local dentist. Eye tests are carried out thorough a visiting optician service but some residents go to a local optician; a visiting chiropodist calls every 8 – 10 weeks. Access to other healthcare professionals are either through GP referral or with direct contact with the relevant person. All health care appointments and visits are recorded in the daily notes and this does not make it easy to access records of health care appointments and visits and the home should consider how it records this information to enable easy access. The home has produced a new medication policy and procedure and all staff who are authorised to administer medication have received relevant training from a local training organisation and all are staff are completing an NVQ2 in medication. The Medication Administration Records (MAR) were looked at and all medication had been signed for. There was some discrepancy with the recording of “when required” (PRN) medication staff were recording medication as “refused” for PRN medication which had not been offered. In order to ensure that staff have clear information the manager needs to produce a clear policy with regard to PRN medication and this should give staff information on the procedures to follow and should include information on who makes the decision on when PRN should be given and how this should be recorded. It was noted that some medication had instructions for “one or two” to be given, however the MAR sheet did not provide clear information on the amount of medication administered. The home uses a monitored dose system from a local pharmacist and this was stored in a cabinet, which was kept inside a locked room. The home holds some Controlled Drugs (CDs) for residents “temazepam” and this was stored in a locked compartment within the medication cupboard and a CD record was kept with double signatures obtained. However the cabinet is not secured with suitable fixings that meet the requirements of the safe custody regulations. The “Misuse of Drugs” (safe Custody) regulations 1973 have been amended and care homes must now store all CDs, including temazepam, in a proper CD cabinet. A proper CD cabinet is one, which meets the standard set in the Misuse of Drugs (Safe Custody) Regulations 1973. Suppliers of CD cabinets can confirm that the cabinet meets the legal requirements. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear and accessible complaints procedure, which includes timescales for the process. The home is aware of its responsibilities and it provides training for staff to help protect service users from any form of abuse, however, the management of individual finances must be addressed in order to fully protect their rights. EVIDENCE: The home has a complaints procedure and a copy seen during the visit contained all of the required information. Residents spoke with said that they would address any concerns to a member of staff or would speak with the manager or someone in the office. Staff were aware of the complaints procedure and said they would bring any issues to the attention of the manager or one of the senior carers. The home has a complaints log and we were informed by the manager that there had been no complaints received since the last inspection and that any complaints received would be recorded. All staff at the home have undertaken training in adult protection and this training was provided by a local training organisation, training records seen showed that this had taken place in August 2007. Staff members spoke with are aware of their responsibilities in this area and said that they would bring any concerns to the manager or one of the senior carers. They were also aware that they could raise any issues with the CSCI or social services. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a safe and adequately maintained environment, however the décor in the house is poor and a plan of refurbishment and decoration needs to be implemented. EVIDENCE: A tour of the premises showed that there had been improvements to the fabric of the home, the outside of the building was clean and tidy and there were new carpets in some areas of the home, namely the ground floor. The kitchen area had new flooring and we were informed that there was an ongoing plan of refurbishment for the home. All of the bathrooms were in a reasonable state of repair and all had hand-washing facilities, there were soap dispensers on the walls and these were all working. Bathrooms had hand towels for residents to use but we were informed that these regularly go missing, hand towels have been previously used but these were thrown into toilets and caused major blockages. The manager told us that he was looking to provide hand driers in bathrooms, as these would be more hygienic. The home has had a new shower room installed and this has proved very popular with Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 20 residents, staff spoken with said it was easier to encourage residents to have a shower and residents spoken with said that they liked the shower room, although there were others who said that they preferred a bath. All staff have received training in infection control and this was carried out in November 2007. The home has a dedicated smoking room, which was clearly identified and this is the only area in the home where residents can smoke, however in the past residents were able to smoke freely throughout the home and this has resulted in paintwork and decoration being discoloured. Although improvements have been made the home is in need of decoration throughout, the manager has said that this will be carried out on a priority basis. Staff spoken with said that they felt there had been improvements to the home and that it was now much cleaner and it was a more pleasant atmosphere to work in. The laundry at the home has new tumble drier and a washing machine, which is able to wash clothing at appropriate temperatures. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is undertaking suitable recruitment checks but staff are not given all the training they need to undertake their role effectively. EVIDENCE: The home employs a total of 10 care staff and 2 senior carers and of these 6 care staff are currently under taking NVQ2 training and one of the senior carers is nearing completion of NVQ4 and the Registered Managers Award. In addition to the care staff the home employs a cleaner for 20 hours per week and also a cook. Residents spoken with said that they got on well with the staff and that there was always someone around if they needed help. Staff spoken to felt that staffing levels were sufficient and they said that they were being supported by the senior staff and the manager. Recruitment files were seen for 2 recently appointed staff members and the files contained, application form, 2 x references, CRB/POVA check and contract of employment. There was no copy of passport or birth certificate contained in the files. We discussed recruitment files and the manager stated that he had seen copies of passports and birth certificates when checking the individuals CRB application form, however he recognised that he had omitted to get copies for staff records and the home needs to ensure that all the required Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 22 information detailed in Schedule 2 of the Care Home Regulations is kept at the home. Training records were inspected for staff at the home and the manager had produced a training matrix, which gave clear information on what training had been completed and also gave details of planned training. The home has used a local trainer and staff have been issued with certificates and these were kept in staff files. Training records showed that staff had received training in 1st aid, food hygiene, fire safety, manual handling, adult protection, medication and infection control, training for staff in dealing with aggression is planned to take place shortly but no dates have been confirmed. There was no training recorded or planned for staff in mental health or LD and these are areas, which are relevant to the client group and the manager needs to provide staff with training that is relevant to the residents staff are expected to support. Staff induction takes place, but this was an “in house” induction procedure, which covered relevant points within the home. The manager showed us a copy of the “skills for care” induction and foundation standards and said that he would be ensuring that new staff complete the skills for care induction. Supervision records were looked at for staff and we were informed that supervision had recently been started and that this now takes place every two months in line with the National Minimum Standards. Records seen showed supervision had taken place in December 2007 and this needs to be continued so that staff receive the supervision and support they need to do their jobs. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. The management arrangements must be improved to protect those living at the home especially in relation to risk assessments, care planning, medication management and individuals finances. The quality assurance systems are not yet imbedded enough to benefit those living at the home. EVIDENCE: The manager is also one of the registered providers and he is at the home for between 3 and four days per week, he is supported in his role by 2 senior carers who look after the home in his absence. The homes staff rota confirmed the times that the manager is at the home, however some of his time is spent on care duties and this distracts from his management role. The home has made improvements since the last inspection, but in order to move the service forward the manager needs to carry out dedicated management duties in order to get care plans, risk assessments and recording issues sorted out. The shortfalls identified in other areas of this report indicate that the management Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 24 arrangements at the home are not satisfactory. The roles of the senior carers are not clearly defined and this needs to be made clear. Staff members spoken to were aware of the management arrangements and said that they would speak to one of the senior carers if the manager was not around. The majority of residents are not able to manage their own money, therefore all residents monies are paid into a corporate account “Beaconsfield care Ltd”. Monies stay in this account and are paid out as requested usually daily. Resident’s sign when they receive any payments of their allowance and this provides a clear audit trail. The majority of resident’s monies are small amounts, however one resident has been left some money in a will but at present he is unable to get this money, as he does not have a bank account. This matter has been referred to his care manager who is looking in to this so that he is able to receive his entitlement. Another resident has a larger amount of money sitting in the corporate account and this is not accruing any interest. We discussed this issue with the manager and administrator as this system is not considered good practice. We were informed that the home had been trying to resolve this problem, but they have not been able to open a bank account for this person, as he does not have suitable identification to enable him to open an account. The manager would prefer not to have this money in the corporate account and will continue to investigate an alternative arrangement so that the resident could gain interest on the money he has. Solutions to managing individuals money can be found in publication “In safe keeping” on the CSCI professional website The home has developed a quality assurance procedure, however this has not yet been fully implemented, questionnaires have been developed for residents, staff relatives and other professionals and supervision has now been put in place for staff. The home has staff meetings, which are recorded but these are not regular and take place as required. Residents meetings are also held when specific issues come up, which affect everyone at the home. Now that the system is in place the manager will need to take this forward and collate responses to questionnaires and provide evidence that the views or residents and other stakeholders are taken into consideration. The record keeping systems in the home do not always support what staff and management are saying takes place in the home, residents are happy with the care they receive, however In order to provide clear evidence the home must train staff so they know what is expected of them and develop the recording processes in the home. The fire logbook was looked at and all required testing has been carried out; there is a record of staff completing fire training and the fire officer visited in December 2007. As a result of this visit a number of areas were identified as needing improvement. The fire officer returned in January 2008 and appropriate action had been taken to address the issues identified at the Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 25 December visit. The fire risk assessment has identified a need to improve the emergency lighting and an action plan has been put in place to carry out the work. Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 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 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 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 2 2 2 X 1 X 2 X 2 2 X Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 27 Yes 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 YA6 Regulation 15(1) Requirement The registered person must ensure that service users plans of care contain information which sets out how the service users needs in respect of their health and welfare are to be met and should include information for staff on the support that service users require. The registered persons must ensure that service users plans of care are kept under review and the review should provide an evaluation of how the care plan is working for the individual. In order that staff are fully aware of the recording procedures for any “when required” medication and to ensure a clear audit trail of all medication that has been administered the registered persons must produce clear written guidelines so that staff are aware of their responsibilities in this area. Timescale for action 01/04/08 2 YA6 15(2)(b) 01/04/08 3 YA20 13(2) 01/04/08 Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 28 4 YA20 13(2) The registered person must ensure that a Controlled Drugs cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973, is provided for the secure storage of any Controlled Drugs, including Temazepam, which are prescribed for people who use this service. 01/04/08 5 YA35 18(c)(i) So as to protect the welfare 01/04/08 of the people who use this service the registered person must ensure that staff receive training appropriate to the work they are to perform and this should include training in mental health and learning disability. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beaconsfield Care Home DS0000066435.V357922.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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