Inspection on 29/07/08 for Beaconsfield Care Home

This inspection was carried out on 29th July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beaconsfield Care Home 28/01/08

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 13/03/2009.

CARE HOME ADULTS 18-65 Beaconsfield Care Home 13 Nelson Road Southsea Portsmouth Hampshire PO5 2AS Lead Inspector Annie Kentfield Unannounced Inspection 29th July 2008 10:00 Beaconsfield Care Home DS0000066435.V366951.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.V366951.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.V366951.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.V366951.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. 11th April 2008 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. The responsible individual 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.V366951.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 1 star. This means the people who use this service experience adequate quality outcomes. This report details the evaluation of the quality of the service provided at Beaconsfield Care Home and takes into account the accumulated evidence of the activity at the home since the last inspection, which was carried out in January 2008, with an additional visit to the home in April 2008. The additional visit was to monitor compliance with statutory requirement notices because the home had not made required improvements to care plans and risk assessments. The report takes into account; the previous key inspection report and the outcome of the additional visit, relevant information from other organisations and what other people have told us about the service. Information was received from Social Services who have been making monitoring visits to the home since January 2008 because of concerns about the protection of the residents. Included in the report is the outcome of an unannounced visit to the home, which took place on 29th July 2008 – with two inspectors (Annie Kentfield and Mick Gough) who were in the home for 6 hours. Evidence for the unannounced inspection was obtained from reading and inspecting records, looking around the home and from observing the interaction between staff and users of the service. It was also possible to speak with 8 people who live in the home, 3 members of staff, and the senior support worker. The manager was on holiday. We also received the Annual Quality Assurance Assessment. This is a self-assessment about how well the service is providing good outcomes for people living in the home. 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” Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 6 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. 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 in medication good practice. A new medication room has been set up that provides safer storage for medication in the home. The storage and recording of controlled drugs meets regulatory requirements. Care plans and risk assessments have been reviewed and updated and provide clearer guidance for care staff on what they must do to support the residents and manage any risks or events. The home has developed a staff training programme to make sure that care staff have the skills and knowledge for the work they do. • • What they could do better: When new residents move into the home, the care plan needs to be reviewed to ensure that care needs are being met. This should be recorded to ensure that staff have guidance if care needs have changed. The home must review a general risk assessment for all residents that is written for care staff to tell them what to do in the event of anyone being trapped in their room. This does not provide clear and accurate guidance for care staff and does not protect the residents in the event of an incident where residents are locked in their bedrooms. Bedroom doors must have locks that allow staff to enter residents’ bedrooms in an emergency to protect residents’ safety and well-being. The home must ensure that where medication is not given at the time prescribed, any changes to the way that the medicine is dispensed, are discussed and agreed with the person prescribing the medication. The home must ensure that improvements to the way that health care needs are recorded and met are sustained and care plans must be kept under review and any changes recorded and agreed. The management of residents’ individual finances must be addressed in order to fully protect their rights. Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 7 The home must provide staff with a policy and procedure for dealing with soiled laundry to ensure good practice in the control of infection. We have recommended at previous inspections that it would be good practice for staff to have hand-washing facilities to promote good hygiene, in the laundry room. At the moment, the only hand washing facilities for staff are in the kitchen, in the basement. We noticed that the mugs used by residents and staff are very stained and there is a risk of cross infection. The senior carer is responsible for supervising care staff and she has identified her own professional development training needs: to have some training in supervision skills. The registered manager must demonstrate that improvements already made will be sustained and embedded in practice in the home and that identified plans for further improvements are put into place. The registered manager must ensure that any event that affects the safety and well being of a resident are notified to the Commission in writing. This is a legal requirement. 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.V366951.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.V366951.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): 2 - 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. The home has made improvements to the initial assessment process, but further development should consider what the home could do to personalise the process of moving into the home taking into account the individual needs and concerns of new residents. EVIDENCE: The home has 20 residents with one room currently vacant. We looked at the assessment for a new resident who has moved in since the last inspection. The majority of residents in the home have all been admitted through social service referral and we were informed by the 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 services and relevant health care professional assessments are obtained. Since the last inspection a new resident has moved in and the home has improved their assessment process to include their own assessment that is used with the care manager assessment to gather relevant information about personal and care needs. However, the care plan for the new resident has not been reviewed since April and although staff have spoken to the resident there Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 10 is no record of how the home is meeting this person’s needs since they moved in, or whether there have been any changes to the care plan. Beaconsfield Care Home DS0000066435.V366951.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): 6, 7 and 9 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made improvements to their systems to demonstrate that care plans provide clearer guidance for care staff on how care is to be provided. Risk assessments have improved and provide clearer guidance for care staff on how to manage risks and events in the home. Current care plans do not adequately reflect residents’ decisions about their care and their personal goals and aspirations. EVIDENCE: Care plans were seen for 3 residents and these had a pen picture with a photograph and this gave good information on residents’ history. Following the last inspection we issued a statutory requirement notice for the home to update and review care plans and risk assessments to ensure that care staff were provided with clear guidance on what they must do to provide care and manage any risks or events. When we looked at 3 care plans we found that records have improved and the care plan provides clearer Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 12 information for care staff and there were comprehensive risk assessments in place, with guidance for care staff on how risks or events are to be managed. Further work on developing the care planning process has been identified as an area for improvement by the registered manager, in the Annual Quality Assurance Assessment (AQAA). The AQAA states that the home plans “To continue to review and update care plans to give staff clear information on the support that residents require, and how, and when, they would like their support to be given”. The home recognises the right of the residents to make their own decisions and choices and residents moved freely around the home and were able to be involved as much or as little as they liked in the daily life of the service. 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. We have also received information from Social Services who have been making monitoring visits to the home following the last inspection because of the concerns about the lack of detailed care plans and risk assessments. Social Services report that there have been improvements to the home’s recording of care and managing any risks. The home must review a general risk assessment for all residents that is written for care staff to tell them what to do in the event of anyone being trapped in their room. This does not currently provide clear and accurate guidance for care staff and does not protect the residents in the event of an incident where residents are locked in their bedrooms. Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16 and 17 - 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 residents’ 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 Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 14 and the home has said that they will support the resident in this and have raised this issue with his care manager. 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. In the Annual Quality Assurance Assessment the home have said that they want “to continue to encourage residents to become more assertive and independent.” The AQAA states that the home wants to develop the opportunities for residents to access leisure, social and educational resources. 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 say that the food was good. 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 stocked 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. The home records what the menu choices are each day, however, it would be good practice for the records to show what each resident actually eats each day. Although the home has 20 residents, there is no dishwasher and all washing up is done by hand. We noticed that the mugs used by residents and staff are very stained. All cutlery and crockery was not, therefore, thoroughlycleaned. Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 15 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): 18, 19 and 20 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans have improved to provide better guidance for care staff on how residents’ health care needs must be met. The systems for storing and recording residents’ medication have improved. The home has not yet demonstrated that improvements are sustained and care plans kept under review and any changes recorded and agreed. EVIDENCE: We looked at 3 care plans and spoke to some of the residents and staff. We also looked at the storage and recording of medication. Personal support to residents is given in private and residents are able to state what support they require. Records show that care plans provide clearer guidance for care staff on what they must do to support residents. 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. The care plan and risk Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 16 assessment for one resident was discussed with the senior carer. The care plan has assessed that a resident is not able to self-medicate with an inhaler. However, the resident may be at risk if they go out without this and it would be good practice for the risk assessment to be reviewed in consultation with health and social care professionals who are involved in the care of this resident to ensure that the resident is protected. 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 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 is 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 in the care plan. 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 staff are completing an NVQ 2 in medication. The Medication Administration Records (MAR) were looked at and all medication had been signed for. Since the last inspection a new medication room has been built in the basement and a new medication cupboard fitted that meets current regulatory requirements for the storage of controlled drugs. We found evidence that requirements from the last inspection have been met and the procedures in place provides a clear audit trail for all medicines that come into the home, are dispensed, or returned to the pharmacy. Residents who self-medicate have been assessed and written agreement recorded with the resident and their GP. The home is not currently ensuring that where medication is not given at the time prescribed, that any changes to the time that the medicine is dispensed, are discussed and agreed with the person prescribing the medication. The Annual Quality Assurance Assessment has identified what the home could do better: “Look at ways of improving our record keeping and provide appropriate training to staff.” Plans for improvement are: “To liaise with other pharmacies and companies to see if there are any updates or more efficient ways of improving the method our medication is dispensed from the present pharmacy.” During our visit, the senior carer told us that she was in discussion with the pharmacy to change the medication administration record sheets so that they were easier for staff to use and record medication. Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 17 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): 22 and 23 - 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 has not been adequately 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 that there had been no complaints received since the last inspection and that any complaints received would be recorded. In the Annual Quality Assurance Assessment the home have stated that they could improve their practice by “Making better use of the complaint record by noting even small matters of concern so residents can be assured their voice is listened to and will be able to see for themselves in what manner their concerns are addressed.” 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 Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 18 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. The home has not addressed the concerns about the management of residents’ personal finances and the AQAA says: “In order to fully protect the residents rights, we will continue to try and find a solution to address the management of their individual finances.” Beaconsfield Care Home DS0000066435.V366951.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 and 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 does not provide residents with homely surroundings. The home must provide staff with a policy and procedure for dealing with soiled laundry to ensure good practice in the control of infection. EVIDENCE: We looked around the home and noted 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 the ground floor. 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, paper towels have been previously used but these were thrown into toilets and caused major blockages. The home has had a new shower room installed and this has proved very popular with residents, staff spoken with said it was easier to encourage residents to have a shower and residents Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 20 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 in the Annual Quality Assurance Assessment that this will be carried out on a priority basis. During our visit one bedroom was in the process of being re-decorated. 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. However, the home employs a cleaner for 4 days per week – four hours each day. When we visited, the cleaner was away and care staff were doing the essential cleaning tasks themselves. The home is large and covers several floors and this made it difficult when they also had to provide care and support. At previous inspections we have noticed a strong smell of damp and mildew in the corridor of the ground floor extension. This is still evident and we were told that the manager has not been able to identify the source of the damp smell in order to rectify the problem. The laundry at the home has a new tumble drier and a washing machine, which is able to wash clothing at appropriate temperatures. However, there is no procedure for staff with regard to how they must deal with soiled laundry. . The laundry has a sink but there are no facilities for staff to wash their hands, such as soap or paper towels. We have recommended at previous inspections that it would be good practice for staff to have hand washing facilities to promote good hygiene, at the moment, the only hand washing facilities for staff are in the kitchen, in the basement. Beaconsfield Care Home DS0000066435.V366951.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 and 35 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s recruitment procedures. The home has started to develop a staff training programme. This is not yet sustained to ensure that staff have the relevant skills and knowledge to meet all of the residents’ needs. 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 16 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. However, on the day that we visited the home, there was not enough staff on duty for some of the residents to attend their usual activities with staff support. A recruitment file was looked at for one recently appointed staff member, however, although we were told that satisfactory checks had been received, Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 22 these were not available in the home. We asked for confirmation of the staff recruitment records and these were provided immediately following the inspection. 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 First 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. Since the last inspection, staff have received some training in mental health awareness and dealing with challenging behaviour. The home has obtained a copy of the ‘Skills for Care’ induction programme for new staff in care, but this has not been put into practice yet. 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. We saw some supervision records that showed the last supervision date was May 2008. We discussed with the senior carer how the record of supervision is going to be improved to demonstrate how work and practice issues are identified and monitored. The senior carer is responsible for supervising care staff and she has identified her own professional development needs to have some training in good practice in supervision. In the Annual Quality Assurance Assessment, the manager has identified what the home could do better: “Encourage staff to continue to develop themselves to enable them to bring new ideas to the home, which can contribute, to improving the care package we provide.” Beaconsfield Care Home DS0000066435.V366951.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 and 42 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has started to develop effective management systems to protect those living at the home especially in relation to risk assessments, care planning, medication management and residents’ finances. The quality assurance systems are not yet imbedded enough to benefit those living at the home. EVIDENCE: The manager is also the responsible individual and he is on the staff rota Monday to Friday each week and is supported in his role by 2 senior carers who look after the home in his absence. The home has made improvements to the way that the home is managed since the last inspection. The roles of the senior carers are not set out, so that they know their responsibilities in the provision of care and support. Although the rota shows that the home employs a cook for seven days per week, we were told that the cook does not Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 24 work on Mondays and one of the senior carers has to cook all of the meals, this means that the senior carer is not able to carry out any care or management tasks on that day. After the last inspection we issued statutory requirement notices because the home had not made the required improvements to care plans, risk assessments and medication arrangements and had failed to comply with the regulatory requirements of the Care Homes Regulations 2001. Improvements have been made as a result of our enforcement action and the home must now demonstrate that improvements will be sustained and be embedded into practice in the home, for the benefit of the residents. In addition, Social Services have been visiting the home to monitor how practice in the home affects the safety and well being of the residents. Social Services report that practice in the home has improved, particularly in the area of care planning, risk assessments, and medication arrangements. In the Annual Quality Assurance Assessment, the manager has clearly identified where further improvements to practice in the home are needed. However, the AQAA does not provide clear evidence of how the improvements will be made. The AQAA says that the home “should continuously review and develop how service is delivered, concentrating on the outcomes for residents.” The manager has told us that he is now spending more time in the home to concentrate on developing effective management systems that will enable him to further improve the service provided. The manager has also told us that the considerable amount of work needed to improve the fabric of the building has been one of the barriers to improvement in the last 12 months. However, the manager says in the AQAA that further improvement to the quality of the service provided will be: “through auditing, monitoring and taking residents views into consideration, the home will continuously review and develop its service.” 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. We were informed that the home has been trying to resolve this problem, but they have not been able to open individual bank accounts. The manager would prefer not to have this money in the corporate account and will continue to investigate alternative arrangements, but this has not been resolved. Solutions to managing individuals money can be found in the 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 Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 25 not regular and take place as required. Residents meetings are also held when specific issues come up, which affect everyone at 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 December visit. The home has not been notifying us in writing of all events that happen in the home. This is a legal requirement. Guidance on making notifications under Regulation 37 of the Care Homes Regulations is available on the Commission website www.csci.org.uk Beaconsfield Care Home DS0000066435.V366951.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 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 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 3 X 2 X 2 X 1 3 X Beaconsfield Care Home DS0000066435.V366951.R01.S.doc Version 5.2 Page 27 NO 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 YA24 Regulation 23(2)(a) Requirement Timescale for action 30/08/08 2. YA41 37 3 OP35 16(2)(l) 20(1)(a) The premises must meet the needs of residents in the home. Locks on internal doors must be of a suitable design to enable staff to enter rooms in an emergency. Events in the home that affect 15/08/08 the safety or well being of the residents must be notified in writing to the Commission. To ensure that residents finances 01/12/08 are protected the registered persons must ensure that any money held for individuals is kept in an account in the name of the service user to which it belongs. 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.V366951.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection 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.V366951.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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