CARE HOMES FOR OLDER PEOPLE
Beauchamp House Proctor Road Chedgrave Norwich NR14 6HN
Lead Inspector Susan Golphin Unannounced 07 April 2005 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beauchamp House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Beauchamp House Address Proctor Road Chedgrave Norwich Norfolk NR14 6HN 01508 520755 01508 528646 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Norfolk County Council Mr Graham Pollard Care Home 43 Category(ies) of Dementia - over 65 years of age (7), registration, with number Old age, not falling within any other category of places (36) Beauchamp House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to 7 service users with dementia and over 65 years of age may be accommodated. 2. Up to 36 older people may be accommodated. 3. The total number not to exceed 43. 4. The rooms below 12 sq metres are not suitable to accommodate wheelchair users at the point of admission. 5. The registered manager will maintain overall responsibility for the care and support of the service users and the management of staff and services of the Homeward Bound Unit. 6. There must be one member of staff on duty at all time with recognised training in dementia awareness. 7. Up to one (1) person under the age of 65 years may be accommodated in the Homeward Bound Unit. Date of last inspection 07 October 2004 Brief Description of the Service: Beauchamp House is a Local Authority Home situated in the village of Chedgrave. Originally built in 1973 and partly upgraded and refurbished in 1995, the home can accommodate up to 43 older people in single rooms (without en suite), on the ground and first floor. 30 service users can be accommodated in the main home and 7 within the separate EMI unit. In addition there is a designated Homeward Bound Unit offering short term rehabilitative support to 6 older people. This unit is an integral part of the residential environment. Part of the garden is enclosed, and offers a discreet and safe environment for service users. There are ample parking facilities to the side of the premises. The home is supported by local GP surgeries and other health services. Beauchamp House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out by the lead inspector Susan Golphin and the Pharmacist Inspector. Mark Andrews . At the previous inspection carried out in October 2004, fifteen requirements and one recommendation were made . An action plan was submitted to the CSCI by the registered providers and manager and this unannounced inspection was used to review the progress of the home and to monitor compliance in line with the National Minimum Standards for Older People and the Care Homes Regulations. Not all the standards were inspected on this occasion. The Registered Manager Mr Graham Pollard was working out of the premises on the day of the inspection The inspection was undertaken with one of the Care Co-ordinators Ms Jane Sheldrake the duty manager. The registered manager was appointed last year and it was acknowledged during the registration process and at the last inspection that there were areas of the service and service delivery that needed to be improved and reviewed. From the discussions with the duty manager all the requirements are being addressed by the management team. A positive approach is also being taken with the longer term projects involving recruitment and selection of staff, staff training; quality assurance audits, and better communication systems between staff and also with other healthcare professionals. Five of the requirements have been met in the given timescale and the remainder are at various progressive stages or nearing compliance. A partial tour of the premises was undertaken, and the inspector was able to talk to three service users and one visitor. The inspector was also able to attend part of the staff ‘hand over’ meeting when the duty shift changed, to observe the exchange of information regarding care input and practice. What the service does well:
The home has a prominent place in the community, and continues to work at maintaining a good rapport locally. The staff who have worked at the home for a long time are supporting new staff and agency staff to re-establish a greater sense of stability and promote team work. The premises were well maintained on the day with decoration and furniture and fittings in good order. The service users were complimentary about the
Beauchamp House Version 1.10 Page 6 range of meal choices and confirmed that the meal of the day had been appetising and well presented. One service user commented on the forthcoming outing to the Norfolk Broads which will include a short river cruise. The home offers a selected activity each day and outings and special events parties throughout the year. Many of the staff will support special social events or fundraising in their own time. The activity planned for the day of the inspection had been cancelled as the therapist was on holiday. What has improved since the last inspection? What they could do better:
The home accommodates older people with special needs, and work on promoting and implementing initiatives through the care planning processes and risk assessments with this group needs to be given a high priority. The staff group have recently completed in-house training about understanding dementia and this is a positive step. The formal supervision and appraisal process and development of the staff skills must also remain a priority task. Beauchamp House Version 1.10 Page 7 The unannounced pharmacy inspection was carried out by the Pharmacist Inspector and separate and detailed report is available. The report highlights the need for improvements in the recording and coding system in use, and the time of day prescribed medication is issued. ( see report) Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beauchamp House Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Beauchamp House Version 1.10 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1and 3 The homes Statement of Purpose and Service Users Guide provide prospective service users with information about the services provided in the home, so they are able to make an informed choice about admission to the home. There is a satisfactory pre-admission assessment process in place in the home that ensures the home can meet service users needs. EVIDENCE: Both standards were subject to requirements at the last inspection and have been met in part. The statement of purpose and the service users guide have recently been updated and revised. A draft copy was available on the day of the inspection, but is yet to be made available to the service users currently accommodated and their representatives. The assessment and review processes are being reviewed as part of the improvements to the care planning procedure Service users and their representatives are being asked to be involved in the assessment / planning process and to sign up to any agreed plan of care.( see standard 7) Beauchamp House Version 1.10 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 The home is now better at meeting service users health care needs. There is evidence that the home has been committed to improving medication practice since concerns were raised in 2004. Disappointingly, however, there remain some shortfalls in the safety of both record-keeping and medicine administration practice. EVIDENCE: Some progress has been made with the implementation of new care plans. 27 having been replaced with 10 remaining to be completed. The plans identify the healthcare needs of the service users and indicate how their needs will be met. A new audit process is in place for monitoring accidetns and incidents. Both standards were the subject of requirements at the last inspection and have been met in part. Care plans are currently being reviewed by care coordinators . Key carers, who have day to day contact with the service users will become more involved in the review process, but this arrangement is not yet in place. Beauchamp House Version 1.10 Page 11 Service uses and a visitor to the home said that they were satisfied with the service and level of care received. Staff handover meetings provide the opportunity for staff to share thoughts and opinions about service users as well as the formal exchange of information relating to their care As a direct action arising from a complaint made last year, there is a new process in place for monitoring accidents and incidents. The new procedure will enable improved recording and reporting, and one of the senior managers is responsible for auditing the incidents and accidents each month. It was acknowledged that all these recent modifications in monitoring and recording the care service are at an early stage and will be looked at again at the next inspection. Standard 9 was inspected separately by the pharmacist inspector.( see detailed report) Beauchamp House Version 1.10 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12and 15 The dietary needs of the service users are catered for. Menus offer a varied range of meals to suit personal taste and choice. Although assessment and care planning processes are in place which identify service users preferences, social and recreational interests for all service users need to be more personalized. EVIDENCE: The home have recently introduced changes to the time and the way the breakfast meal is served and supervised The changes provide for a more informal and leisurely approach and within easy reach of service users own rooms. From the discussions with staff and service users on the day the change has proved to be a popular move. Daily activities are in place with members of staff and outside therapists and entertainers. The activities are mainly standard group type, and service users commented favourably about them. Whilst the staff have a good understanding of service users needs and preferences, the opportunity to provide and develop a more personalised and individual activities programme for those with specialist needs should be considered to promote interest and stimulation and detract from aimless wandering
Beauchamp House Version 1.10 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home have a satisfactory complaints system There is some evidence that service users are offered the opportunity to express their views, and concerns and complaints are acted upon. Staff training has increased knowledge and understanding of adult protection issues which protects service users from abuse. EVIDENCE: As a result of a major complaint last year the management have reviewed their processes for dealing with and monitoring concerns and complains. The complaints procedure and a printed survey leaflet asking ‘how are we doing’ is now on display in reception and accessible to service users and visitors. Staff are attending formal training sessions to promote their awareness and knowledge about adult abuse. Issues around this topic are also to be raised and discussed at staff meetings and through supervision. Beauchamp House Version 1.10 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23,26 The overall quality and standard of the décor and furnishings of service users rooms is good, and provides an individual and homely atmosphere. EVIDENCE: A brief tour of the premises showed that service users rooms are suitably equipped and furnished. Continence problems have been identified in a small area of the home and clinical guidance and professional advice is being sought to address individual continence management. Increased domestic and cleaning techniques are also being applied to counteract the immediate problem. Beauchamp House Version 1.10 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 30 Increased numbers of permanent staff and greater uptake of NVQ training has improved consistency of care. EVIDENCE: Since the last inspection four permanent care staff have been appointed plus two senior staff. There are still staff vacancies and the management continue to rely on agency staff to meet the shortfall and back up sudden absences or illness. With the cooperation of the agency, and wherever possible, the management are able to use the same agency staff to ensure there is a continuity of care. The providers have recently undertaken a review of staffing levels and development to ensure there are sufficient numbers of staff with the appropriate expertise to meet current need. Service users said they were satisfied with the level of care they receive, and gave examples of personal input and kindness. However from the brief overview taken on the day the client group have high dependency needs including those service users with a designated mental frailty and require a constant level of physical support and supervision Staffing levels must reflect a balanced input of emotional and physical care. Beauchamp House Version 1.10 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Limited progress has been made in the development and implementation of the supervision and appraisal processes for staff EVIDENCE: This standard was the subject of a requirement at the last inspection, and some progress has been achieved. A programme of supervision is in place, although the supervisors have not received supervision training or guidance on which supervisory practice is to be used . Members of the management team are due to attend training on staff appraisal in April /May 2005. If staff are to benefit from the process of supervision those undertaking the role must be competent and confident to be able to address all aspects of practice: the philosophy of the home: and career and training development. Beauchamp House Version 1.10 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x x x x 3 x x 2 STAFFING Standard No Score 27 3 28 2 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x x Beauchamp House Version 1.10 Page 18 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 1 Regulation 4, 5 Requirement The registered providers must make available to the service users and their representatives the recently revised copies of the homes Statement of Purpose and Service Users Guide The registered providers must continue to complete the care planning and risk assessment review for all service users and bring the revised process into use. The registered providers must undertake to ensure full and accurate records are maintained and that prescribed medication are administered as directed. The registered providers must comply with the requirements 9.3,9.4 and the recommendations 9.1,9.3,9.4 9.5, 9.7, 9.8,9.10 as set out in the Pharmacist Inspectors report The registered providers must continue to identify initiatives to promote the emotional and recreational well being of those service users with special needs to ensure the routines of daily living are flexible and within their personal capacity.
Version 1.10 Timescale for action 31st May 2005 2. 7 14 31st May 2005 3. 9 13 30th April 2005 4. 12 12 07/04/05 Beauchamp House Page 19 5. 19 23 6. 28 18 7. 29 18 8. 36 19 The registered providers must ensure that the premises are kept clean hygenic and free from odours throughout the home, and that professiona and clinical guidance sought to ensure appropriate management of continence problems. The registered provider must continue to promote and provide NVQ training opportunities for all staff. The registered providers must continue to recruit and select appropriate staff to the home so that service users are supported and protected by the process and receive a consistent level of care. The registered providers must ensure that those undertaking supervisory roles must have the expertise and knowledge to carry out the procedure. 07/04/05 07/04/05 07/04/05 September 30th 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Beauchamp House Version 1.10 Page 20 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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