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Inspection on 27/01/09 for Beauchamps Country House Care

Also see our care home review for Beauchamps Country House Care for more information

This inspection was carried out on 27th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beauchamps Country House Care Village Road Hatch Beauchamp Taunton Somerset TA3 6SG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Shelagh Laver     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Beauchamps Country House Care Village Road Hatch Beauchamp Taunton Somerset TA3 6SG 01823480276 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Beauchamp House Nursing Home Ltd Name of registered manager (if applicable) Patricia Anne Britten Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Elderly persons of either sex, not less than 60 years, who require general nursing care. Four places for persons of either sex, in the age range 30-60 years, who require general nursing care. Up to 20 places for personal care Date of last inspection Brief description of the care home Beauchamp Country House Care is in the village of Hatch Beauchamp. The home is a large detached property decorated and furnished in country house style and is very well maintained. The home is well equipped and provides good access for residents, including a lift between floors. The grounds are extensively landscaped to include ponds and summer houses and is accessible to wheelchairs. A small close care housing development has Care Homes for Older People Page 4 of 26 care home 40 Over 65 40 0 Brief description of the care home been built in the grounds. There is a registered manager supported by a deputy nurse manager and a general manager. A registered nurse is on duty at all times. The home is owned by Care South and benefits from the management support and staff training oppportunities of this company. Fees range from £760-£950 per week. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, Commission for Social Care Inspection made two visits to the home. The first was unannounced and took place on 27th January 2007. At this visit people in the home were visited and spoken with in their rooms. Some care documents were reviewed and staff spoken to. The second visit was announced on Thursday 5th February and gave the opportunity to meet the manager and to complete the review of documentation. On arrival at the home on 27th January it was warm, busy but calm. The deputy manager was in charge of the home and provided assistance to the inspector. One Care Homes for Older People Page 6 of 26 person was leaving the building for an appointment accompanied by a member of staff. Some people were coming to the sitting room, one person was finishing his breakfast and reading the paper in the dining room. All staff were wearing the Care South uniforms and looked very smart. There was a friendly relaxed atmosphere throughout the home. Prior to the visits to the home an Annual Quality Assurance Assessment document was submitted in October 2008.The AQAA gives factual information about the home and outlines how they think they are meeting the National Minimum Standards. The manager wrote in the AQAA The home has a friendly warm welcome for all and offers a pleasant tranquil setting to service users and their families.We offer first class care by a professional team of dedicated experienced staff. We encourage our residents whether long or short stay to achieve the highest level of independence and to participate in social and recreational activities within the home and the village. Comment cards were sent to the home. All 10 were returned from people who live in the home. 8 comment cards were returned by staff. A review was also made of information sent to CSCI since the last inspection. What the care home does well: What has improved since the last inspection? The care plan documents have improved since the last inspection. There is evidence that staff have received training in the use of the system. Plans written are meaningful and give clear guidance and information. Review and evaluation has improved. The organisation and recording of training given to staff has improved. It is now very clear what training people have received. Care Homes for Older People Page 8 of 26 All staff receive training according to their role in the home. There is a formal Quality Assurance system in place. Each month an area of provision is audited. The manager is clear about areas for improvement and the actions to be taken. Peoples views are sought through meetings, reviews and questionnaires. Care South have offered the manager structured regional support and the benefits of being part of a larger organisation. Generally systems in the home are more structured and resources have been provided by regional teams in the areas of human resources, health and safety and activities. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home produces information to assist people to make a choice prior to admission. People are admitted to the home following an assessment by skilled staff. Evidence: The home produces information for people to assist with making a choice about coming to the home in the form of a brochure and a web site. All people are invited to view the home but not all people are able to visit prior to admission due to illness or frailty. From comment cards received and when talking to people in the home it was clear that peoples families were often important in making a decision about which home was chosen. Care Homes for Older People Page 11 of 26 Evidence: One person said My daughter toured Somerset and finally chose this one as the best. The home offers care to people who want permanent, short stay and respite care. Some people come into the home for rehabilitation and will return home. People who were not able to visit the home prior to admission are offered the option of moving to another room in the home if they prefer and a suitable one becomes available. Assessments are carried out by the manager and deputy manager who are both experienced nurses. They ensure that staff are trained to meet peoples needs and that any equipment needed is in the home prior to arrival of the new resident. Care files contained assessments completed by home staff and supporting documents completed by other health professionals. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive personal support that is varied and responsive to individual needs. The home has an efficient medication policy supported by procedures and practise guidance. People have their privacy and dignity respected. Evidence: The home uses an established system of care planning that is comprehensive and detailed. Staff have received training in its use. Three care plans were studied in detail showing a good standard of recording and regular review and up-dating. The plan covers all key areas including guidance on mobility and pressure damage prevention. People are weighed monthly and weekly if they are assessed as being at risk of weight loss. When asked about a surprising weight gain for one person the Care Homes for Older People Page 13 of 26 Evidence: manager explained the medical reason and the prompt action taken. There is detailed guidance regarding peoples preferences for personal care and clearly detailed professional visits. People who returned comment cards said that they always or usually received the medical support that they needed. People are able to keep their own GP if they wish. Doctors visit the home to address both routine and emergency health concerns. People spoken to said that they had seen an optician and a chiropodist. Recently an optician has begun providing a service to people in the home and training to staff in the awareness of sight problems. Medication systems are organised and sound. There is a system that enables people to self medicate and appropriate risk assessment and reviews were seen. All people who returned comment cards said that staff listened to them and acted on what they said. Door knockers on bedrooms serve to remind staff to always knock. Throughout the inspection staff spoke to people with respect and kindness. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can chose how they spend their days at the home. The activities programme should be developed further. Meals offered are varied and nutritious. Evidence: People can chose how they spend the day at the home. One person said I have breakfast in my room and like to be downstairs for coffee but sometimes I just feel like a lazy day and stay here. Care plans seen included a social care plan. These outlined peoples preferences and showed when people had taken part in activities offered. One person had been to flexercise, communion, a pub lunch and a pantomime. She had also had a visit from the pet therapist and been out with her family. Other people prefer to remain in their own rooms and pursue their own interests. Care Homes for Older People Page 15 of 26 Evidence: A monthly activities programme is produced and was seen in peoples rooms. In addition to the regular painting, singing and flexercise, social events are planned to include family and friends. One relative mentioned the fetes, fairs and barbecues that had been enjoyed. An activities questionnaire was sent out this year and as a result of the responses changes were made to the planned programme. People wanted more frequent shorter outings as they found travelling tiring. This will be incorporated into the spring and summer programme. There were some comments that indicated that people wanted more stimulation and that they felt that the home could provide a fuller range of social activities. One person said There are some nice people here...nice staff but they dont have time to talk to me. Another person said I want to do more of the sort of things I used to enjoy. I do have some brain left. Access to the gardens is important for some people who enjoy a walk or just sitting. As the home is situated in a small village it can be difficult to access shops One person commented that it was difficult to buy anything and he had not bought a bar of chocolate in two years. Another person however said she was able to go shopping with staff support. People spoken to were very pleased with the food. One person said I am quite surprised at how good the food is. It is all very nice. Menus are reviewed regularly to reflect the seasons. The current menu indicates two main choices for lunch and one main dessert. Through talking to staff and people in the home it is clear that other choices are always available. It would be good practise to have an alternatives menu printed so that people were clear that they could always have omelets or salads when they wished. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to protect people in the home. There is a complaints procedure in place that people feel able to access. Evidence: The home has policies and procedures in place to enable people to make a complaint. All staff who completed comment cards said that they knew what to do if anyone had concerns about the home. One card said We have policies and procedures. We are given training about this. All but one person who returned a comment card said that they would know how to make a complaint. One person wrote I have made a complaint and it was resolved satisfactorily. Staff have received training in safeguarding adults. Policies and procedures are in place. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an attractive and appropriately, adapted environment for people to live in. There are systems in place to reduce the risk of infection in the home. Evidence: This home is set in lovely gardens and from most rooms there is a view of the countryside or the gardens. Some people have bird feeders or enjoy watching the gardens as the seasons change. Since the last inspection the lounge has been redecorated. Individual rooms vary in size but all are comfortable and personalised. One person who has a very small room had been offered alternatives but found her room cosy and comfortable. Another room is large with excellent views and elegant decoration. There is also a choice of more modern rooms on the ground floor. The housekeeping staff at the home receive training and supervision. People who returned comment cards said that the home is always fresh and clean. Care Homes for Older People Page 18 of 26 Evidence: There are policies and procedures in place to minimise infection. During the inspection staff were observed to be working according to appproved guidelines. There were plenty of gloves, aprons and handwashing facilities in the home. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient appropriately trained staff on duty to make peoples needs. The home offers training opportunities to staff. The home exceeds the expected number of staff having National Vocational Qualifications. There are sound recruitment and induction systems in place that protect people in the home. Evidence: The home has an established team of trained nurses and carers. Staff spoken to during the inspection were positive about working in the home. Staff could discuss recent training that they had received which included Manual Handling up-dates and fire training. The home has offered a placement to a student nurse. She confirmed that working in the home was a good experience. The placement is monitored and the manager is acting as a mentor. 8 staff returned comment cards sent to the home. Staff said that they always received up-to-date information about peoples needs. The induction had covered everything Care Homes for Older People Page 20 of 26 Evidence: that they had needed and training was provided. Staff in the home have access to the training department of Care South. When there is sufficient demand the company will run courses at the home. Dementia Awareness and Protection of adults have both been delivered in the home. There is access to training and assessment to NVQ level 2 and above. The home currently has 86 of care staff qualified to NVQ level 2 and above. Recruitment policies and procedures in the home are sound. The personnel files of two new staff were seen. They contained the require written references and Criminal Record Bureau checks. The process of obtaining CRB clearance has been improved as the home manager is now a signatory. The home always has at least one qualified nurse on duty. In the morning there are 7 carers on duty, in the afternoon 4 and two are on duty at night. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified and experienced and has a sustained track record of running the home well. The operational systems in the home are robust having improved since the last inspection. The home has effective and regular support from its corporate owner. The home is run in the interests of the people who live in the home. Evidence: At this inspection the management of the home was very good. The manager Pat Britten has been at the home for some years. She maintains and develops both her management and clinical skills. A review of her training record shows that since the last inspection she has undertaken training that includes being up-dated as a Manual Handling trainer and completing training to be a mentor. She has completed a BSc in Gerontology Nursing this year. Care Homes for Older People Page 22 of 26 Evidence: She continues to provide strong leadership in the home. Staff, relatives and people who live in the home find her approachable and committed to the continued development of the home. Mrs Britten has welcomed the opportunity to be part of the Care South management team and to be involved in corporate iniatives. Quality Assurance in the home is provided through Care South systems. The home receives monthly visits from the regional manager. (Regulation 26 visits). Thorough reports are completed and support and guidance given to the home. There are a range of audits covering all aspects of the home operation including Health and Safety, Infection control and Resident Care. The audits clearly identify action to be taken with time scales. External consultants are used to provide additional quality assurance information and support. There is a structured and monitored Health and Safety system in the home. There are staff with clear healthand safety responsibilities for instance undertaking regular checks relating to fire safety and water temperatures. Maintenance records are kept up to date and accessible in the home. Those for hoists and the lift were seen. Risk assessments and staff training in fire prevention are completed by an external company. Record keeping in the home was of a consistently high standard. records are kept securely and all information requested by the inspector was readily available. There is a named nurse and key worker system in the home. Staff confirm that there is always someone to ask for guidance however regular staff supervision meetings should be more frequent according to National Minimum Standards. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 The home should continue to develop opportunities for stimulation through leisure and recreational activities in and outside the home which suit peoples needs and preferences. The home should ensure that people are aware of the choice of meals available by including the options on the menu. 2 15 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!