Inspection on 07/02/06 for Beauchamps Country House Care

This inspection was carried out on 7th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Beauchamps Country House Care 27/01/09

Beauchamps Country House Care 01/12/06

Beauchamps Country House Care 24/08/05

Beauchamps Country House Care 17/03/05

Beauchamps Country House Care 21/07/04

Beauchamps Country House Care 09/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Beauchamps Country House Care Village Road Hatch Beauchamp Taunton Somerset TA3 6SG Lead Inspector Dee McEvoy Announced Inspection 7th February 2006 10:00 X10015.doc Version 1.40 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 Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 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 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. Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beauchamps Country House Care Address Village Road Hatch Beauchamp Taunton Somerset TA3 6SG 01823 480276 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) Mr David Peter Kohlman Patricia Anne Britten Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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 24th August 2005 Brief Description of the Service: 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 been built in the grounds. There is a registered manager and a general manager. A deputy nurse manager was appointed in February 2003. A registered nurse is on duty at all times. Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was the second inspection of the current year and took the inspector one day to complete. National Minimum Standards, which have been met at the previous inspection on 24 August 2005, were not inspected on this occasion. This inspection focussed on key National Minimum Standards, which had not been inspected at the previous inspection or those, which were the subject of previous requirements and/or recommendations. During the inspection the inspector spoke at length to seven residents and met with several others in the dining room and sitting room. Residents talked with the inspector about their lives and the home. The commission received eight comment cards from residents in respect of the service. The inspector also spoke with one relative and eight members of staff including the registered manager, nursing, care and ancillary staff. The inspector toured the premises and a sample number of records were inspected which included, care plans, medication records/procedures, service and maintenance certificates and a pre inspection questionnaire. The inspector spent a significant amount of time observing the care and attention given to residents by staff. Finally, findings were discussed with the management team. What the service does well: What has improved since the last inspection? Several residents said that the quality and variety of the food provided had improved since the last inspection. Comments from residents included, “A big Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 6 effort has been made to improve the food” and “The food is generally very good.” Since the last inspection staff have received adult protection training and the home’s policies and procedures were being reviewed to ensure residents’ were protected from harm. Residents and staff said that staffing levels had improved since the last inspection allowing them to spend more time to give care. One relative spoken with was happy with the number of staff on duty and felt their relatives’ needs were met. Staff felt that morale had improved greatly. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 8 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 the following standard(s): The key standard was met at the previous inspection. EVIDENCE: Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7&9 Whilst most care records were of a good standard, there was insufficient detail in some to ensure staff had all the information to meet those residents’ needs. Medication systems are generally good. However, one aspect of practice does not ensure safety. EVIDENCE: There is a consistent care planning system in place to provide staff with the information they need to meet the majority of the residents needs. One of the four residents case tracked was diabetic. The care plan did not contain clear guidance for staff as to what was a normal range for this resident or what staff should do if blood glucose levels fall outside this range. A comprehensive nutritional tool is used and weights are monitored regularly when appropriate, however in one case a dramatic weight loss was recorded for a resident with dementia and although action had been taken initially the weight loss had continued. The manager said that the community dietician was to be contacted again but this had not been recorded in the care plan. Residents spoken with were generally happy with the care, and one relative spoken with was also satisfied. One resident told the inspector, “The staff have a good attitude” another said, “The staff show endless patience.” Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 10 Medication systems are well established, for example, records of receipts, newly required medicine disposal procedures are in place, and drug fridge temperatures are noted daily; maximum/minimum temperatures are record, which is good practice. Some handwritten entries on Medication Administration Record (MAR) charts weren’t dated or signed by two staff to verify the accuracy of the entries. Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12 & 15 Social activities continue to provide some daily variation and interest for people. Further consideration could be given to developing the activities for residents who lack capacity. A balanced diet is provided, and efforts are made to try to ensure menus reflect individual preferences and needs. EVIDENCE: The activities currently organised within the home included gentle exercise sessions, painting and group discussion. Some trips are organised during the clement weather. Three residents said they would enjoy more trips and the opportunity to go shopping occasionally. On the afternoon of the inspection a member of the care staff was facilitating the exercise session. Seven or eight residents were in the sitting room for this session but only four or five actually participated. One resident appeared to enjoy watching but another was restless and disrupted the session, which would suggest that this activity was not entirely suitable for their needs and capabilities. The more able residents can and do pursue interests and hobbies outside of the home but others who lack capacity would benefit from a ‘person centred approach’ to planning activities to ensure interesting and meaningful occupation for all residents. Three staff members identified activities as an area for improvement, one said, “It would be good to be able to do more one to one things with residents.” Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 12 Residents spoken with and those responding with comment cards were generally happy with the food provided. Three said that the food had improved since the last inspection; one described it as “excellent” another told the inspector, “The food is more interesting and varied now.” A resident admitted to the home recently said, “The food is nourishing and I have managed to put weight on since coming here.” Two residents responding with comment cards said that they liked the food “sometimes”. The cooks are developing menus to suit the residents’ needs and preferences and a choice is always available. The lunchtime meal was well presented. Alternatives are offered. It is a challenge to ensure some residents receive the necessary diet but some staff were observed to be attentive and helpful wherever assistance was needed during the meal. Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 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 the following standard(s): 18 Residents are protected from abuse by the home’s procedures and well informed staff. EVIDENCE: Since the last inspection most staff have received adult protection training; three staff interviewed said the training was valuable and “very useful.” Senior staff spoken with were aware of local protocols for dealing with issues of concern. The inspector was told the home’s adult protection policy and procedure was being reviewed in line with local guidelines, which is good practice. All residents spoken with and those responding with comment cards felt safe at the home. It was noted that one resident uses a reclining chair (a potential form of restraint) in order to maintain safety; this was recorded in the care plan but not reflected in risk assessments. Consent for the use of this chair had not been obtained. Better evidencing of decision-making is needed prior to using reclining chairs, to safeguard residents’ welfare. Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 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 the following standard(s): The key standards were met at the previous inspection. EVIDENCE: Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Sufficient numbers of staff are currently deployed, with an appropriate variety of training and skills, to meet residents’ needs. Residents are protected by the Home’s rigorous recruitment practices. EVIDENCE: Residents and staff said that staffing levels had improved since the last inspection. Staff interviewed said that staff at the home no longer provided care to the independent cottages, allowing them to concentrate on the needs of the residents. One resident told the inspector that regular agency staff are used, the resident said, “We get to know them. I get all the attention I need.” The use of regular agency staff provides some continuity of care. Although improvements were recognised three residents felt that staff were always busy and that ‘you sometimes have to wait.” On the day of the inspection residents’ needs appeared to be met in a timely way. Residents and one relative praised staff for their care and kindness. Comments included, “They are cheerful and friendly”, “The nurses are jolly good” and “The attitude is good, this is so important.” Two residents said the night staff deserved a particular mention, one resident said, “The night staff are first class!” During the inspection staff were seen to be attentive and considerate when interacting with residents. The home operates a robust recruitment process; three files were examined for the most recently recruited staff. All contained the necessary documents to ensure that residents are protected. Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 16 The home has achieved The Investors in People award in recognition of the commitment to the development of staff skills. Currently 45 of staff have achieved or are working towards NVQ level 2 or above, ensuring the staff team are competent to do their job. A comprehensive induction is offered to new staff and records showed that staff completed the induction programme. Various training is offered throughout the year including, mandatory training such as manual handling, fire safety and first aid. Staff interviewed and the pre inspection questionnaire confirmed that specific training relating to residents’ needs is also available to staff and includes diabetes and catheter care and pressure area and wound care. Staff spoken with felt well supported and able to do their job well. Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 17 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 The home is well managed. Residents are involved in the running of the home, with evidence that their views are sought. However, formal review of the quality of care is less well addressed. The health and safety of residents and staff is in the main being promoted. EVIDENCE: The registered manager has been in post for some years; she is a registered nurse and has completed the Registered Managers Award (RMA). Staff described the manager as “approachable” and said that they were listened to and that communication was generally very good. A general manager and administrator/secretary support the registered manager to ensure the smooth running of the home. There are systems for involving residents and their representatives in the running of the home; questionnaires are distributed twice a year and some residents’ meetings are held. The feedback from the last questionnaire Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 18 (January 2006) was looked at; the majority of responses were positive with residents describing staff, meals, laundry etc as good or excellent. One resident told the inspector that they would like the home to “speed the response” to little concerns and niggles and would appreciate information about the outcome of some suggestions and ideas. No formal review/analysis has been completed of the ‘quality of care’ survey results (which should include the quality of nursing), and residents and CSCI have not received a report on any review of quality of care. The manager told the inspector that the home is not involved in managing the finances of residents. Residents are encouraged to manage their own money as much as possible. Some residents receive support from their families to mange their affairs. A range of servicing and maintenance records were seen at this inspection; all were satisfactory with the exception of the electrical periodic report and some PAT testing. It was identified during the inspection that a periodic report was not available; the manager agreed to take steps to ensure the necessary safety certificate was obtained. Other aspects of health and safety were well managed. Comprehensive risk assessments for a safe working environment and practices had been completed. The manager undertakes a regular analysis of accidents and hazards within the home in order to develop actions to reduce risks. Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 19 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. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 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 Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Beauchamps Country House Care DS0000003241.V273398.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 21/03/06 arrangements for the recording AND safe administration of medicines received into the care home. (when transcribing medicines on to the MAR sheets, two signatures are to be obtained in accordance with the Royal Pharmaceutical Guidelines.) The registered person shall 07/06/06 supply a report to the Commission in respect of any review of the quality of care provided at the care home, and also make a copy available to residents. Requirement 2. OP33 24 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 OP7 Good Practice Recommendations It is recommended that more detailed and relevant DS0000003241.V273398.R01.S.doc Version 5.1 Page 21 Beauchamps Country House Care 2. 3. 4. OP12 OP18 OP38 information be included in care records, for example the acceptable ranges for individual blood sugars. It is recommended that resident activities are extended and developed according to individual need, with particular consideration given to residents who may lack capacity. It is recommended that reclining chairs are only used when included as part of the care plan and risk assessment and where consent has been given. It is recommended that periodic inspections and certificates be obtained to maintain the health and safety of residents and staff. In this case for electrical installations and PAT testing. 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