CARE HOMES FOR OLDER PEOPLE
Beaufort Hall Nursing Home 28 & 30 Birnbeck Road Madeira Cove Weston Super Mare North Somerset BS23 2BT Lead Inspector
Juanita Glass Key Unannounced Inspection 20th November 2007 10:30 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 Beaufort Hall Nursing Home DS0000050501.V349686.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 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. Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beaufort Hall Nursing Home Address 28 & 30 Birnbeck Road Madeira Cove Weston Super Mare North Somerset BS23 2BT 01934 620857 01934 414426 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) Boyack Enterprises Ltd Mrs Jacqueline Margaret Bowen Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability over 65 years of age (6) of places Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. May accommodate up to 6 persons aged 65 years and over with physical disabilities May accommodate up to 33 persons aged 65 years and over requiring nursing care 17th April 2007 Date of last inspection Brief Description of the Service: Beaufort Hall Nursing Home is registered for 33 elderly people aged 65 years or over. The home is on Weston-Super-Mare seafront and occupies a prominent position overlooking Marine Lake. The approach to the main entrance of the home is up a steep slope. Wheelchair access is available at the other end of the building. The home has 25 rooms used as single occupancy and four double rooms. All rooms have en suite toilets. Beaufort Hall is a four-storey building and has a six-person passenger lift accessing all floors. The home has been suitably adapted for the current resident group with handrails in corridors and grab rails in toilet facilities. There is a large dining room on the ground floor and two spacious lounges on the first floor, each of which has a small dining area. The home has a nurse call bell system throughout. There is a Registered Nurse on duty at all times. The home is well maintained and comfortably furnished. It is close to local amenities and the town centre. The current fees are £523.57 per week with additional charges being made for hairdressing, chiropody, newspapers, escorts, toiletries and social therapy entrance fees. This information was provided in April 2007. Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second key inspection for 2007. We did not look at all the key standards but concentrated on the standards that were the subject of a requirement or recommendation at the last key and random inspections. We gathered evidence to support our judgement by carrying out a review of some of the documentation held in the home. We also reviewed a copy of the Annual Quality Assurance Assessment forwarded to the Commission by the manager of the home. We received 20 completed comment cards; 6 from people living in the home, 5 from relatives and 9 from healthcare professionals and other service providers who visit the home on a regular basis. On the day of the inspection we discussed progress in the home with the manager, we observed staff working practices, spoke to people living in the home and carried out a short tour of the premises. What the service does well: What has improved since the last inspection?
It was evident during this inspection that a lot of hard work has been put into meeting the requirements and recommendations made at the last inspections by both the manager and her staff team. The team at Beaufort Hall should be proud of the progress they have made.
Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 6 Morale in the home was high and staff were more relaxed and cheerful than at previous inspections. Residents were happy and relaxed and showing evidence of wellbeing including residents who had been withdrawn when spoken to previously. The manager has met all 13 requirements and 9 recommendations made at the last key inspection. Progress in these areas can be seen in the way staff work and understand the people living in the home. The manager confirmed that the regular staff supervision now carried out has helped highlight problem areas and ways of improving the service provision in the home. She said that staff were more open to change and development now that they felt their views were being seriously considered. Care records reflect person centred care, highlighting personal preferences which staff are aware of. They contain a full needs assessment and identified needs are dealt with promptly. New people moving into the home are now seen as routine by the falls and continence assessors so needs are identified before they become a problem. All people in the home are offered a varied programme of activities that is appropriate to their ability. Recruitment practices are stricter and all required checks are now carried out before a new member of staff commences work in the home. They then work supervised and complete an in-depth Induction, which underpins and prepares them for the NVQ level 2 training. Two quality assurance questionnaires have been carried out since April as a consequence of this a shower has been installed in the home, and a relatives forum is planned for the New Year. A new chef has been appointed and meals have improved. People living in the home commented this on more than one occasion. Staff have attended all mandatory training and training in safeguarding adults has been provided. 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. The summary of this inspection report can be made available in other formats on request.
Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 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 Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, and 5. 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People planning to move into the home receive a comprehensive pre admission assessment, which highlights their needs and whether the home is equipped to meet those needs. All people in the home have a contract or statement of terms and conditions. All people enquiring about placement at Beaufort Hall are encouraged to visit the home first. EVIDENCE: The care plans for three people living in the home were reviewed; they all contained very comprehensive pre admission assessments, which highlighted the specific needs of the individual. This assessment, alongside the hospital or social services care plans provides the evidence for an initial plan of care to be available on the day of admission. They also include personal preferences such as whether a person is an early riser or not and preferred interests. The manager has developed a statement of terms and conditions that are individual to the person, as personal contributions vary. These have been sent
Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 9 to all funded people in the home or their relatives, many were still to be returned to the manager signed. People who enquire about moving into Beaufort Hall are encouraged to visit the home and meet staff and other people living there before they decide if the home is right for them. Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs including specialist, nursing and dietary needs are clearly recorded. Personal support is responsive to varied and individual needs supporting a person centred approach to care. This includes a clear and individual end of life plan agreed with the person in the home. The home has an efficient medication policy supported by guidance that staff understand and follow. EVIDENCE: The care plans reviewed all showed very clear and consistent guidance for staff. Since the last inspection they have been developed to include a life history, personal preferences and an end of life plan. These are linked to the ‘Gold Standards Framework Programme for England.’ (‘..Supporting Care Home (with nursing) staff to improve end of life care, and improve collaboration with
Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 11 primary care and specialist teams.’ NHS End of Life Care Plan). This reflects good practice. One person living in the home commented when asked and said they thought it a good idea as they wanted to remain in the home and this document now stated their wishes clearly. The development of this plan has enabled the home to strengthen their contacts with specialist teams within the area. All the care plans reviewed showed that the home retains a close relationship with visiting healthcare professionals. The continence and falls nurses assess all new people to the home to identify needs before they become a problem. Care plans also contained references to visits by the CPN (Community Psychiatric Nurse) Diabetic Nurse, Physiotherapist and the Optician. Staff interaction with people in the home was observed throughout the inspection. They had a very cheerful relaxed relationship with the people living in the home. People said that the staff were caring and considerate respecting both their right to privacy and dignity. Staff were observed to knock on doors and ask before entering a room. One person living in the home said ‘if I were not happy I could leave but I’m still here so that must say something for you.’ The manager has recently started a new contract with a pharmacy to provide medication for the home. The policies and procedures in place are robust and all staff have the relevant training and understanding of the processes to follow. An audit of medication held in the home was carried out and no errors found. Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can take part in a variety of activities within the home and the local community. The home tries to be flexible and attempts to provide a service that is as individual as possible using its staff and resources effectively. EVIDENCE: A varied programme of activities is offered in the home and people are encouraged to decide for themselves if they attend or not. One person living in the home does not like the reminiscence sessions so chooses not to join in. Care records showed that people have been offeredreminiscence, musical sessions, cards, and dominoes. They receive help to read the newspaper or a book. Holy Communion is also available for those who wish to attend. One person living in the home said they enjoyed the trips but they had stopped, as it was winter. A record is now being maintained of the activities that people attend. Continued progress in this area will be assessed at the next inspection. People were observed exercising choice and control over their day. This was more evident at this inspection than on previous occasions. Care records
Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 13 clearly state personal preferences and staff support people to make their own decisions. One person spoken to said they could go out if they wanted so long as they let staff know. One person informed the manager during the inspection that they were going out; staff ensured their mobile phone was fully charged so they could get in touch with the home if they needed to. Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is provided to all people in the home, it is clearly written and easy to understand. The policies and procedures for Safeguarding Adults and Whistle Blowing are available and give clear specific guidance to those using them. EVIDENCE: Since the last inspection all complaints and concerns are now recorded fully in the homes complaints book. These include the complaint, action taken and outcome. People living in the home said they felt they could talk to any member of staff including the manager if they had to raise a concern. Copies of the complaints procedure are made available in the home. Since the last inspection only the most recently employed staff have not attended POVA training. The manager stated that they would be on the next available course. All new staff sign that they have read the policies and procedures for Safeguarding Adults and whistle blowing in the first week of their induction. All staff revisit the policies and procedures through regular supervision which has now been put in place by the manager.
Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Beaufort Hall provides a physical environment that meets the specific needs of the people who live there. It is comfortable, and has a programme of improvement to decoration, fixtures and fittings. The home is clean and tidy; there is a good infection control policy. EVIDENCE: A short tour of the premises was carried out to ascertain progress made in the areas that resulted in a requirement or recommendation at the last inspection. All fire doors identified at the last inspection now closed fully providing a more adequate barrier to smoke in the event of a fire. Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 16 Rooms identified as needing window restrictors either had them fitted or had a risk assessment in place, for people who wished to be able to open their window wider. It was evident that there was a programme of redecoration and refurbishment, with empty rooms being decorated. All areas are accessible and adequate communal space is provided. All bedrooms were well furnished and showed signs of personal belongings. The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility and aid independence within the home. All bedrooms are provided with locks that are accessible to staff in an emergency. People spoken to said they liked their rooms and they could bring in their own furniture. One person said everything in the room was from their own home making it easier to accept moving into a care home. Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager safeguarding people living in the home follows a robust recruitment procedure. Staff receive training specific to the needs of the people in the home as well as the mandatory training required. A full and comprehensive induction is provided for all new staff. EVIDENCE: Since the last inspection three new members of staff have been employed. Their personnel records were reviewed. They showed that all the required checks had been carried out prior to them commencing work in the home. Evidence of references, POVA 1st checks, completed CRB’s and proof of Identity were kept on file. Verbal references were followed up with a written confirmation. All three staff members had followed a full induction and worked supervised whilst following the first stage of the induction process. The home has adopted an induction programme that is in line with the Common Induction Standards. The documents reviewed showed that the induction also underpins ‘basic pathways’ to achieving a suitable level of knowledge to commence NVQ level 2 training.
Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 18 A comprehensive training programme had been put into place since the last inspection ensuring that all staff have completed their mandatory training as well as other areas specific to the needs of the people in the home. Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and competent to run the home. She has developed a strong leadership and promotes equal opportunities, has good people skills and understands the need for person centred care. The home has developed and acted on a clear Quality Assurance process. Staff supervision has been introduced with an overall improved service for people living in the home. Health and safety is satisfactory EVIDENCE: The manager has a wealth of experience in care of the elderly. People living in the home feel the manager is approachable, available and seeks to ensure all
Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 20 their needs are met. Following the introduction of regular supervision staff feel they have a say in the running of the home. It was evident by the progress that has been made in the home following the last inspection that the manager has shown a clear commitment to improving the service provided by Beaufort Hall. This is also evident in the clear lines of leadership that she has established and maintained. The work ethos in the home is no longer task orientated although care staff had asked if they could keep the lists that they are used to, but use them in a different more person centred way. The manager has almost completed a second Quality Assurance process for this year. It was evident that issues raised through the QA have been taken on board and acted upon; hence the installation of a shower room requested by one person in the home. The manager is also introducing a relative’s forum in the New Year, which will include the manager and a senior carer. The manager also stated that she was aware of the changing community of Weston-super-Mare and wished to reflect this in the ethos of the home. She was looking into ways of developing a multi faith ethos. She has already identified a butcher who could supply Halal food if requested, and is looking at other areas she could build on. The manager confirmed that both herself and the deputy manager had attended a course on Clinical Supervision giving them a firm basis to introduce regular supervision in the home. Staff had benefited from the supervision sessions and were becoming more ready to talk about things they felt they could help change. This was also evident in the improved morale in the home. Staff confirmed that they found the approach to supervision helpful whilst it also made them feel they had a say in the way the home was developing. The generic risk assessments have been reviewed and bought up to date. They reflect current working practices in the home. The manager stated that she had recently requested the COSHH guidelines be provided in Portuguese and Polish as well as the English ones, enabling her foreign staff to have a clearer understanding of the guidelines for proper safe use of products. All service records are up to date and a review of the fire log showed that all the relevant checks are being carried out. All staff have attended fire training and fire drills have been carried out. Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 21 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 Beaufort Hall Nursing Home DS0000050501.V349686.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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