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Inspection on 04/02/09 for Beaufort Hall Nursing Home

Also see our care home review for Beaufort Hall Nursing Home for more information

This inspection was carried out on 4th February 2009.

CSCI found this care home to be providing an Good 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: Beaufort Hall Nursing Home 28 & 30 Birnbeck Road Madeira Cove Weston Super Mare North Somerset BS23 2BT     The quality rating for this care home is:   two star good 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: Juanita Glass     Date: 1 6 0 2 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 27 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Beaufort Hall Nursing Home 28 & 30 Birnbeck Road Madeira Cove Weston Super Mare North Somerset BS23 2BT 01934620857 01934414426 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Boyack Enterprises Ltd care home 33 Number of places (if applicable): Under 65 Over 65 33 6 old age, not falling within any other category physical disability Additional conditions: 0 0 May accommodate up to 33 persons aged 65 years and over requiring nursing care May accommodate up to 6 persons aged 65 years and over with physical disabilities Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 27 Brief description of the care home 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. Current fees can be obtained on request from the manager. Care Homes for Older People Page 5 of 27 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: two star good 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: This inspection took place over two days and a total of eight hours were spent in the home. To gather enough evidence to support our judgments for this inspection, We The Commission asked the service provider to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gives us some numerical information about the service, and how they intend to maintain or improve outcomes for people using their service. We also sent surveys to the people living in the home and to staff who work there. We Care Homes for Older People Page 6 of 27 received nine surveys from people in the home and four from staff. Once we had received this information we carried out a visit to the home and spoke to people living there, the staff and relatives. Whilst in the home we also looked at documents maintained for the day-to-day running of the service. These included care plans, staff recruitment, training and supervision. Also records relevant to the administration of medication, the service records and health and safety. What the care home does well: What has improved since the last inspection? What they could do better: We did not make any requirements following this inspection. Two best practice recommendations were made. When we were looking at the medication records we noted that one person who was prescribed a PRN (as required) medication was receiving it regularly at 8am every morning. We recommend that this prescription is reveiwed to reflect the regular dose the person is receiving. Whilst looking around the home we noted that some areas were still in need of redecoration, we recommend that the provider continues to follow a programme of redecoration and refurbishment in all areas of the home. Care Homes for Older People Page 8 of 27 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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. Prospective residents benefit from adequate written information a chance to visit the home and a full assessment of their needs. This means they can make an informed decision before moving in and their needs are fully met. Evidence: We the Commission looked at a copy of the homes Statement of Purpose and Service User guide. They were readily available in the home and provided immediately. We saw that the Statement of Purpose was well written and contained all the information a person would need to tell them about what care the home can and cannot provide. It also states clearly the fees and what they pay for with a list of extra charges clearly mentioned. The document also makes a statement about meeting peoples needs whilst repecting their religion, culture, race, sexuality and sexual orientation. We spoke to the manager about how she would assess a person who wished to move Care Homes for Older People Page 11 of 27 Evidence: into the home. She said she visits the person either at their home or in hospital. She talked to them, a relative or advocate and staff at the hospital or a social worker. She would also look at existing care plans for the person. We then looked at the records held in the home for two people who had not lived there very long and the records for two people who would move in during our visit. They all had completed pre-admission assessments and community or hospital care plans. We then spoke to people living in Beaufort Hall however they did not comment on the experience the two people moving in were very busy getting used to their new home. People wanting to move into Beaufort Hall can visit and spend some time there to meet other residents and staff. This is often done by a relative or advocate on their behalf. If the manager and staff feel they can meet the needs of the person they will offer a trial period when both the person moving in and staff can decide whether the home is really the best placement for them. Care Homes for Older People Page 12 of 27 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 living in Beaufort Hall benefit from personal and specialist health care support that is provided in a person centred way respecting their privacy and dignity. They benefit from and are protected by the homes policies and procedures for the administration of medicine and can be supported to continue to manage their own medication if they wish. Evidence: We looked at the care plans for four people living in Beaufort Hall. All care plans were recorded in a person centred way. They showed us that staff had a clear understanding of the way to record the personal likes and dislikes of the resident in their care. All the care plans we saw reflected this approach with clear guidelines for staff about peoples personal likes and dislikes. Staff spoken to said they knew each individuals preferred way of being looked after, residents spoken to said they thought staff understood what they wanted. Surveys received also said that staff are very kind and caring, staff always ready to help, chat and have a laugh. We observed staff chatting with residents in a friendly and relaxed way, care was provided in a dignified Care Homes for Older People Page 13 of 27 Evidence: and respectful fashion with screens being used when the hoist was used in lounge areas with other people present. People we spoke to said they were happy with the way in which they were cared for. One person said they really liked living at Beaufort Hall and added, the manager Jaqui is wonderful and we want to see a good report from you. Another person wanted to know why the home needed an inspection with such good staff and a really good manager. All the care plans we looked at included appropriate risk assessments and showed signs of regular review. Care plan reviews also reflected the changes in peoples lives showing a continuity of care. We sat in on the staff handover carried out between each shift, staff communicated peoples specific needs that day ensuring that everybody knew what care was needed. People living in Beaufort Hall have access to healthcare specialists and care plans showed that the district nurse or a specialist nurse could be consulted when the home felt they needed some expert advice. People were also helped to attend outpatient appointments, the dentist, optician and chiropodist. Beaufort Hall has very clear policies and procedures for the receipt and administration of medication. We looked at the records kept by the home for medication and the way that medication was stored. We saw that all procedures were being carried out correctly, we saw risk assessments for people who wished to continue to manage their own medication following an assessment to check their ability to do so. We did note in one persons medication chart that a PRN (as required) medication was being administered every morning at 8am, the manager needs to ask the GP to change this prescription to reflect the regular dose. Care Homes for Older People Page 14 of 27 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 living in the home benefit from the development of meaningful activities which recognises their diverse needs, enabling them to maintain some control over their lifestyle. They benefit from continued contact with family, friends and the local community. A well-balanced menu means people benefit from a healthy nutritional diet. Evidence: We discussed the provision of activities in the home with the manager, staff and some of the people living there. We saw that there was a very clear record being kept to show that people were offered the opportunity to join in an activity. One person we spoke to said that that there was always plenty to do, another person said they were never bored. Surveys indicated that people were offered activities, one survey stated that they had enjoyed a trip out, another that they had been helped to do their Christmas shopping whilst another person said they had enjoyed a walk out in the wheelchair. We saw evidence to show that people took part in trips out in the home minibus, they attended regular reminisence therapy, as well as joining in with musical entertainment Care Homes for Older People Page 15 of 27 Evidence: quizzes, bingo and where helped to read the newspaper to keep up with current affairs. People can also take part in a church service if they wish and the manager can organise contact with other ministers of religion if requested. A residents forum is held every two months the minutes for the meeting in January 2009 showed that 9 people attended when they commented on the lifestyle in the home and made suggestions about the meals they would like whilst the kitchen was being replaced. This shows us that people living in Beaufort Hall continue to maintain some control over their daily lives. People we spoke to also praised the standard of food they received, We talked about lunch on the day of our visit and they said they had enjoyed a very nice quiche with salad and jacket potatoes. They also confirmed they had the choice of a stew, with rhubard crumble for dessert. One person when asked said, of course the meals are good I wouldnt eat them if they werent and I would complain to Jaqui (the manager). The standard of meals available in the home had been raised as a subject of concern to the Commission however on both days of this inspection people said they generally had a good meal. Nutritious meals with fresh fruit and vegetables were seen to be offered both days. We saw that the meal time was unhurried and was treated as a social occassion. Menus showed that people were offered a choice of nutritious wholesome meals, the manager confirmed that the residents had been consulted during their forum meeting about meals they would like to see included. Some staff did express concern that some provisions were supermarket value ranges and this was evident in the larder, however these did not appear to be main ingredients and did not lower the nutritional value of the meals provided. Care Homes for Older People Page 16 of 27 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. People benefit from and are protected by the complaints and safeguarding procedures in the home. Staff are fully aware of the procedures to follow to protect people from abuse. Evidence: Beaufort Hall has a very clear complaints policy and procedure, which is easy to read. It shows a clear timeline and action to be taken if someone wishes to raise a concern or complaint. A copy is clearly displayed in the hall, and can be provided in large print if necessary. People we spoke to said they knew who to approach, one person stated they could always talk to the manager and the minutes of the residents forum showed that people could discuss issues openly. Most people spoken to did not comment on how to raise a complaint, resident surveys indicated that most people were aware of whom they could talk to. The manager keeps a full record of all concerns, complaints and compliments they receive. Most of the staff working in the home had attended training in safeguarding vulnerable adults whilst new staff were covering abuse issues in their induction process. They were all aware of the homes policies and procedures raising complaints and whistle blowing. Staff spoken to knew what procedures to follow and who to contact if they Care Homes for Older People Page 17 of 27 Evidence: suspected that a person living in the home was at risk of harm or abuse. Care Homes for Older People Page 18 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Beaufort Hall benefit from living in well maintained rooms that are appropriately furnished and reflect their personal likes and interests. Some areas continue to need redecoration and refurbishment. People benefit from a clean tidy home with no offensive odours, staff follow good infection control policies. Evidence: We carried out a tour of the home; we looked in some peoples rooms. The home is well furnished in such a way that people living there can chose where they wish to spend their time either in their room, or one of the two lounge areas, in warmer weather they can also sit on a paved area at the front of the home. The furniture and fittings are of a good standard and communal areas are pleasantly decorated. We saw rooms that were full of personal possessions reflecting the persons life and family. People we spoke to said they liked their rooms. We asked people if the heating in the home was sufficient following a random visit carried out in December specifically to look at heating issues. People confirmed that the heating in the home was sufficient and all rooms we entered were warm enough for people to sit in. Care Homes for Older People Page 19 of 27 Evidence: Some areas of the home were in need of redecoration which was being carried out gradually with a full refurbishment of the kitchen underway at the time of the inspection. The home showed a good standard of housekeeping and no offensive odours were apparent. The manager and staff showed a clear awareness of infection control policy and procedures and the manager confirmed that she could obtain guidance from outside agencies if required. Care Homes for Older People Page 20 of 27 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. People benefit from and are protected by the staffing levels and skill mix of staff in the home. The homes recruitment procedures and staff training further protect people from the possibility of abuse. Evidence: The staffing rota showed that there is always enough staff in the home with the right skill mix to support the diverse needs of the people living in there. They also showed that staffing is flexible so that extra staff can be bought in to cover extra busy times such as activities or trips out. People spoken to said that there were always enough staff in the home to do the work that needed to be done as well as take time to chat and have a laugh. Written surveys also indicated that staffing levels were appropriate to meet the needs of people in the home with ease. We observed adequate staffing levels on the day of our visit and staff were not over stretched providing care in the home. The manager confirmed that staff are encouraged to obtain an NVQ Qualification in Health and Social Care. This is evident when most of the care staff have obtained a level two or above qualification whilst others are attending training. Qualified staff have been encouraged to obtain the NVQ level 4 and Domestic and kitchen staff to obtain NVQs relevant to their role in the home. Staff spoken to said they felt well Care Homes for Older People Page 21 of 27 Evidence: supported in attending training relevant to the needs of the people in their care. Records showed that staff have all attended mandatory training as well as training that is necessary to provide a good level of care to the people living in the home. We saw evidence of training attended by both qualified and care staff enhancing their understanding of the specific needs of the people in the home such as Understanding Dementia Care and the Mental Capacity Act. Beaufort Hall has strict policies and procedures for the recruitment of new staff. The personnel files for four people who had recently been employed showed that the manager followed these guidelines as all the relevant checks such as references and a CRB (Criminal Record Bureau) check had been completed before the person started work. This protects people from possible harm or abuse. All new staff then follow a concise induction programme which follows the Skills for Care guidelines. Care Homes for Older People Page 22 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well run home with an appropriately qualified manager and supervised staff. The home does not manage residents finances. Both people working and living in the home are protected by robust health and safety procedures. Evidence: The Registered Manager has a wealth of experience in the care of the elderly including people with Dementia. She is a Registered Nurse and has attained the NVQ Level 4 Management in Health and Social Care. People spoken to said they felt they could talk to the manager openly, more than one resident referred to the manager by her first name and said they were very happy with the way the home was run. Staff also said they felt well supported and could approach the manager to discuss the needs of people in the home as well as training needs. The organisation carries out a regular quality assurance process where peoples ideas and comments are sought, the resident forum also ensures that people can take part Care Homes for Older People Page 23 of 27 Evidence: in decisions made about the running of the home. The manager confirmed that the home currently does not directly handle residents financial affairs. Staff personnel files showed that regular supervision is planned and carried out. Any training and development needs are identified and followed up where possible. Staff confirmed that they received supervsion which they felt helped them identify areas where they excelled or needed support. We looked at records relating to the servicing of equipment in the home. All the records were up to date and available for inspection, these included the COSHH records, which are guidelines for staff to follow if they spill, drink or are splashed by chemicals used in the home. These can also be provided in an alternative language if required. The implementation of health and safety within the home was satisfactory. All residents have personal risk assessments. Generic risk assessments were in place and reviewed regularly including the hot water checks. A review of the firelog showed all tests, training and drills were being carried out to the Fire Brigade guidelines. Care Homes for Older People Page 24 of 27 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 25 of 27 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 9 The registered person needs to ensure that the one medciation entry written as PRN (as required) is reveiwed to reflect the regular morning dose administered. The provider needs to ensure that a programme of redecoration and refurbishment is followed to improve some areas of the home. 2 19 Care Homes for Older People Page 26 of 27 Helpline: 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 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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