CARE HOMES FOR OLDER PEOPLE
Beaufort House Rectory Road Burnham-on-Sea Somerset TA8 2BY Lead Inspector
Shelagh Laver Unannounced 25th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Beaufort House Address Rectory Road Burnham-on-Sea Somerset TA8 2BY 01278 786320 01278 786320 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Royal Agricultural Benevolent Institution Mrs Christine Rowe Personal Care Home Only 32 Category(ies) of Old Age registration, with number Physical Disability of places Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Registered for 32 persons in categories OP and PD (over 50 years of age). Date of last inspection 25th January 2005 Brief Description of the Service: Beaufort House is a residential home owned by the Royal Agricultural Benevolent Institution. It is situated in a pleasant residential area of Burnhamon-Sea and is surrounded by large and attractive grounds. The home is a large Victorian building that is comfortable and very well maintained. There are four large sitting rooms (one with bar facilities) and a spacious dining room. All bedrooms have en-suite facilities and call bells. There is a passenger lift and facilities for assisted bathing. The home benefits from a low staff turnover. Staff are experienced and benefit from an established training programme. General Practitioners and district nurses visit service users in the home to provide professional health care. The management and staff at the home assist service users to live as independently as possible. There is an interesting range of activities within the home and links to the wider community. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on one day over four hours and was conducted by one inspector. A tour of the premises took place where a selection of bedrooms and all communal areas were seen. Seven service users were spoken with individually. The inspector met other service users taking part in a craft activity group. The registered manager was on duty and was able to assist the inspector. Records relating to care, staff and health and safety were examined. What the service does well:
It is clear that the registered manager’s aim in running the home is to provide the best possible individual care to service users. There is an established positive group of carers. Service users confimed they were well cared for at Beaufort house. One service users said staff provided kindness “in excess….they couldn’t be nicer” Service users benefit from the contributions made by all members of the support staff. Service users enjoy a wholesome and varied menu which takes into account the needs and preferences of people in the home in a very individual way. The home environment is very well maintained. It safe, clean and comfortable. Communal areas exceed the required Minimum Standards. The gardens surrounding the homes are particularly attractive and contribute significantly to the enjoyment and sense of well-being of some service users. Service users are actively supported in the development of a variety of lifestyles and daily routines that suit them individually. There is a varied activities and social programme enjoyed by many. There are also opportunities for service users to spend their days as quietly as they wish. The home has excellent support from the local GP practice although service users can choose to maintain their own GP. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, 4, 5. Standard 6 does not apply as Intermediate care is not provided. The manager ensures that the home can fully meet the assessed needs of prospective service users prior to making a decision about admission. The pre-admission process is detailed and well managed. The manager ensures that prospective service users are provided with appropriate information which will assist them in making a decision about admission. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide which is made available to service users, prospective service users and their representatives. The home’s current fee range is dependant upon the room to be occupied and the assessed needs of the service user. Current fees are £339- 416 The manager ensures that prospective service users are fully assessed prior to admission.
Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 9 The manager stated that a service user is visited if possible and information from other health professionals and for example hospital care notes are taken into account. Service users are invited to visit the home whenever this is possible. The assessment period extends to a one month trial in the home during which time in-depth assessments and observations are made. It is a testimony to the effectiveness of the initial assessment that service users rarely leave following completion of the assessment period. Documentation relating to pre-admission assessments was seen in the three care plans examined. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10. The home takes appropriate action to ensure the health care needs of service users are met. The home’s procedure for the management and administration of medication was found to be satisfactory. Service users are treated with respect. Care practices support privacy and dignity. EVIDENCE: All service users have care plans maintained. Three were examined and were found to be up to date and well maintained. There were monthly reviews. Care plans are compiled from appropriate assessments which include preadmission assessment, prevention of pressure sores, moving and handling needs and nutrition. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 11 The Standex care planning system is used and is initially completed in great detail by the manager. The planning of individual care was noted to be very thorough and included guidance on the psychological care and specific emotional support required by service users. All staff attended to and addressed service users with respect and in a dignified manner. All service users asked confirmed that they are well cared for at Beaufort House. It was observed from care plans that service users have access to appropriate health care professionals. There was evidence of particularly good support from the GP practice with weekly visits from the doctor. Pro-active treatment and monitoring of long term conditions is provided as well as a rapid response to acute illness. Service users received visits from chiropodists and opticians. Some maintain links with services in the community. The home uses the Monitored Dosage System (MDS) with some additional boxed prescriptions and pre-printed MAR charts. All records examined were appropriately completed. Medicines were seen to be appropriately stored. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15. Service users are able to chose a variety lifestyle patterns in the home. The home provides a wholesome and varied menu which takes into account the needs and preferences of service users. Arrangements for service users to maintain contact with family and friends is good. The home provides activities and entertainments to enrich the service users lives. EVIDENCE: The home menu is wholesome and appetising, varied and takes in to account the needs and preferences of service users. The inspector observed the “summer menu” that includes a salad choice each day. Other choices are Salmon, roast chicken and a range of home made sweets such as red berries tart and sherry trifle. There is a cooked breakfast choice each day. The dining room is pleasant and tables are set to restaurant standard.
Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 13 One service spoke of the efforts made to ensure she had something to eat she liked. Care is taken to ensure that soft diets are appealing and wholesome. The home seeks the views of a dietician when needed. Visitors are made welcome at any reasonable time in accordance with the wishes of the service user. There is a choice of communal areas ensuring there is always “a quiet spot”. Some service prefer to meet visitors in their rooms that were seen to contain sufficient seating. The inspector spoke with a group of service users participating in a craft activity. It was clear that the social interaction between the member of staff and the group members was as important as the activity itself. Service users were smartly dressed and have the regular services of a hairdresser. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, 18 The complaints procedure in this home is good with evidence that the views of service users/visitors are listened to and acted upon. Procedures and policies aim to protect service users from abuse. EVIDENCE: The inspector observed one informal complaint that had been recorded and responded to. Service users spoken to knew who they were able to speak to if they wished to complain. Service users were encouraged to vote in the last election. Staff recruitment procedures, training, supervision contribute to the protection of service users from abuse Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26. Service users live in a comfortable, safe and clean environment and are able to personalise their own bedrooms. The home’s environment is able to meet the assessed needs of service users. The home provides specialist equipment to ensure the needs of service users are met. EVIDENCE: All communal areas and most bedrooms were seen at this inspection. Bedrooms were pleasant and comfortable and it was evident that service users were encouraged to bring personal possessions into their rooms. Specialist beds and pressure relieving equipment were seen to be in place where there was an assessed need. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 16 Service users informed the inspectors that they were very satisfied with their rooms. Some appreciated the views from the bedroom windows across the gardens. There is a choice of sitting areas and the standard of decoration and furnishing exceeds the minimum standards. The home has a lounge, a dining room and a conservatory. There is a large hall that provides additional sitting area. The hall, stairs and landing carpets have recently been replaced. Service users have a choice of where to spend the day. Some prefer to spend a great deal of their time in their bedroom although all are encouraged to come to the dining room for lunch if they are well. Overall the home is very pleasantly decorated and well maintained. The standard of cleanliness was very good. Domestic staff on duty were satisfied with the time provided to care for the home and the equipment provided. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30. The home ensures that there are sufficient staff on duty to meet the service users needs. The home’s recruitment practices are robust and designed to protect the service users. Staff are well trained and have access to a range of mandatory and developmental training opportunities. EVIDENCE: On the day of inspection there were five care staff on duty. Also on duty was the chef, housekeeper and two domestic staff and a laundry lady. There is a full-time maintenance man and two gardeners. The duty rota showed permanent staff working in numbers to meet the needs of service users. Staff spoken to confirmed they had received Manual handling up-dates and fire training. Infection control and medication training had been provided for some staff. Written records of training were seen. Some staff had attended a Dementia Care conference. It is recommended that all care staff receive some training in dementia care. Two recruitment files were observed. Both contained evidence of a thorough recruitment process. References must be received in the home before staff commence employment. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37, 38. The home is effectively managed by the registered manager who promotes a clear and inclusive style of management. Measures are taken which ensure the needs and well-being of service users takes priority and that staff are appropriately supported and supervised. The home’s systems for ensuring the health, safety and welfare of service users and staff are structured and well managed. EVIDENCE: The manager demonstrated through discussion with the inspector she had a very clear understanding of the needs of service users living at the home. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 19 Staff benefit from regular meetings. Supervision takes place but is often informal. Following the appointment of a deputy manager there will be further formal and recorded supervision. There is an experienced administrator responsible for managing the finances of the home and maintaining appropriate records. At the time of this inspection, the home was taking appropriate steps to ensure the health & safety of service users, staff and visitors to the home. The following records were examined: FIRE – Records indicated that appropriate checks were being carried out on the home’s fire detection and fire fighting equipment. Regular training is conducted for all staff. SERVICING – Servicing schedules indicated that hoists are serviced according to LOLER. . There are planned dates for all servicing. ACCIDENT– The home maintains appropriate records relating to accidents at the home. The accident records include action to be taken and evidence of analysis. HOT WATER/SURFACES – Bath hot water outlets are thermostatically controlled to reduce the risk of scalding. Those checked at this inspection were found to be within the acceptable limits. First aid training is provided for staff. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 4 3 3 3 3 3 3 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 Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 2 Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. 1. Refer to Standard OP38 Good Practice Recommendations The testing of the water in thermostatic mixing valves should be tested in line with the guidance provided in the Health and Safety in Care booklet. Records of the tests should be maintained. Beaufort House D53- D02 S15977 Beaufort House V227426 240505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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