Inspection on 11/01/07 for Beaufort House Care Home

This inspection was carried out on 11th January 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beaufort House Care Home 22/09/07

Beaufort House Care Home 07/06/06

Beaufort House Care Home 31/01/06

Beaufort House Care Home 17/08/05

Beaufort House Care Home 15/03/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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 Beaufort House Care Home High Street Hawkesbury Upton South Glos GL9 1AU Lead Inspector Grace Agu Key Unannounced Inspection 11th January 2007 09:15 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 House Care Home DS0000061734.V324134.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 House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beaufort House Care Home Address High Street Hawkesbury Upton South Glos GL9 1AU 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) 01454 238589 01454 238589 Beaufort Care Ltd Ms Glenda Elizabeth Graham Care Home 28 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (22) of places Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2006 Brief Description of the Service: Beaufort House is situated in an attractive village location where there are shops, community facilities and a bus service. The home is situated approximately 4 miles from Wooton-Under-Edge and 8 miles from Chipping Sodbury. Bristol and Bath are within easy commuting distance. The property is a large mature house that has been extended. Accommodation is arranged on three floors. There is a passenger lift. Rooms consist of 26 single bedrooms and one double room. 17 bedrooms have en-suite toilet facilities. The home is set in attractive, well maintained gardens with lawns and a patio area. The gardens are accessible to all service users and have been made safe. The categories of registration change will be noted in future inspection reports as: DE (E) Dementia - over 65 for 6 and OP Old age for 22. Fees range from £415-£450 per week. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was undertaken by two inspectors over nine hours to review medication and other requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. The pharmacy inspector reviewed the home’s medication and her report can be found in the body of the report under Standard 9. The inspection also followed up concerns raised by district nurses in relation to various areas of service provision including high incidence of pressure sores at the home. A tour of the building was undertaken and a number of records were viewed. Five residents, and three staff members were spoken with on the day. No relatives or visitors were spoken with on the day; however, comments received from them about the home before and after the inspection are included in this report. What the service does well: Generally the home was found clean, tidy and warm. Staff were working as a team and interacting with residents in a positive, dignified and sensitive manner, residents were found to be relaxed and looked well cared for at the home The manager was unavoidably absent on the day however the two providers met on the day said at a discussion that the home provides a homely and stimulating environment for the residents through organised activities and encouraging visits from relatives, friends and representatives. From the interaction noted on the day between staff and residents it was evident that staff know the residents very well and provide them with qualityindividualised care. The home supports and encourages the residents to maintain independence in order to enhance their quality of life. A comprehensive Service User’s Guide is given to the prospective resident to enable them to make an informed choice about moving to the home and residents and relatives are informed on admission of a one month trial to enable the person to make a decision whether to stay. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 6 In order to ensure adequate nutrition for the residents, good meals are provided and are not hurried; those who are unable to feed themselves are fed in a respectful, sensitive and dignified manner. In addition, to ensure that residents are adequately protected, ongoing training courses are provided for staff and appropriate recruitment procedures have been followed for recently employed individuals at the home. The home is adequately staffed to include care and domestic staff. What has improved since the last inspection? What they could do better: At the last inspection six requirements were made in regard to different areas of service provision to ensure that the residents are protected and that the quality of service provided is what they expect and deserve. It was noted that four of the requirements were met, however, there was evidence to show that the home is making efforts to ensure that the remaining requirements are met. Whilst the requirements made at the last inspection in relation to handling of medication were met some discrepancies were noted at this inspection. Residents would be better protected if records of all medicines administered and returned by staff are kept including prescribed creams and ointments and the receipt and return of all medication; all medicines must be administered as prescribed by the doctor and a suitably qualified person must provide training to give medicine by a specialist technique. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 7 It is recommended that the medicine policy includes a list of homely remedies with guidance for their use, approved by the residents’ doctors. On admission a record should be kept of the resident’s choice to selfadminister medication or their consent for staff to administer it. Written confirmation should be requested for all changes in medication to reduce the risk of mistakes in medicines administration, which could harm residents’ health. To ensure that staff are aware of measures and procedures to follow in fire emergency, regular fire drills must be provided for all identified staff. Residents would be better protected and their needs met if their care plans are clearly and comprehensively written after assessment and consultation with them and or their representatives. It is acknowledged that the home is working towards a more comprehensive system of care planning. In the meantime it is important that all changes to a persons health and well -being are recorded. In relation to the above the home must consult the appropriate health professional to provide guidance in respect of administration of prescribed specialist medication to an identified individual. In addition, staff must receive appropriate training in this subject to enable them to identify unusual symptoms and concerns that could put the person’s health at risk. A resident would enjoy a better and more comfortable environment if their room was kept free from offensive odours at all times. Despite efforts by the staff to eliminate odour, this will not be fully achieved until the carpet is replaced as part of an ongoing programme. In order to promote and maintain effective Infection Control measures and prevent toxic conditions at the home it would be better if the identified house keeping staff attend training on infection control and Control of Substances Hazardous to Health. 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 House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 8 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 House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 9 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): 1,2,3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home provides information to prospective residents and their representatives and ensures that the admission process is well managed to meet the assessed needs of the resident. EVIDENCE: The home’s statement of purpose has detailed information about services and facilities to be provided. The home has a comprehensive Service User’s Guide that is given to the prospective resident and or their representatives to enable them to make an informed choice about moving to the home and are informed of a one month trial period to enable the person to make an informed decision whether to stay. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 10 The care record of one recently admitted resident had detailed assessment from Social Services as well as the home to include physical, mental and social needs. Terms and conditions of their stay were also noted in the care files viewed. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are respected and treated in a dignified manner and their right to dignity is upheld. Individual care plans must be clearly and comprehensively written to reflect the assessed needs. Medication policies and procedures are in place to protect residents’ health care, but care must be taken to make sure that these are followed. Records relating to medication in residents care plans need to be improved to show that residents’ health is protected EVIDENCE: Four care files were reviewed following concerns raised by the district nurses of high incidences of pressure sores at the home. All the care files contained detailed assessment of their needs however; the care plans had limited Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 12 information in regards to how staff were supported in meeting the needs of identified individuals. Furthermore it was noted that the home was managing a resident with unstable medical condition without appropriate guidance and reviews from specialist health professionals. The individual lacked comprehensive care plans and adequate instructions in regard to how staff were to manage this condition and what actions to take in emergency. A requirement was made for the home to consult appropriate health professional to provide a written guidance and regular support for the management of this individual. Other care files reviewed contained required information to include weight monitoring and were reviewed monthly to reflect the residents changing needs. Whilst it was noted that records were maintained for each resident, this was not consistent. It was noted that the recommendation made at the last inspection in relation to the above had not been considered. This was discussed with the providers and the deputy manager and it was agreed that that the approach would be reviewed to ensure that vital information about the care provided are consistently recorded. The home had recently employed a deputy manager and the inspector was informed that one of her roles is to support the manager to review the care planning system with the view to making it more detailed in order to reflect individual needs. There was evidence of detailed risk assessments in relation to manual handling and monitoring of pressure area care to prevent further damage of pressure areas in the care file of residents with pressure sores. The district nurses provide clinical treatment and wound dressing to the affected residents. Residents spoken with stated that staff respected their privacy and treated them with dignity. One resident stated, “ I am very happy here, staff are respectful and kind, I have a choice of when I get up and go to bed. They answer when I ring the bell. Another resident stated, “ I am treated well. One comment card received from a relative regarding care provided said “My relative moved to Beaufort House in July. The transition phase was quite traumatic but the home managed expertly. They were always very caring and considerate for us all at a difficult time. My relative is now well settled and very happy. I am very happy with all aspects of my relative’s care” Whilst requirements made at the last inspection in relation to handling of medicines were met, discrepancies were noted when this was reviewed. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 13 The pharmacist inspector looked at arrangements for handling of medicines in Beaufort House. Arrangements have been made for all residents to be registered with one local doctors practice, with the aim of improving care for the residents. It is planned that all medication will be reviewed as part of this process. The pharmacy supplies medicines monthly using a blister pack monitored dosage system. A small number of medicines such as Paracetamol are kept as homely remedies. There was no record of the receipt of these medicines so the stock could not be checked. Also it was noted that whilst there was no distinct policy related to the safe uses of these medicines, reference is made in the overall policy. The medicines policy includes a section on self-medication but there was no record that residents had been given the choice of looking after their own medicines, if appropriate, or of them giving consent for staff to administer their medicines. This information should be included in the records kept when people are admitted. The medicines administration record sheet showed that one resident looked after some of their own medicines but this was not written in their care plan and the manager explained later that the medicines were no longer needed and not kept. Secure storage is available for medication. A medicine trolley is used to take medicines around the home. This trolley should be chained to the wall when not in use. A medicines fridge is available and the temperature is recorded daily. The fridge must be locked to make sure that the medicines are secure. I saw the medicines being administered at lunchtime. The medicines administration record sheet was signed when the medicines had been administered. Care must be taken that medicines such as eye-drops are given at a suitable time and place for the residents rather than in the middle of a meal. The pharmacy provides a printed medicines administration record sheet each month. Blister packs of medicines indicated that medicines had been given as recorded on the medicines administration record sheet. Some of the records were not complete for example the application of some creams had not been recorded. On two records no prescription or written evidence from the doctor was seen to evidence the changes in dose of medicine or the method of administration. Some records were seen in residents’ care plans relating to medication. These should be signed and dated by the person making the entry. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 14 Verbal messages to alter medication must always be confirmed in writing to reduce the risk of medication errors happening. The medicines received into Beaufort House are recorded on the medicines administration record sheet; additional items such as antibiotics received part way through the month must also be recorded. Unwanted medicines returned to the pharmacy are recorded in a disposal book, the medicines refused by residents must also be recorded before being sent back to the pharmacy for disposal. Action has been taken to provide training about medicines for staff, and this is good practice to help staff administer medicines safely. One medicine administered by staff requires some specialist training but records did not show who had given this training or what was covered and so did not show that staff were suitably trained for the task. There was a record of when each resident had seen a doctor, the reason for referral and the treatment. Records of visits from other health professional including chiropodists and district nurses were also seen. One staff spoken with confirmed that they are able to meet the needs of the residents through reviewing the care plans, regular hand over and discussion with the residents. The staff member spoken with demonstrated knowledge of caring for the dying and the importance of keeping information about the residents confidential. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to maintain links with their families and are also provided meaningful activities the food is nutritious with varied choices available. EVIDENCE: On the day of inspection residents were noted relaxing in the lounge and enjoying the company of each other, some residents were noted sitting in their bedrooms other residents were also observed interacting with staff accessing different areas of the home without restriction. One resident met in the bedroom stated that staff were always there and would attend to her needs in emergency and that they are satisfied with the care provided at the home. To strengthen the relationship between the home and the community and to support the residents who practice their faith, the local vicar visits once a Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 16 month to offer full church service and holy communion and would visit midweek sometimes on request. On the day of this inspection, residents were noted taking part in puzzles and playing cards with staff in informal and personalised manner. Activities undertaken before the inspection included musical quiz 9/107,musiacal entertainment 20/12/06, Christmas party 2/12/06. It was also noted that residents who were able were taken out for a walk when the weather was good. The activities book reviewed, identified residents who participated in activities and those who declined but preferred to watch. One resident met in their room stated that they chose to be in their rooms. The resident said, “I don’t like going down for activities, I feel happier staying in my room to do crosswords read newspapers and watch television”. The visitors’ book showed that the relatives and representatives regularly visit the residents. Residents spoken with stated that they had regular visitors. Comment cards received from relatives contained complimentary statements about the home and the services provided. One comment card states, “ New efforts have been made recently to get residents involved in social and creative activities” The lunch on the day looked nutritious and balanced and the residents spoken with stated that they enjoyed their meal. Staff were noted wearing aprons and interacting with them in a respectful manner whilst assisting them with their lunches. The kitchen was found clean and staff has attended basic food hygiene to ensure that the residents are adequately protected. There was evidence of regular recording of fridge, freezer and food probing temperatures The certificates for Basic food hygiene updates for the kitchen staff were noted displayed in the kitchen A recent report in relation to the visit from the Environmental Services was noted to be exceptionally good. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 17 Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 18 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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are protected from abuse through appropriate policies and procedure. EVIDENCE: The home’s complaint procedure contains required information and details of how to contact the Commission for Social Care Inspection if they were not satisfied with the outcome of their complaint. The complaint procedure was displayed in the lounge area of the building. The document was also seen in all the care files reviewed. There was no recorded complaint since the last inspection, One new staff members’ file reviewed evidenced that two satisfactory references and Criminal Record Bureau Disclosures had been obtained before commencement of employment. Evidence from speaking to staff and review of staff records showed that the home has made efforts to ensure that Twenty one staff members receive Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 19 training on residents. Protection of Vulnerable Adults from abuse in order to protect the The home has a policy and guidance on the Prevention of abuse as well as the South Gloucestershire Council policy on reporting incidents of suspected abuse. A notification received at the Commission in relation to aggressive behaviour by a resident towards another individual was handled in accordance with the guidance on the Protection of Vulnerable Adults. Residents spoken with stated that they felt safe at the home Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 20 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): 19,21,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents enjoy a suitable, safe and well-maintained environment however the home fails to provide a resident an odour free environment. EVIDENCE: Whilst touring the building, all areas visited were found to be generally clean, tidy, well lit and suitable for its stated purpose. Residents sitting in the lounges, looked relaxed, well cared for and enjoying each other’s company. It was noted that there was an on-going refurbishment at the home to ensure that a comfortable and well- maintained environment is provided for the residents. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 21 Some of the areas completed include, new decoration in the dining room and floorings in the bedrooms. Replacement of all the beds and bedside tables and chairs in all the bedrooms. One comment card received from a relative said “the management of the home are always looking for ways of improving the fabric and care within the home” It was particularly pleasing to note that the home has invested a tremendous amount of resources into a new heating and plumbing system at the home to provide residents with a better heating and comfortable environment. This latest development has remedied the problem of lack of hot water on the top floor and other areas of the building that was identified at the last inspection. This is commendable. Whilst some bedrooms, bathrooms and toilets were found clean, one resident’s bedroom flooring was noted with very unpleasant odour. A requirement was made for the flooring in the resident’s room to be replaced. The providers stated that a programme of changing the flooring would commence as soon as the plumbing work is completed on 15/01/07. Two domestic staff were noted carrying out their responsibilities. There is a separate laundry facility, which is located in the basement. This included washing machines with a separate sluicing facility programme. The area was found clean and had hand-towels aprons and soap. The laundry person stated that staff inform her when there is any infection and that all infected clothing are washed separately, however this staff member had not attended Infection Control and Control of Substances Hazardous to Health training to provide the individual with necessary information relating to that role. Staff were noted wearing aprons and gloves and washing their hands after attending to the residents. The maintenance book was up to date clearly stating jobs to be carried out, date completed and any relevant comment in relation to outstanding jobs. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with sufficient numbers of staff to meet their needs. Whilst the home provides training to staff in various areas of care and service provision, it has not equipped staff with training on administration of specialist medicine and a staff member on Control of Substances Hazardous to Health. EVIDENCE: Evidence from staff rota and discussion with the providers showed that the home has a sufficient staffing level to meet the needs of the residents. The home has included an extra staff on night duty to ensure that residents are adequately monitored and to minimise falls. Residents spoken with stated that staff attended them promptly when they rang the bell. The home operates a key working system to enhance the resident/staff relationship. The manager has developed a training matrix to enable the home to identify what courses each staff member has attended and to ensure that relevant courses are provided. Staff have attended training to include manual handling Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 23 update fire awareness and Protection of Vulnerable Adult from Abuse, Dementia Awareness, food hygiene First Aid and medication update. It was also noted from staff records that some staff members have achieved National Vocational Qualification (NVQ) at level 2 and 3. The district nurse visited the home on the day of inspection to provide staff with training on Tissue Viability (prevention of pressure sores) following concerns raised by district nurses about high incidence of the condition at the home. However, it was noted that staff have not received specialist training to allow them to safely administer one medicine to a resident with a medical condition as stated in standard 9 and a requirement has been made accordingly. Staff records and discussion with a laundry person evidenced that they had not attended Infection Control and Control of Substances Hazardous to Health training to provide the individual with necessary information relating to that role. Review of records of recently employed staff members showed that statutory required documentation were in place. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 24 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): 31,32,33,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed, staff are supervised regularly’ however the residents are protected through satisfactory health and safety practices. EVIDENCE: Glenda Graham is the Registered Manager of Beaufort House. Glenda had completed the required National Vocational Qualification at Level 4 in Care, May.02 and Registered Managers Award, December 02 Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 25 On the day of inspection, there was a friendly and interactive atmosphere in the home. Residents looked well cared for and were noted talking to staff in an informal way. The manager was unavoidably absent on the day however; the two providers and the recently appointed deputy manager assisted professionally with the smooth running of the home and participated satisfactorily in the inspection process. Staff spoken with made complementary remarks about the manager and would approach her if there was any problem. No relatives were met on the day however comment cards received were positive, for example, one comment card states “I am pleased that a newsletter is issued regularly by Glenda Graham the manager. I also hear from her directly about issues affecting my mother. Clearly the manager, owners and staff are genuinely caring about the residents and this aspect is important to me”. Evidence from staff records and staff discussion showed that staff are receiving regular supervision to enable them to discuss areas of concern in relation to residents care. The fire logbook was noted to be well maintained and up to date and staff have attended fire lectures. However according to the records sent to the Commission eight staff members have not attended fire drills at all and four staff members have attended once since the last inspection. This practice puts the residents, staff and visitors at risk. The home must ensure that all staff undertake fire drills at regular intervals to ensure that staff are aware of their responsibilities in terms of actual fire emergency. This requirement is repeated. The home is reminded that failure to meet requirement could lead to enforcement action. The manager informed the Commission before this report was completed that fire drill has been booked for the identified staff on 5th March 2007. Health and Safety records showed that the home had undertaken generic risk assessments of vulnerable areas of the home. Other health and safety records are up to date. Methods used by the home to review its quality of service were reviewed. The providers said that the home undertakes formal and informal meetings with relatives to obtain feedback about services provides. The home produces a Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 26 regular newsletter to update residents and their relatives about any changes and future events. Questionnaires are sent to families to provide feedback on the home’s performance in terms of staffing, environment, food and group activities and that the outcome was satisfactory. Feed back from the last questionnaires were positive and complimentary. Other tools used to audit the quality of services include statutory providers monthly visits, meetings with General Practitioners, Social Services, staff and directors of the company. The manager also undertakes medicine audits weekly. One letter received from a doctors surgery states “ I cannot find any reason for any concern about the level of care and commitment in looking after residents at Beaufort House: in many respects we find their level of care exemplary” The home has policies and procedures to include whistle Blowing, Medication, and Protection of Vulnerable Adults from Abuse and staff supervision and Confidentiality. All residents’ records were securely locked away Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 2 Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP30 Regulation 18 Requirement The registered person shall ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work are to perform: • Staff working in the laundry must receive training on infection control and Control of Substances Hazardous to Health “The registered person shall after consultation with the fire authority ensure by means of fire drill and practices at suitable intervals, that the persons working at the care home and, so far as practicable, service users are aware of the procedure to be followed in case of fire, including the procedure for saving lives.” All staff must undertake fire drills. “The registered person shall having regard to the size or the care home and the number and needs of the service users keep DS0000061734.V324134.R01.S.doc Timescale for action 11/04/07 2. OP38 23 11/02/07 3. OP26 16 11/04/07 Beaufort House Care Home Version 5.2 Page 29 the care home free from offensive odour.” Deep clean/replace the flooring to eliminate offensive odour in a resident’s room. 4 OP7 15 “Unless it is impracticable to carry out such consultation, the registered person shall after consultation with the service user, or a representative of his prepare a written plan (“ the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met.” Provide detailed care plans for all residents. 5 OP8 13 18/02/07 “The registered person shall make arrangement for service users to receive where necessary, treatment, advice and other services from health care professional.” Obtain written guidance from a specialist health professional in regards to a resident with a medical condition. “The registered person shall make arrangements for the 11/02/07 recording handling, safe keeping, safe administration and disposal of medicines received into the care home:” • Records must be kept of: The administration of all medicines by staff including creams and ointments, the receipt of all medicines and return of all unused medicines. • Medicines must be administered as prescribed by the doctor. DS0000061734.V324134.R01.S.doc Version 5.2 Page 30 30/04/07 6. OP9 13(2) Beaufort House Care Home • A suitably qualified person must provide the training to give a medicine by a specialised technique to safeguard residents’ health. 7 OP8 12 “The registered person shall ensure that the home is conducted so as to promote and make proper provision for the health and welfare of service users.” Maintain detailed consistent record in relation to health and welfare of all residents 11/02/07 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 OP9 Good Practice Recommendations It is recommended that the medicine policy include a list of homely remedies with guidance for their use, approved by the residents’ doctors. On admission a record should be kept of the resident’s choice to self-administer medication or their consent for staff to administer it. Written confirmation should be requested for all changes in medication to reduce the risk of mistakes in medicines administration, which could harm residents health. Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 © 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 Beaufort House Care Home DS0000061734.V324134.R01.S.doc Version 5.2 Page 32 - 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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