CARE HOMES FOR OLDER PEOPLE
Beaufort House Care Home High Street Hawkesbury Upton South Glos GL9 1AU Lead Inspector
Melanie Edwards Unannounced 17 August 2005 09:30 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 Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Beaufort House Care Home Address High Street Hawkesbury Upton South Glos GL9 1AU 01454 238589 01454 238589 Beaufort Care Ltd 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) Mrs Carol Ann Bird Care Home for Older People 28 Category(ies) of DE(E) Dementia - over 65 (6) registration, with number MD Mental Disorder (1) of places OP Old age (21) Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Dementia - over 65 years of age (DE(E)) 6 Mental disorder, excluding learning disability or dementia (MD) 1 Old age, not falling within any other category (OP) 21 Date of last inspection 15 March 2005 Announced Brief Description of the Service: Beaufort House is a family run home in an attractive village location where there are shops, community facilities and a bus service. Several staff members working in the home live in the village. The home is registered to accommodate 27 older people and may accommodate 6 people with dementia. The home is approximately 4 miles from Wotton-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 25 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. The gardens are accessible to all service users and have been made safe. Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Please note due to their mental health needs, many residents are unable to express their views verbally about the Home. As a consequence of this the inspector spent time talking to staff on duty about their roles and responsibilities, and sitting in the lounge with residents observing staff carrying out their duties. The inspector spoke to the manager responsible for the day-to-day running of the service, (who is not the registered manager of the Home), three care staff, the cook, and the laundry assistant about their roles and responsibilities, their training needs, and how they assist and support residents, and carry out their duties. Staff were also observed assisting residents with their needs and it was noted that they have built up close relationships with residents. A range of records relating to the day-to-day running and management of the Home were inspected. A selection of resident’s care records and care plans were also reviewed. The majority of the environment was seen and the only areas not viewed were a small number of resident’s bedrooms. What the service does well: What has improved since the last inspection? What they could do better:
All residents would benefit if their care plans and assessments are formally reviewed and updated on a regular basis to indicate that staff monitor their changing care needs. The health of residents would be further protected if there were an up to date, record of when residents see the Doctor or other health care professionals.
Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 6 Currently this information is written in residents’ daily records of their health and wellbeing, and cannot be easily found. The staffs understanding of residents overall needs, as well as the maintaining of residents dignity would be maintained if the current assessment form devised by the Home was revised. The wording of parts of the form is very subjective and negative and does not help staff to understand the persons overall needs. There would be an additional safeguard to residents’ health and well being if, when they have additional medicine for calming them down, there were detailed guidelines written to assist staff to know when they should administer the medication to calm residents when they are agitated, or very angry. Residents safety and their health would also be further protected and maintained if there was an up to date photograph of each resident maintained with their records, so that residents can be identified if necessary. It would protect and safeguard residents’ wellbeing if all serious incidents that affect their well being were reported to the Commission for Social Care Inspection as is legally required. From information written in one resident’s records it is evident there had been an incident in May 2005 when one resident had been placed at risk by the actions of another resident and this should have been reported under Care Homes law to the Commission for Social Care Inspection. The reporting of such incidents that put residents at risk also ensures that the Commission can make Social Services protection officers aware if needed, in case there is a significant risk of harm to residents who due to their levels of confusion are very vulnerable to risk or harm. Residents’ safety and wellbeing would be further protected if staff were monitoring and supervising residents in the main lounge throughout the day. Many residents who live at the Home are vulnerable and confused. The inspector witnessed one incident where one resident shouted at another resident in the lounge, and there were no staff in the room for over twenty-five minutes. The rights of residents would be maintained if a copy of the complaints procedure were readily available and accessible to residents and their representatives, to ensure that people have the necessary information needed if they wish to complain about the service. There would be a further safe guard for everyone in the building and particularly for vulnerable residents, if someone with suitable knowledge of health and safety matters carried out regular checks of the general safety of the environment. The inspector saw a bottle of bleach that had been left on the floor with other cleaning materials and was there for over two hours. There was also a mattress being stored along one corridor wall that people could fall over, and a drinking glass left on the top of a radiator protector which residents could have knocked over, and cut themselves on.
Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 7 It would be beneficial to the health and safety of residents if uncooked sausages and cold meats that have been stored in the fridge and appropriately covered, were also dated so that food products are not kept and used past their use by date, and hence become a food safety risk. The health and safety of residents would be further maintained if the temperatures of the fridges and freezers were monitored on a daily basis to ensure they are operating within agreed food safety maximum levels. 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 Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4 Residents’ assessed needs are partially met. EVIDENCE: Three residents assessment records were reviewed to inspect how care needs are assessed. There was some general assessment information in place relating to residents care needs however assessments had not been reviewed on a regular basis to demonstrate that peoples range of needs are being monitored by staff. The Home also uses an assessment form that includes negative judgmental wording, and the form does not show what is done with the information or its purpose. The use of negative and judgmental wording could have an impact on staffs’ understanding of residents needs. Two of the records inspected were not accurate as they did not reflect the behaviours and needs of the two residents, and they did not include up to date risk assessments to help support the residents, and to maintain their safety and the safety of others when they exhibit certain behaviours, or become distressed. There were comments of satisfaction expressed by two relatives to the inspector about the care and kindness of staff.
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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 Residents’ plans of care do not fully meet their needs, and needs are not regularly reviewed. The systems in place for the handling of resident’s medication is only partially safe. EVIDENCE: To review care that is provided three residents’ care plans were inspected. The care plans contained some information about how to support the residents with their physical, and mental health care needs. However care plans were not up to date, and two residents care plans were not accurate as they did not include necessary information about the range of behaviours people may demonstrate, or any potential risks to the people concerned as well as to others. Care plans had not been written from a residents centred prospective, which would be beneficial to staff when trying to understand the needs and feelings of someone who has Dementia. Care plans had not been formally reviewed or updated for over twelve months. A selection of progress records written by staff to monitor residents’ health and well-being, were read. There were a number of entries that referred to physical health needs of the person. There was information written in one resident’s progress record requesting that the person see a Doctor, and there was no evidence of whether this had taken place.
Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 11 There was no separate record readily available to show a Doctor had seen residents in response to concerns written by staff. The manager said that all Doctors visits were written in the progress records. This makes it harder to ensure that people’s medical needs are being followed up by the Home, when staff identify a potential health care concern. Medication procedures and practices in the Home were also reviewed, and demonstrated the Home is not operating a safe system of administration, disposal and storage of resident’s medication. Specifically there was no up to date, named and dated photograph of each resident for identification purposes kept in their files. Also there were omissions seen on two residents administration charts for two separate dates when there was no staff signature to confirm that medication had, or had not been given. One resident’s medication was still in a dispensing pot, and the persons records had not been signed to show if the person had refused the medication, or the reasons for them not having the medication. Two residents are prescribed additional medication on an occasional basis if they are very agitated or very angry in mood. There are no guidelines in place to assist staff to know when the residents concerned require these medications. The inspectors spent time observing staff assisting residents with care needs. Staff were polite, ‘warm’ in manner and friendly when helping residents. Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 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) 12,15 Residents are provided with a healthy, diet, however the Home falls to demonstrate food in fridges is stored safely. The Home provides suitable social and therapeutic activities for some residents. EVIDENCE: The manager said that a trip to Weston super Mare had recently taken place for residents. During the afternoon of the inspection a group of residents sat with staff in the garden under a tree for afternoon tea, and residents looked to be enjoying this activity. One new member of staff was observed trying to encourage residents to take part in a ‘ball game’ during the morning, two male residents seemed to like this activity. Two other members of staff spent time painting female residents fingernails, which they clearly enjoyed. It was also reported that since the new owners have taken over the ownership of the Home there has been an increase in actives of this kind with residents. Other activities that take place include `sing a longs’ with staff and outside entertainers are also invited into the Home for musical activities with residents. However residents care plans do not demonstrate that social and therapeutic activities are based on finding out what activities residents enjoy and then planning suitable activities for each individual accordingly. The inspector took the opportunity to sample lunch in the company of residents. The meal consisted of roast pork, roast potatoes, cabbage, with a
Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 13 dessert of rhubarb crumble; the meal was tasty and well cooked. There was no evidence of alternative dishes but staff reported that a record of resident’s food likes and dislikes is kept for each person, to ensure personal preferences are catered for. The resident’s menu choices seen were nutritionally well balanced. Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 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) 16,18 The Home fails to demonstrate it protects residents from abuse and harm, and the complaints procedure is not accessible for residents or their representatives. EVIDENCE: A copy of the Homes complaints procedure is included in the residents care files, however there is no copy of the complaints procedure on display, which would mean that residents and their representatives might not know how to obtain this information if wishing to complain. Staff told the inspector since the new owners took over the running of the Home, there had been far more opportunities to go on training courses. Several staff said they had been on Protection of vulnerable adults from abuse training that they had found useful in their work. As referred to in the introduction of the report, the inspector read information in one resident’s file that related to an incident when they had been placed at potential risk of harm from another resident. The manager said they had spoken to the Community Psychiatric Nurse about this incident. However the Commission for Social Care Inspection had not been informed which the law requires when an incident takes place adversely affecting the well being of a resident. The manager had not contacted South Gloucestershire adult protection team which is also required under current protection of vulnerable adults from abuse guidance for all care Homes, to ensure suitable measures are taken to protect residents from harm or abuse. The inspector was concerned as they spent time sitting in the main lounge on two occasions in the company of a large group of residents and there were no staff present in the room for over twenty five minutes on each occasion. The
Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 15 inspector saw one resident shout at another resident, and as such the resident was at risk of harm during this time. Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 16 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) 19-26 The environment is suitable to meet the needs of residents currently living at the Home, and is clean and satisfactorily maintained. EVIDENCE: The Home is set in its own landscaped gardens in a quiet area off the main road of the village of Hawkesbury Upton, near to a church and village pub. The gardens are clearly a source of pleasure for residents, and the inspector observed a small group of residents sitting in the gardens and looking very relaxed. The property is a forty-minute drive away from the City of Bristol where there are shops, services and amenities. The Home is also a short drive away from nearby motorway access. The building is an older spacious converted property, built over three floors, with adaptations in place throughout the Home, although there is no lift access for people with limited mobility. The inspector walked around the inside of the Home, and viewed all of the communal living areas and the majority of resident’s bedrooms. The standard of fixtures and fittings are satisfactory and were domestic in style. The environment was very clean, tidy and satisfactorily maintained.
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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) 30 Staff are provided with a range of training to enable them to meet residents needs. EVIDENCE: All staff are able to attend range of regular training opportunities on a range of issues, including Dementia care training to help them in their work and to understand residents needs. Staff were carrying out their duties helping residents in a courteous manner, and residents evidently have close relationships with staff. Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 36,38 Residents are supported by staff who are supervised, however the health and safety of residents is not protected. EVIDENCE: The staff on duty told the inspector that they receive regular support and supervision from the manager, and during the inspection the manager carried out a supervision session with one member of staff. The kitchen was inspected to see if safe systems and practices are being followed. The kitchen was generally tidy however there were no up to date records to demonstrate fridges and freezer temperatures were monitored regularly. The chopping boards used to prepare different foods were being stored in a cupboard unit stacked against each other, this could lead to a risk of cross infection. There was also a tray of eggs being stored in the kitchen store cupboard and not in a fridge as food safety guidelines advise.
Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 20 The inspector walked around the Home and identified three potential hazards to the safety of vulnerable residents. Specifically there was a bottle of bleach left on the floor with other cleaning product, that is a safety risk for confused residents. There was also an empty drinking glass left on top of a radiator cover that was also a risk to confused and ‘unsteady’ residents who may knock it off and cut themselves in the process. There was a mattress that it was reported was normally stored in the ‘hairdressing’ room being stored along the side of a corridor wall, again residents who are unsteady on their feet or may be visually impaired could easily fall over the mattress being positioned where it was. Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 x x x x x 2 x 1 Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 22 not assessed 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 3 and 4 Regulation 14 Requirement The assessment format used to assess residents must demonstrate an objective measurable usefull assesssment of the persons needs is carried out. Residents care plans must accurately demonstrate what the persons range of care needs are, and how these are to be met. Care plans must be regularly reviewed and updated. The Home must be able to demonstrate residents physical health care needs are monitored by a GP when required. There must be an up to date photograph kept in the Home of each resident. When administering medication there must be the signature recorded of the member of staff dispensing the medication, or the reasons for any ommission on all mediciation administration records . A copy of the complaints procedure must be accessible to residents and their representatives. All incidents that take place in Timescale for action By 1/09/05 2. 7 15.1 15.2(b) By 1/10/05 3. 8 Schedule 3(k),12.(1 0(a) Schedule 3.2 13.2 By 1/09/05 4. 5. 9 9 By 31/08/05 By 18/08/05 6. 16 22.5 By 1/09/05 7. 18 37 By
Page 23 Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 8. 18 12.(1)(b), 13.1(6) 9. 38 13.4,13.1 (6) 10. 38 13.4c,16. 2(g) the Home that adversly affect the wellbeing or safety of a resident must be reported to the Commission for Social Care Inspection in accordance with the regulation. Residents must not be left unsupervised in the communal areas for significant amounts of time, and their safety must be maintained at all times. Bottles of bleach must not be left in areas acessible to residents, and must be stored safely when not in use.Drinking glasses must not be left on top of radiator covers.The mattress being stored against the wall of a communal corridor must be removed . The Home must be able to demonstrate that the temperatures of the kitchen fridges and freezers are being regularly checked, and are within food safety guidance levels 18/08/05 By 18/08/05 By 18/08/05 By 19/08/05 11. 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. 2. Refer to Standard 12 9 Good Practice Recommendations Social and theraputic activities for resident should be planned based on an individual assesment of each residents likes and needs. There should be written protocols in place that guide staff when administering medication that is given on an occasional basis, to calm residents when they are agitated or very angry in mood. The chopping boards in the kitchen should be stored seperatly. 3. 38 Beaufort House Care Home D56 D05 S61734 Beaufort House V228744 170805 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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