Inspection on 12/01/06 for Beaumont

This inspection was carried out on 12th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Beaumont 09/10/08

Beaumont 23/04/08

Beaumont 03/05/07

Beaumont 09/05/06

Beaumont 15/12/04

Beaumont 25/05/04

Beaumont 02/03/04

Beaumont 01/02/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beaumont 2 Church Rise Forest Hill London SE23 2UD Lead Inspector Ornella Cavuoto Unannounced Inspection 12th January 2006 10:00 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 Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 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. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beaumont Address 2 Church Rise Forest Hill London SE23 2UD 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) 0208 6992310 Mr P S Rekhi Mrs T K Rekhi Mrs T K Rekhi Care Home 12 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0), Old age, not falling within any other category (0), Physical disability over 65 years of age (0) Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home is registered for 12 persons of whom up to 12 may be elderly, up to 2 may have a mental disorder and be over 55 years, Up to 5 may have dementia, up to 1 may have a physical disability and be over 55 years and up to 1 may have a physical disability and be over 65 years old 2nd August 2005 Date of last inspection Brief Description of the Service: Beaumont is a care home providing personal care and accommodation for 12 older people. The home is a family concern. Mr P.S Reikhi is the owner whilst Mrs T Reikhi is the Registered Manager. However, she has handed over the management responsibilities of the home to her son Mr M.S Reikhi who has been the acting manager for several months and was waiting to undergo the process for registration by CSCI to become the registered manager at the time the inspection was held. However, since this time Mr Reikhi has taken the decision to withdraw his application for the foreseeable future. The premises consists of a three storey detached Victorian property. Accommodation is provided on the ground and first floors with eight single and two double bedrooms none of which have en-suite facilities. There is no lift available and the home would not be suitable for individuals with restricted mobility. There is some car parking at the front and a rear garden. The home is situated in a quiet residential area in Forest Hill. There are local shops and public transport facilities. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out over one day. The inspection involved speaking to two staff members and six service users. The acting manager was present for the duration of the inspection. Other inspection methods included a tour of the premises and inspection of records. What the service does well: What has improved since the last inspection? A full assessment of need for the service user who was recently admitted to the home was obtained before admission to ensure the home could make a decision about whether the home could meet their needs. The acting manager has introduced a new format for service user care plans to try to ensure that information about service users needs is more clearly recorded. The acting manager has arranged training for all staff on adult abuse. The majority of the staff team have now been enrolled to complete the NVQ (National Vocational Qualification) in care Level 2. The acting manager has made some improvements to the complaints policy and attempted to revise the whistle blowing policy although both still need to be looked at and revisions made. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 6 What they could do better: The home still needs to look at providing a statement of purpose and service user guide that includes all the information required by regulation to allow prospective service users to make an informed decision about living at the home. The acting manager needs to give strong consideration to engaging an external consultant to help develop these documents and all the home’s policies and procedures to ensure they meet with national minimum standards and regulation. The home needs to ensure that all service users are provided with a contract fully outlining what services and care service users can expect to be provided by the home for the fees paid and that the service user signs these. The home needs to draw up care plans and risk assessments that fully detail all the personal, health and social care needs of service users, how these will be met and these need to be signed by the service user, their relative or a representative where appropriate as way of showing their involvement in the care planning process. Furthermore, the home must ensure that all service users must have a completed care plan in place. The monthly review forms also need to be reviewed to ensure that the changing needs of service users are more clearly reflected. The provider needs to give strong consideration to recruiting a staff member that has substantial experience in care and has worked with the same client group to help support the acting manager and the care staff to ensure the needs of service users are more effectively assessed, to draw up comprehensive care plans and to ensure the home is fully addressing the needs of all service users. In addition, the acting manager needs to consider implementing a key worker system whereby the care staff undertake responsibilities for drawing up care plans to help them become more familiar with the needs of service users. The acting manager must ensure that all staff are fully aware of service users right to privacy and to be treated respectfully. Also, the wishes of service users are sensitively obtained in respect to death and dying. The home needs to ensure that more individual and group activities are arranged for service users that reflect their personal interests and preferences and to use a key worker system to ensure that this information is gathered. The provider needs to consider how objectivity will be brought into the home in recognition that the home is run as a homely concern. This is particularly important in respect to the complaints procedure, whistle blowing and other areas involving the need for the protection of service users. Consideration needs to be given to provide a non-smoking area for service users and also to rearrange the layout of the seating in the lounge to encourage more social interaction between service users. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 7 The provider needs to ensure that restrictions around access within the home are fully addressed in the statement of purpose and the registration certificate is amended in recognition that the home cannot specifically cater for people with physical disabilities. Also, that where service users needs increase the home needs to consult with a GP and/or OT to ensure that the specialist equipment and adaptations in place are adequate to meet service user’s needs and also for staff to provide care. The acting manager must ensure that the home is kept free from offensive odours. The provider must ensure that safe recruitment practices are used by the home and all necessary checks and documents are obtained prior to new staff being allowed to start work within the home. The acting manager needs to ensure that specific and mandatory training needs are identified for all staff as part of appraisals and supervision and that an annual training plan is developed. The provider must clarify in writing to CSCI what the arrangements will be in respect to management cover now that the acting manager has withdrawn his application to become the registered manager. The home must ensure that effective formal quality assurance systems are put in place and consultation is carried out with service users and other stakeholders. The provider must ensure that all records in relation to service user finances are accessible. The home must ensure that all staff receive regular supervision and this is recorded. 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. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 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 Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 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 the following standard(s): 1, 2, 3 &4 (Standard 6 is not applicable). Prospective service users still do not have the information they need to make a fully informed choice about the home. Not all service users have a written contract/statement of terms and conditions with the home and the contract in place does meet the required standard. Although there was evidence that service users had had their needs assessed the home needs to ensure that the assessment obtained by the home is used as the basis on which to draw up the care plan and the information is up to date as possible. The home is not clearly able to demonstrate its capacity to meet the assessed needs of the individuals admitted to the home. EVIDENCE: At the five previous inspections (Feb ’03, March ’04, May ’04,Dec ’04 and Aug ’05) it was identified that although the home had a statement of purpose this did not include all the information required by the national minimum standards and regulation. In relation to a service user guide at the last inspection it was found that the home had drafted a document, previously one was not in place but that amendments and additions were required to ensure that this also met with regulation. Consequently, a further requirement was stated at the last Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 10 inspection in respect to both documents with specific areas highlighted that needed to be addressed. In addition, a recommendation was also stated that the manager should consider engaging an external consultant to help develop the home’s policies and procedures including the service user guide and statement of purpose. The acting manager reported that as yet neither document has been revised but that the intention is to engage an external consultant as recommended. Neither a copy of the statement of purpose nor the service user guide was seen. Five service user files were inspected. Although there was evidence that a contract had been issued to one service user who was recently admitted to the home, it was not signed. For another service user who had lived at the home for some years there was no evidence that a contract had been issued. Furthermore, the content of the contract needed to be reviewed as it did not fully address what service users can fully expect to be provided in terms of overall care and services covered by the fees paid. Furthermore, the contract made reference to the complaints procedure and included details of the National Care Standards Commission (NCSC) as opposed to the Commission for Social Care Inspection (CSCI). This needs to be changed. Previous inspections have noted that the home has not always been consistent in obtaining a full needs assessment for service users prior to admission to ensure the home can fully meet their needs. There was evidence that for one service user who was admitted recently that an assessment and detailed care plan and risk assessment had been obtained from the referrer meeting the previous requirement. However, this was not used as a basis on which to draw up a care plan and risk assessment to be used by the home. Also, some of the information contained in the assessment had been written over a year ago. The acting manager should ensure that any assessment received from referrers is up to date as possible. There was insufficient evidence to be able to fully assess the home’s capacity to meet the assessed needs of individuals admitted to the home. The acting manager did report that some of the service users have come from other services where they have had difficulties settling in but they have managed to do so at Beaumont. Although, this is commendable the home also needs to be able to clearly demonstrate that they understand and can meet the needs including the specialist needs of service users. Also, that staff individually and collectively have the skills and experience to deliver the services and care which the home offers to provide. (See requirements in relation to standard 1,7,27 & 30). Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 &11 Not all service users had a completed care plan whilst the care plans that were in place did not clearly set out service users’ health, personal and social care needs. Although there is some evidence that health care needs are being partially met further improvements are required to ensure that their health needs are more comprehensively met. Although, generally service users stated they are treated respectfully there is a lack of awareness shown by staff around service users rights to privacy. Not all service users have been consulted about their wishes with regards to death and dying. EVIDENCE: Five service user plans were inspected. The acting manager has introduced the Standex format for care plans and risk assessments to try to ensure that information around service user needs are more clearly recorded. The home does not use a key worker system. Instead, the manager completes all the care plans. Subject to a previous requirement that the home must ensure all service users have a risk assessment and a comprehensive plan of care in which health, Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 12 personal and social care needs are clearly laid out and are regularly reviewed this has not been met. None of the care plans inspected had addressed in any detail the health, personal or social care needs of service users. Furthermore, the care plans demonstrated an overall lack of knowledge and awareness in relation to completing care plans and of the assessment of service users’ needs and the level of care required to meet those needs. For example, as previously mentioned one of the service users who was admitted recently to the home and has a history of mental health problems; a full needs assessment and a detailed care plan and risk assessment from the referrer had been obtained. However, none of this information had been used as a basis to draw up the care plan or a risk assessment. This raises concerns that service users’ needs are being overlooked as well as risk factors presented by service users not being adequately addressed. This can potentially place the service user, staff and other service users at risk. For another service user there was evidence of a local authority review that had recently been held that discussed concerns about a substantial increase in the needs presented by the service user in particular that they have become increasingly confused and that they require two carers to help them mobilise. However, the service user did not have a completed care plan and a manual handling risk assessment also had not been completed. None of the care plans had been signed to evidence service user or, where appropriate, family or a representative’s involvement in the care planning process. None of the service users had a completed risk assessment. In terms of reviews, a separate form is used that is kept in a separate file and is also completed by the manager. This lists aspects of personal, health and social care including memory, sleeping patterns, communication, interest and activities, skin condition, bathing, mobility, ethnic or cultural needs amongst others. Although there was evidence that these had been completed monthly, they did not clearly reflect service users’ changing needs or that service users, relatives or a representative, where appropriate, had been involved. Overall, the information contained in the review forms was basic and very limited. For example in respect to bathing and dressing it simply stated, “needs assistance”. Also, the language used was not always appropriate. For example, one service user in respect to communication was referred to as being “mute”. This proved not to be an accurate assessment of the service user’s ability to communicate. It is strongly evident that the method and format for conducting reviews needs to be looked at to ensure that they are more effectively carried out with service user or family/representative involvement where appropriate and to ensure the changing needs of service users are more accurately reflected within care plans. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 13 There was evidence that personal care was being carried out, in that personal care charts were being filled in regularly and most of the service users were observed as generally well dressed and well groomed; however, details about service users needs in respect to personal care or their preferences on how this should be carried out had not been recorded. Also, evidence was that service users were being supported with having body washes more regularly than baths or showers. One service user was described as being able to address his personal care needs independently but it was recorded that for three consecutive days the service user had only had a face wash indicating they lacked motivation to address their personal hygiene. This was confirmed by the fact that this service user has a history of mental health problems with a diagnosis of schizophrenia being stated within the file. Such a diagnosis would indicate the service user would be at risk of self-neglect and is a further example of a lack of knowledge in the assessment and planning of service users’ care. There was some evidence that service users’ healthcare needs are addressed with appointments made with G.P’s, chiropodists and opticians. There was also evidence that a district nurse was regularly visiting one service user to administer an injection and for one service user there was evidence of close liaison with mental health services. However, there was little evidence of service users needs being met in respect to nutrition, pressure area care or incontinence. The lack of detail in care plans around service users’ health, personal and social care needs was also reflected by a lack of familiarity and comprehensive knowledge of service users needs by care staff which became evident in discussions with them. This is clearly not helped by the fact that the care staff do not have any responsibility for drawing up care plans and risk assessments. The majority of carers are undertaking the NVQ Level 2 and the manager should consider implementing a key worker system to enable carers to undertake these responsibilities for specific service users. It was strongly evident that the manager does not have the necessary skills and knowledge for the assessment and care planning of service user needs. Consequently, consideration should be given to introduce a staff member who has substantial experience in care to help support the manager to address service users’ needs more effectively and also to support staff in respect to their duties in this area. Service users spoken to stated that staff treated them respectfully and respect their privacy by knocking on their door before entering. Service users sharing rooms have been provided with adequate screening to ensure that their privacy is maintained when personal care is given. However, not all staff showed they had an understanding of service users’ rights to privacy and to be treated respectfully. For example, in trying to identify a private place to talk to one of the care staff the inspector was led into a service user’s bedroom, which Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 14 was shared, and one of the service users was in the bedroom asleep. They demonstrated a lack of awareness of the inappropriateness of the situation. This clearly needs to be addressed and is subject to a requirement. Although the home has a policy on death and dying four of the five service users plans looked at had not addressed service users wishes on death and dying. Subject to a recommendation. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 &14 The home needs to look at providing more group and individual activities to ensure that service users lifestyle experienced in the home satisfies their social and recreational interests and needs. Service users are helped to exercise choice and control over their lives but this needs to be more effectively risk managed for some service users. EVIDENCE: The home does not have a weekly activities schedule but it was reported that bingo is provided once weekly and there are puzzles, cards and other board games for service users to use. One service user confirmed that they do play dominoes sometimes. Videos and DVD’s are also provided. During the summer there are visits to the local museums and parks. It was reported that the home has tried to engage service users in different activities in the past but this proved unsuccessful. No activities around reminiscence are carried out. On the day of the inspection although there were several staff members around there was little evidence of service users being encouraged to interact socially and to engage with any activities. The lay out of the communal lounge is such that it does not facilitate social interaction between service users as the chairs are all positioned against the walls. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 16 In an annual review of one service user a comment was made that the reason why the service user maybe spending long periods in bed could be partly due to the lack of structured activities being offered by the home. Service user plans contain very little information about service users personal backgrounds, life history and personal interests. Although there was some information contained in service users’ assessments this had not been included in individual care plans to ensure that these needs are addressed. If a key worker system is introduced this could be used to work individually with service users to gain more information about their life histories to facilitate the development of group and individual activities. In addition, the home regularly has trainee carers working at the home who could be used more effectively to carry out structured activities with service users. However, at present it is evident that not enough is being done to provide service users opportunities for stimulation through leisure and recreational activities in and outside the home. It was evident that service users are given a lot of autonomy and choice in respect to being able to leave and enter the home as they please and around how they spend their time including being able to spend time in their rooms or watching television in the communal lounge. However, for some service users the risks around this needs to be managed more effectively. For example, one service user regularly goes missing from the home for long periods but this had not been addressed within a risk assessment. (See requirements made in relation to standard 7). Furthermore, although the home has a policy on advocacy a previous recommendation that the home ensures an agreement with a suitable organisation that provides advocacy for service users particularly for those who have little or no contact with their families this has not been met. The policy also does not specify organisations where advocacy services can be accessed. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 16 &18 Although the home has improved the complaints procedure it remains inaccurate in parts and needs to be reviewed to ensure that service users are fully aware of their rights to complain and are reassured about objectivity in how investigations of complaints will be carried out Staff have received training on adult protection but the home’s policy on adult protection and whistle blowing need to be reviewed. EVIDENCE: At the previous three inspections it was raised with the home about the way the complaints policy has been drafted that it was not comprehensive, included inaccuracies that needed to be addressed and also the policy should include different avenues open to complainants if not satisfied with the response from the home. Concerns were raised that the fact the home is a family concern might hinder service users from making complaints. The home’s complaints policy was inspected; it was positive that the home had made further changes to try to address the requirements stated at the last inspection. These have been partially met in that the policy now gives timescales in which complaints will be looked into and addressed. It also states that CSCI can be contacted at any stage of the complaints process and mentions contacting the Ombudsman although does not give details about how to do this. However, there are still inaccuracies. For example, the address given for CSCI is not the local office, which it should be and does not provide a telephone number. Furthermore, the policy still does not adequately address how complaints will be dealt with objectively. For example, the policy states that to ensure “fairness and impartiality” a third party will be instructed to Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 18 carry out investigations but does not clearly specify who this will be or from where they will be accessed. The complaints records were checked and the home has received no complaints since the last inspection. Service users spoken to appeared happy with the home and expressed they did not have any complaints. However, the acting manager reported that minor or low level complaints are not recorded. A record of all complaints needs to be kept both formal and informal. A recommendation is made that the home makes the complaints policy more accessible to service users, relatives and representatives by ensuring that the copies of the policy displayed within the home are written in large print and placed where they are easily visible. Previous requirements were stated in regards to the home’s adult protection and whistle blowing policy and procedures that they need to be appropriate, effective and also consistent with the expectations of the placing authority. Also that staff including the acting manager must have training on adult abuse. These have been partially met. The manager reported that the adult protection policy has still not been reviewed. Although changes have been made to the whistle blowing policy some of the language used within the policy is not appropriate in that it potentially could discourage staff from whistle blowing. For example, it states, “A qualifying disclosure is restricted to any disclosure of information which in the reasonable belief of the worker making the disclosure tends to show one or more of the following has happened…” The list given does not include bullying, harassment or abuse all of which can potentially be difficult to place in the context of being a “reasonable belief” but may still be important for a staff member to raise and discuss with management. As previously mentioned, at the last inspection a recommendation was made that the acting manager considers engaging an external consultant to develop the home’s policies and procedures. It is evident that without any professional input or advice that standards around policies and procedures will continue to remain unmet. Therefore, this recommendation needs to be given strong consideration by the manager. Evidence was seen that the acting manager did arrange for an in house training session on adult protection for all staff to attend that was provided by John Ruskin College. This was a basic introduction to adult abuse and looked at definitions of abuse, who is vulnerable and action to take if abuse is suspected or identified. Staff spoken to did confirm that they had had training and showed good knowledge of adult abuse/protection. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 19 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 the following standard(s): 19,20,21,22, 24 &26 The home has undergone a lot of refurbishment to create a generally safe and well-maintained environment although the home must address recommendations specified within a recent fire inspection report. Communal areas are generally safe although the home does not have a designated non-smoking area for those service users who do not smoke. There are sufficient and suitable lavatories and washing facilities although the home needs to obtain professional advice about adaptations. The home does have some adaptations and specialist equipment but as service users needs increase the home must ensure the home is equipped to meet their needs and obtain professional advice as required. Generally service users’ own rooms suit their needs but the home still needs to ensure that a clear policy is in put in place about the sharing of rooms to ensure that service users make a positive decision to share. The home needs to ensure that the home is kept free from offensive odours. EVIDENCE: The home has undergone a lot of refurbishment in the last year providing a well-maintained environment that is homely and generally safe for service Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 20 users. The home recently had a fire inspection in which it was found that the home needs to install new smoke detectors and also that a couple of the bedrooms doors did not shut properly posing a fire risk. The home has until March 2006 to ensure these are met. The home is not wheelchair accessible. The accommodation is on two floors and access to the first floor is by stairs. The home does not have a chair lift or passenger lift. Previous inspection reports have raised the issue of access and that the first floor rooms are not suitable for anyone with restricted mobility. Consequently, as service users’ mobility becomes restricted a move would have to be considered if a ground floor room cannot be provided otherwise the home will need to consider ways in which it can improve access for service users as their needs increase. The home must ensure that these access restrictions are clearly set out in the statement of purpose. (See requirement in respect to standard 1). In addition, it was noted that at the last inspection the acting manager requested that the registration certificate be amended in recognition that the home could not specifically cater for people with physical disabilities. However, this remains unchanged. The manager needs to consider addressing this and contacting CSCI to have a new amended certificate issued. The home has a large communal open plan lounge/dining area on the ground floor which is light and spacious and has furnishings that are domestic in character. However, the lounge allows residents to smoke and although smoking is restricted to the lounge area as it is open plan this means that service users who are non–smokers do not have access to an area where they can sit without being exposed to smoke. The home needs to give consideration as to how non-smoking service users can be provided with a comfortable place to sit and interact with other service users that is smoke free. In addition, consideration needs to be given to the seating arrangement of the lounge to try to promote more social interaction amongst service users. (See recommendation in relation to Standard 12) The home has sufficient toilet and washing facilities although there were not any grab rails in one of the toilets on the first floor and professional advice should be sought about this. Furthermore, although the home has a walk in bath and shower on the ground floor and a bath chair on the first floor the home must ensure that these adaptations are adequate to meet the needs of all service users. It was mentioned previously that in a review held recently one of the service user’s mobility had become more restricted. Therefore, the home needs to take measures to ensure that it has the necessary specialised equipment to support the service user and also assist staff in providing the required personal care. Advice should be sought via the G.P and an occupational therapist. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 21 There are five bedrooms on each floor, two of which are shared and none have en-suite bathroom facilities. A previous recommendation that the home must develop a clear policy for the sharing of rooms to ensure that those who share make a positive decision to do so and this is summarised in the home’s statement of purpose and service user guide has not been met. There have been no changes in the service users who are presently sharing since the last inspection. Although, the home was generally clean and hygienic one of the service user’s bedrooms on the ground floor smelt quite strongly of urine. The home must ensure that the home is kept free from offensive odours and where service users are incontinent that this is managed effectively. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 There were sufficient numbers of staff on duty to meet service users needs although any changes to the rota must be recorded. Over 50 of the staff team are now undertaking NVQ Level 2 qualification to enable them to be able to work safely with service users. The home’s recruitment policy and practices are not currently completely protecting service users. Staff need specialist training to ensure that they can fully meet the needs of all service users. EVIDENCE: The home’s staffing levels are sufficient to meet the needs of the service users. However, the rota was inspected on the day of the inspection and did not exactly represent the staff members who were on duty. Any changes to the rota in respect to who is working on a shift and the numbers on duty must be recorded. The home has a stable staff team with little turnover, which is positive for service users in that this provides some consistency and continuity. The acting manager also reported that the home has a number of trainee carers working at the home that come from local colleges and also recruitment agencies who are trying to gain experience. They are surplus to the staff working at the home; this was evident from the rota. It was reported that they are inducted although this is not recorded and the colleges and agencies carry out all the necessary checks but they do not provide personal care to service users or assist service users without a permanent staff member always being present. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 23 A previous requirement was made that the home must ensure the skill mix of qualified and unqualified staff is appropriate to the assessed needs of service users at all times although none of the permanent staff are presently NVQ Level 2 qualified; the manager has now arranged for six of the eight permanent care staff to enrol on the course which is positive. Staff spoken to confirmed they were studying for the NVQ. Therefore, this requirement is to be assessed as met. However, there was evidence that there are still gaps in the knowledge and skills of staff and this needs to be addressed in the way of more specific training needs being identified (See requirements in relation to standard 30). In relation to recruitment all permanent staff files were inspected; it was found that Criminal Record Bureau (CRB) Checks had been accepted from a previous employer for four members of staff working within the care home although only one was after July 2004. From July 2004 it was specified that Criminal Bureau checks should not be portable and a new check be carried out at the start of employment for all individuals. Therefore, this constitutes a breach of the Care Standards Act 2002. An immediate requirement was issued following the inspection that the acting manager needed to ensure that a new CRB check and POVA First check was completed for the staff member in question as soon as possible. Written notification was subsequently received from the acting manager informing CSCI that the requirement had been addressed. However, a requirement is made that the home must ensure that for any future staff recruited all necessary checks and documents, several staff files did not include the required number of references, must be obtained prior to them starting work within the home. It was evident talking to staff and looking at staff records that staff have gaps in their skills and knowledge particularly around the specific needs of the service users, such as those with mental health problems, and that there has been a lack of training provided including mandatory training. This was discussed with the acting manager who acknowledged that staff do require further training but the aim is to allow them to complete the NVQ Level 2 and then look at more specific training that maybe required. However, it is important that as part of appraisals and supervision training is discussed. Evidence of appraisals being completed for four staff was seen but the form used does not fully assess or identify training needs with staff and so needs to be reviewed. Also, an annual training plan needs to be put in place and although there have not been any new staff recruited recently the home needs to ensure that a full induction programme is in place. Previous requirements in relation to this standard have not been met. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 36. The home needs to clarify the long terms arrangements for the day-to-day management of the home. The home does not presently have effective quality assurance systems in place to ensure the home is run in the best interests of the service users. The financial interests of service users are not presently safeguarded by the home’s policy. Staff are not being appropriately supervised. EVIDENCE: Although the registered manager still works at the home, she has with all intent and purposes relinquished the position to her son who has been acting manager since February 2005. Subject to a previous requirement, an application to become registered has now been submitted. However, at the time the inspection was held it was explained that due to sickness the process has become delayed as the manager had to rearrange his attendance for the Fit Persons interview. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 25 Also, since the last inspection the acting manager has completed the NVQ Level 4 in management. Although it is positive that the manager has shown willingness to gain the necessary qualifications to be able to manage the home concerns had to be raised about his overall lack of experience and knowledge in care which had become evident through discussion, the inspection of records and the home’s policy and procedures. The manager was very open to feedback and overall was very helpful in facilitating the inspection process. However, as a result of the discussion the manager took the decision that prior to rearranging the fit person interview he would discuss the situation with the Central Registration Team who are processing his application as to whether he needs to reconsider his position in undertaking the position of registered manager at this point. Since the inspection was held, notification has been received from the Central Registration Team that the acting manager has submitted in writing his request to withdraw his application for the foreseeable future. Although, the home does still have a registered manager the acting manager was taking full responsibility for the day-to-day management of the home. Consequently, as a result of the acting manager’s decision to withdraw his application for registration, a requirement is to be stated that clarification is provided to CSCI on how the management of the home is now to be covered. The previous requirement made in relation to quality assurance remains unmet. The home still does not have not have any formal quality assurance systems in place to ensure that the home is run in the best interests of the service users. The home has yet to work on producing an annual development plan that should include development of the systems for monitoring the quality of care provided and does not carry out any consultation in the way of customer surveys with service users or other stakeholders. It was reported that the home does hold service user meetings but a record of this is not kept. In respect to service user finances, this could not be fully inspected. The acting manager reported that the registered manager, his mother, takes responsibility for managing service user finances that are looked after by the home. The acting manager was unable to locate records of transactions in relation to service user finances. It was explained that all records should be accessible at all times by those responsible for the management and running of the home. Also, the home’s policy in relation to the management and protection of service user finances was not robust in that it only focused on the issue that staff should not receive gifts from service users. It did not address other areas where service user may be at risk of financial abuse and arrangements and procedures to be taken to prevent or manage this. A previous requirement was made that the manager must establish regular formal supervision for care staff and this remains unmet. There was no evidence that the staff have received any formal supervision. The acting manager reported that he does do supervision but it is informal with staff on a group basis and this is not recorded. Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 26 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 1 2 2 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 2 2 X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 1 X X Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 27 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 OP1 &OP19 Regulation 4,5(1)(2) 23(1)(2) Requirement The registered provider must produce and make available to service users an up to date statement of purpose and service user guide, which include all the information required by the standard and regulation. The statement of purpose must describe exactly - the range of needs that the home is able to meet in each service user category they are registered for. - the approach to care and support for different ranges of needs. - The expertise of members of staff and training provided to ensure they have the skills to meet the needs of service users in the different categories. - Information about the number of single and shared rooms, their sizes and which parts of the home are only accessible via the stairs. - The possible restrictions in access caused by the stairs in relation to residents’ needs and the action that the home would DS0000025608.V275919.R01.S.doc Timescale for action 31/05/06 Beaumont Version 5.1 Page 28 consider if needs deteriorate. Copies of documents to be supplied to CSCI once completed. (Previous timescales of 30/03/05 & 30/10/05 not met) The registered person must ensure that all service users are issued with a contract which needs to include all services and care provided by the home and which are covered by the fees and this needs to be signed by service users. The registered person must ensure that the full needs assessment obtained prior to the admission of a service user is as up to date as possible. Also that the assessment forms the basis of the care plan that is drawn up with the service user. The registered person must ensure that all service users have a completed comprehensive care plan and risk assessment in place and that this details all the personal, health and social care needs of the service user and fully addresses how these needs and risks will be met. Also that the care plans should be signed by service users, their relatives or a representative to evidence their involvement in the care planning process. (Previous timescale of 30/05/05 not met Standard not fully assessed 02/08/05) The registered person must ensure that the format for carrying out reviews is reviewed to ensure that these fully reflect the changing needs of service users and are directly related to service users care plans. Also DS0000025608.V275919.R01.S.doc 2. OP2 5 (1) (b) 31/05/06 3. OP3 &OP7 14(1) & 15(1) 31/03/06 4. OP7 12(1)(2)& (3) & 15(1) 30/06/06 5. OP7 15(2)(b) (c)&(d) 30/06/06 Beaumont Version 5.1 Page 29 6. OP8 13(5) & 15(1) 7. OP10 12(4)(a) 8. OP12 16(2)(m) 9. OP14 20(3) 10. OP16 22(1)(2)& (7) that service users, relatives and/or a representative where appropriate should be involved in the review process. The registered person must ensure that all the health care needs of service users are comprehensively met and these are recorded as part of the care plan. Also, that a manual handling risk assessments are carried out for service users where appropriate. The registered person must ensure that all staff are inducted and are aware of the importance of respecting service users’ rights to privacy at all times. The registered person must ensure that service users are consulted on and are given opportunities to partake in recreational and leisure activities both on a group and individual basis in and outside the home that are suited to their personal interests and preferences. The registered person must ensure that the home enters an agreement with a suitable organisation that provides advocacy for service users and makes information available on advocacy to all service users. The registered person must ensure that the -there is a simple, clear and accessible complaints procedure that ensures that it fully explains how the home will ensure objectivity is maintained in the investigations of complaints by the manager or the provider when the complaint is against a member of the family. - that the correct details of the CSCI office are included in the policy with a contact telephone DS0000025608.V275919.R01.S.doc 30/06/06 31/03/06 31/07/06 31/07/06 30/04/06 Beaumont Version 5.1 Page 30 11. OP18 13(6) & 21(1) number. -that a record is kept of all complaints including low level complaints and dissatisfactions (Timescale of 30/09/05 partially met) The registered person must ensure that the home has a comprehensive policy and procedure on adult protection and whistle blowing. 30/04/06 12. OP19 23(1),(2) & (4) 13. OP22 13(4) & (5) 14 OP26 16 (k) The policies and procedures need to be reviewed to ensure that they are appropriate, effective and that the adult protection policy is consistent with the expectations of the placing authority. Also, that the whistle blowing policy is written in a way that avoids actively discouraging whistle-blowing practice. 30/04/06 The registered person must ensure that all the recommendations outlined within the recent fire inspection are met. Also, that CSCI should be contacted about amending the registration certificate in recognition that the home is not specifically able to meet the needs of those with physical disabilities. The registered person must 31/05/06 ensure that where service users needs increase and their mobility becomes restricted that advice is sought form GP and an OT about the suitability of the aids and adaptations currently in use in the home to ensure that service users needs can be fully met and staff are able to provide the required support effectively. The registered person must 31/05/06 ensure that the home is kept free from all offensive odours at DS0000025608.V275919.R01.S.doc Version 5.1 Page 31 Beaumont 15. OP27 18 (1) 16. OP29 19(4)(b) & Sched 2 17. OP30 18(1)(c) 18. OP31 8(1)(a), (b)(iii) 19. OP33 24 (1) all times. The registered person must ensure that the rota accurately reflects the staff that are working within the home with any changes in he rota being recorded. The registered person must ensure that prior to newly recruited staff being allowed to start work within the home all necessary checks and documents are obtained. (Immediate requirement of 13/01/06 met) The registered person must ensure that the specific needs of all individual staff are established through the use of appraisals and supervision and that an annual development plan is drawn up. Also, that the home ensures that a comprehensive induction programme is developed. (Previous timescales of 01/04/05 and 01/11/05 not met) The provider must provide clarification to CSCI (Southwark office) the exact arrangements for who is to undertake the dayto-day management responsibilities of the home. To be specific that as the acting manager has now withdrawn his application to become the registered manager for the foreseeable future what arrangements are to be put in place to address this situation. The registered provider must ensure that the home develops formal quality assurance systems such as consultation with service users to ensure that the home is run in the best interests of the service user and to inform how the home should develop. DS0000025608.V275919.R01.S.doc 31/03/06 30/06/06 31/07/06 30/04/06 30/10/06 Beaumont Version 5.1 Page 32 20. OP35 16 (2) (l) 21. OP36 18 (2) (Timescale of 1/04/05 not met. Timescale 30/04/06 not exceeded) The registered person must ensure that records relating to service users’ monies that are looked after by the home are accessible to those responsible for the day to day management of the home and that acting manager makes himself familiar with the systems used to manage service user finances. Also that the home’s policy in respect to managing service user finances is reviewed to ensure it covers all aspects of protecting service users’ rights in respect to their personal finances. The registered person must establish regular, formal supervision for care staff covering at least all aspects of care, philosophy of care in the home and career development. (Previous timescales of 30/05/05 and 30/10/05 not met). 30/04/06 30/06/06 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 OP1 &OP7 Good Practice Recommendations The provider and acting manager should give strong consideration to engaging an external consultant or a staff member experienced in managing and developing services for the same client group and a background in care work to help develop the home’s care plans, policies and procedures and quality assurance systems and to provide support to the acting manager and care staff to help establish better working practices. The registered person should consider introducing a key DS0000025608.V275919.R01.S.doc Version 5.1 Page 33 2. Beaumont OP7 3. 4. 5. 6. OP11 OP12OP19 OP12 OP16 7. 8. OP20 OP24 worker system that allows the care staff to take responsibility for drawing up care plans and risk assessments for individual service users. The registered person should try to sensitively consult with all service users about their wishes around death and dying. The registered person should consider rearranging the lounge to encourage more social interaction between service users. The registered person should consider using the trainee care workers more effectively to engage service users in structured activities. The registered person should consider writing the complaints policy in larger print and displaying it in places within the home to increase its accessibility to service users, relatives or representatives. The registered person should consider allocating a nonsmoking space where service users who do not smoke can sit comfortably and socially interact The registered person should establish a clear policy for the sharing of rooms (based on the principle that double rooms are shared only if the two service users have made a positive choice to share together) is completed and is summarised in the statement of purpose, users’ guide and in the relevant contracts. (This would be a requirement if the existing double rooms should have vacancies) Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 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 Beaumont DS0000025608.V275919.R01.S.doc Version 5.1 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!