Inspection on 23/04/08 for Beaumont

This inspection was carried out on 23rd April 2008.

CSCI found this care home to be providing an Poor service.

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 03/05/07

Beaumont 09/05/06

Beaumont 12/01/06

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Beaumont 2 Church Rise Forest Hill London SE23 2UD Lead Inspector Ornella Cavuoto Key Unannounced Inspection 10:00 23rd &24th April 2008 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.V361900.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 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 0208 699 1550 m.rekhi@btinternet.com 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.V361900.R01.S.doc Version 5.2 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 3rd May 2007 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 and their son Mr M.S Reikhi is the deputy manager. It is aimed that Mr M.S Reikhi will take over as the registered manager although there is no timescale as yet for when this will occur. 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. Potential service users are given information about the home once an initial visit has been completed in the form of an information pack kept at the entrance of the home. Also potential service users are informed that copies of reports issued by CSCI are available on request within the home’s service user guide. Copies of CSCI reports are also placed in a dispenser in the lobby. The monthly fees of the service range from £350 -£500. No additional charges are made. This information was provided to CSCI May 2007. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection that took place over two days. Both the registered manager and the deputy manager were present for the inspection. The registered manager has continued to delegate responsibility for the day to day running of the home to the deputy manager who was mainly involved in assisting with the inspection process. The inspection involved speaking to two of the care staff and two of the service users were also spoken to one of who was case tracked. Other methods used included observation, inspection of care records and a tour of the premises was undertaken. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home to complete. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also provides some numerical information about the service. This will be referred to within the report. The inspection found that previous requirements in relation to eight of the National Minimum Standards (NMS) had still not been met. Continued failure of the home to comply with these requirements has led to the Commission for Social Care Inspection (CSCI) to consider enforcement action. What the service does well: The service users that were spoken to both stated they were happy at the home. One of the service users stated they liked the ‘peace and quiet’ and ‘I’ve got my telly and everything’. The other stated ‘I’ve never had any trouble here’. The home has obtained full needs assessments prior to admitting individuals to the home to make sure they can meet their needs. Overall the home has an effective medication system that is managed well. Service users are supported to maintain contact with family and friends and to also make use of the local community. Individuals are supported to exercise choice and control over their lives. Generally the home provides a nutritious and varied menu that is enjoyed by service users. The home is generally well maintained, clean and free from any offensive odours. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s statement of purpose still did not meet fully with regulation. A needs assessment had been obtained by the home for the service user that had recently moved into the home. EVIDENCE: At the last two inspections it was identified that the home’s statement of purpose did not fully meet with regulation. Specifically, the document had not addressed the relevant qualifications and experience of the registered manager, the number and relevant qualifications and experience of the staff working at the home or the home’s organisational structure. At this inspection the statement of purpose had still not fully been updated to ensure this information was included. This requirement has been outstanding for the past three inspections. Enforcement action is being considered by CSCI. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 9 Since the last inspection one new service user had moved into the home. The personal file belonging to the service user was looked at and was found to include a needs assessment that had been obtained prior to the service user being admitted. There was also evidence that the home had completed their own pre –admission assessment. It was evident that the needs assessment had been used as the basis for drawing up their care plan. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 &11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans generally did cover health, personal and social care needs and monthly reviews had been carried out but not all care plans had been updated to reflect service users’ changing needs. Not all service users’ health needs had been fully addressed. Overall, the home has an efficient medication system that staff had consistently adhered to but the home needs to address issues in respect to storage of medication. Service users’ were treated respectfully and their privacy up held. Service users’ wishes in respect to death and dying still need to be more comprehensively addressed. EVIDENCE: At the last inspection it was identified that although improvements in care planning had been sustained with service users’ needs and presenting risks being addressed more comprehensively not all care plans and risk assessments had been reviewed monthly as specified within National Minimum Standards (NMS). Therefore changing needs had not been clearly reflected potentially resulting in service users’ needs not all being fully addressed. At this inspection six care plans were looked at. The home uses the standex format for care plans and for all service users a care plan had been completed that addressed Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 11 personal, health and some social care needs. There was a separate document providing information on service users’ lifestyle preferences. Monthly reviews had been carried out on the ‘long- term assessment of need’ although as identified at the last inspection service users’ changing needs had not always been clearly reflected. In relation to one service user who had recently died the deputy manager reported that their health had begun to deteriorate approximately six weeks prior to their death. There was also evidence that the service user had incurred a substantial weight loss but this had not been addressed within their care plan despite monthly reviews having been recorded. It also could not be ascertained from the daily records when this service users’ health had begun to deteriorate and generally it was found these records were not very detailed and information provided was repetitive. The deputy manager reported that they had already recognised this as a problem and had brought this to staffs’ attention. This will be monitored at future inspections. For another service user, it was identified from a notebook detailing their contact with health professionals that concerns had been raised regarding pressure areas. There was no information within the care plan that addressed this although the home had taken action even previous to this concern to ensure a pressure- relieving mattress was in place. There was evidence of fall risk assessments within service users’ files but one had not been fully completed and regular reviews of these had not been done. General risk assessments detailing individual risks presented by service users’ needs were also in place. Measures had been specified to address and /or reduce the risk but some had been more comprehensively addressed than others and again these had not all been regularly reviewed. The requirement in respect to this area has been outstanding for the past two inspections. Enforcement action is being considered by CSCI. As mentioned in respect to Standard 7 each individual service user had a notebook in which a range of different health professionals had made entries detailing the reason for their visit and the outcome. It was evident from the sample of notebooks that were looked at that service users had had regular contact with a GP, mental health professionals including a consultant psychiatrist and community psychiatric nurses (CPN), opticians, dentists, chiropodists and podiatry services and district nurses. Service users had also been assisted to attend hospital appointments. However, in terms of monthly weights it was noted for one service user that there was no record of their weight having been taken since December 2007 despite the fact that between October and December 2007 they had experienced a significant weight loss and there was no evidence within records to indicate that action had been taken to address this. For another service user who as mentioned previously in relation to Standard 7 had recently passed away monthly weights had been recorded. These indicated that their weight had been stable until March 2008 when it was noted they had lost a substantial amount of weight. Although there was evidence that the service user was seen by the GP who prescribed nutritional supplements this was a fortnight following their weight having been taken and given the amount of weight loss that had occurred within such a Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 12 short period this should have prompted action to be taken by the home more quickly. Enforcement action is being considered by CSCI. The home users a blister pack system for medication. None of the service users self medicate. A sample of medication records was checked and all administration had been accurately documented. Yet, it was noted that for two of the service users that had been the last to be admitted to the home their medication records did not state whether they had any allergies to medication. This information must be obtained and recorded on their medication records as this has potential health implications for the service users. Also, as one of the service users living at the home has been prescribed a controlled drug, the home is required to purchase a controlled drugs cupboard that meets with requirements. This is due to a change in the law in 2007 that states all care homes, whether providing nursing or personal care, must now keep controlled drugs in controlled drugs cupboard. Finally, the home has regular visits from the local community pharmacist. The last report detailing the findings of the last visit was seen. Overall the feedback about the home’s management of medication was positive although it was noted that the home had not implemented weekly stock checks of all medication that was not kept in blister packs as advised within the report. It is recommended that this be addressed (See Requirements and Recommendations). At the last inspection two family members were observed sitting in one of the shared rooms on the ground floor with the door open. Neither of the service users whose room they were sitting in were in the room at the time. This was not considered to be respectful to the service users and breached their right to privacy. At this inspection no such incidents were witnessed and staff were observed treating service users respectfully at all times during the inspection with their rights to privacy maintained. Since the last inspection a complaint was raised anonymously about service users’ hair being cut in an inappropriate style. The local authority investigated this and it was established that one of the care staff had been cutting service users’ hair (See Standard 22 for further details). As a result the home had taken action to engage the services of a hairdresser to visit the home on a monthly basis and the deputy manager reported that they had recently carried out their first visit. In the main service users appeared clean and tidy but it was noted on the second day of the inspection that at least three of the service users were wearing the same clothing as the previous day and one was wearing a jumper that was quite shabby. This was discussed with the registered manager and deputy manager who reported some of the service users had few personal items of clothing. It is recommended the home identify ways of supporting those service users in need of clothing to obtain this (See Recommendations). A previous recommendation that service users should be consulted about their wishes and any personal instructions regarding death and dying had still to be fully addressed. It was evident from information within personal files that no progress had been made in this area as it had still only been stated whether a Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 13 burial or cremation was requested. The deputy manager reported that service users were not willing to discuss the matter. However, it is advised the home continues to try to address this and obtain more information involving relatives and professionals where appropriate. Yet, there was some evidence of good practice in this area in that the home had handled the death of one service user who was diagnosed as terminally ill sensitively with family members, a local hospice and other professionals involved in their care all being closely consulted to ensure the service user died comfortably and peacefully at the home (See Recommendations). Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have still not been offered sufficient opportunities to partake in activities. Service users have been supported to maintain contact with family and friends and generally have been able to exercise choice and control over their lives. Service users have enjoyed a varied and nutritious diet. EVIDENCE: Previous inspections have identified a lack of structure within the home and service users not being provided regular opportunities for social interaction. Also, despite the home taking some measures to address this such as previously arranging for a few reminiscence sessions for service users with a worker from the Pump House, deploying one of the care workers to ensure time was spent with service users doing activities for a period of time and obtaining information regarding service users’ lifestyles and personal histories to identify how they liked to spend their time, these had not resulted in any sustained changes in this area. At this inspection, the home had still not developed a weekly schedule of activities and during the inspection as has been the case at previous inspections service users were observed sitting in the lounge watching television not interacting and without stimulation. Individual activity records that were seen indicated that those activities, which had been undertaken with service users including ball games, singing, bingo Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 15 and board games, had not been held on a regular basis. Yet, the deputy manager did report that outside entertainers had been brought in at Christmas, which service users had greatly enjoyed and as a result they had been booked again to come into the home in the summer and again at Christmas. Also, an aroma therapist now came to the home on a monthly basis to see some of the service users to do hand, arm and leg massages although they have to pay for this themselves. Furthermore, the deputy manager reported that there were plans to do baking sessions with service users, to encourage service users who may be interested to do some gardening and also to arrange some trips during the summer. However, the home still needs to ensure that a core programme of activities is developed consulting service users and these are provided on a regular basis to promote social interaction and provide more structure and stimulation. In addition, subject to a previous recommendation the home had yet to develop a key worker system to facilitate care workers spending more individual time with service users The home has failed to address the previous requirement specified in respect to this area for the past three inspections. Continued non- compliance will result in enforcement action being taken by CSCI (See Requirements and Recommendations). It was evident from records that contact with family and friends were supported by the home and a relative visited one of the service users on the first day the inspection was held. In addition, links with the local community have been maintained. One of the service users’ works locally and uses local transport facilities and since the last inspection the deputy manager reported that they now regularly accompany some of the service users to the local shops to enable them to buy any items they may need. This was confirmed by one of the service users’ spoken to. In addition, a local catholic priest regularly visits the home and the deputy manager reported that some representatives from another local church had come into the home at Christmas and Easter to see the service users and had brought them presents and Easter eggs. This was confirmed from records that were seen. There was evidence that service users living at the home are able to exercise control and choice in that those service users that are able can come and go from the home as they please. Any presenting risks for individual service users leaving the home had been addressed as part of their care plan. In addition, where service users’ individual choices had been restricted these had been included in their care plan or risk assessment although reasons why these restrictions had been imposed where not always clearly outlined which needs attention. Information on advocacy was available in the home for service users. In respect to meals, the home has a three- week rolling menu that is changed for the summer months. The menus were sufficiently varied and provided meals that were balanced and nutritious. A lunch- time was observed on both days the inspection was held which were relaxed and service users were Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 16 allowed to eat their food unhurried. In addition, one service that required assistance to eat was provided support by care workers in an appropriate and respectful manner. Service users appeared to enjoy the food and those service users that were spoken to, said they were happy with the meals provided at the home. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16&17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints policy in place. Service users have not fully been protected from abuse. EVIDENCE: The home has a complaints policy that meets with National Minimum Standards (NMS) and includes the stages and timescales for the process. It also addresses how the home will address complaints against the management objectively given the home is a family run concern. This was required by CSCI. The home has a complaints log to record informal and formal complaints. The home had received no complaints from service users but a formal complaint was received and investigated by Lewisham social services in respect to concerns about male and female service users living at the home having been given inappropriate hair cuts that had been cut severely short. The Commission for Social Care Inspection (CSCI) was also notified. The outcome found the complaint to be substantiated with a care worker having been given responsibility for hair cutting. However, the home took prompt action following the complaint and recruited the services of a hairdresser to come into the home on a regular basis to cut service users’ hair. In respect to adult protection, a policy and procedure had been drawn up that was comprehensive and addressed different types of abuse and the procedure to follow if abuse was identified and or suspected. The home also has a whistle blowing policy in place. However, the home had still to address a previous recommendation that specified a copy of the multi- agency adult protection Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 18 guidelines for the borough of Lewisham should be obtained. This is to be restated and it is further advised that both management and staff should become familiar with the guidelines (See Recommendations). Since the last inspection there have been two adult protection investigations undertaken in relation to the home. The first investigation related to an incident where one of the service users went missing from the home and there were concerns the home had failed to follow procedures and did not report them missing to the police promptly enough. The outcome of the investigation found the concerns to be substantiated. A second adult protection investigation was undertaken following CSCI being notified of an incident by a person that wished to remain anonymous alleging that two care workers had been involved in physically and emotionally abusing two of the service users. Lewisham social services were alerted of the matter and the police were involved. However, there was insufficient evidence for the matter to be pursued. The home followed advice from the local authority and took action to suspend the staff members against whom the allegations were made in line with adult protection procedures until an investigation was concluded. The home was then asked to undertake its own investigation by the local authority, a copy of which was seen at the inspection. As a result of the investigation the deputy manager reported the local authority made some recommendations including that the two staff members involved should attend adult protection training and information on courses provided by Lewisham Partnership had been given to the home. Also, clarification regarding on -call management arrangements was required (For further details see Standard 27). It was identified at the inspection that of the six newly recruited staff only two had completed adult protection training and in relation to other more established staff the home did provide some internal training but this was in 2005. Therefore a refresher course would be beneficial. Furthermore, neither management nor the care staff had yet to undertake any training in relation to the Mental Capacity Act, which relates to adult protection. This needs to be addressed (See Requirements). Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical environment of the home had generally been well maintained. Non- smoking service users still did not have access to a communal space that was smoke free despite additional communal space having been created within the home. Service users’ bedrooms generally met their needs although some rooms were more personalised than others. The home was clean and hygienic. EVIDENCE: Generally, the home has been well maintained. Although the décor of the home is dated it does provide a homely environment for service users. It is located near shops and amenities in nearby Catford and Forest Hill and Lewisham town centre is also easily accessible. The home is not suitable for wheelchair users and it does not have a chair lift or a passenger lift and therefore first floor rooms would not be suitable for anyone with restricted mobility. Access restrictions had been specified within the home’s service user guide. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 20 The home has a large communal open lounge and dining area on the ground floor. In addition to this, since the last inspection the home had built a conservatory off the lounge area that was bright airy and spacious. It was reported at the last inspection that this was to be built to address a requirement that non- smoking service users should have an area where they could sit and socialise. The conservatory was to provide a smoking area leaving the lounge and dining area smoke free. However, it was identified at this inspection that there were no smoking restrictions imposed in any of the communal areas. The previous requirement specified in relation to this has been outstanding for the past two inspections. Enforcement action is being considered by CSCI. The majority of service users’ bedrooms were inspected. All the service users presently are occupying single rooms. The home has a shared room on the ground floor but this is presently not in use following one of the service users who occupied the room being moved into a home that provides nursing care and the other service user having recently passed away. The deputy manager reported that the room is to be used as a single room unless a referral is obtained regarding two people who want to share. Subject to a previous requirement the carpets that were identified as needing to be replaced in two of the bedrooms this had been met. In addition, in respect to a previous recommendation that service users be supported to help them look at ways of making their rooms more personalised and comfortable as some rooms were identified as quite sparse with few personal belongings, at this inspection some progress in this area was identified with some rooms that were seen having a few more personal possessions but this is still an area that needs attention (See Recommendations). The home was clean and hygienic on the day of the inspection and free from any malodours. The home has suitable laundry facilities sited away from the preparation of food. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were sufficient staff on duty and a rota detailing staff on duty was being maintained. 50 of staff working at the home had achieved a relevant qualification meeting the target specified within NMS. The home’s recruitment practices have placed service users at risk. Not all staff have received necessary training to be able to do their jobs safely. EVIDENCE: There were sufficient staff on duty on both days the inspection was held. Two care staff are on duty at all times during the day and evening and at night one staff member does a waking night whilst another sleeps in. Previous inspections have raised concerns about the home’s rota not accurately reflecting the staff working in the home. At this inspection, it was identified that a weekly rota was being completed and this did accurately reflect care staff that were on duty on the days the inspection was held although it was noted that night staff had not been included on the rota and this should be addressed. However, due to the improvements made the requirement is deemed met. In addition, following a recent adult protection investigation that was held in relation to the home (For further details see Standard 23) it became evident that staff were not all aware of on call arrangements for management and it was recommended this information should be more clearly displayed to ensure staff were informed about who to contact out of hours and at weekends. There was evidence this had been addressed with the information being placed on a notice board in the main lounge/dining area. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 22 It was reported by the deputy manager that six of the twelve care workers presently working for the home had achieved a National Vocational Qualification (NVQ) Level 2 with one of the six care workers having also achieved a NVQ Level 3 and was in the process of doing a NVQ Level 4. There was evidence of certificates within staff files checked and also staff spoken to confirmed they had achieved the qualification. There have been concerns about the home’s recruitment practices identified at previous inspections in that not all required checks and documents had been obtained prior to allowing staff to commence working at the home. At this inspection six staff files belonging to care workers that had commenced working at the home since the last inspection were checked. In respect to four of the staff an application form had not been completed and therefore details regarding work history to be able to identify if gaps in employment had been addressed could not be checked at the inspection. For one staff member there was no evidence of references having been obtained. In respect to those staff where an application form had not been completed it was not possible to verify whether one of the references obtained was from the previous employer although for one of the staff information within their file indicated they had been working at another home but there was no evidence of a professional reference only references from individuals known to the staff member personally. In addition, for two staff members Enhanced Criminal Record Bureau (ECRB) checks had still to be obtained. There was evidence that as an interim measure checks had been made against the Protection of Vulnerable Adults (POVA) list to establish if they had been assessed as not suitable to work with vulnerable adults but it is required that where staff commence working based on a POVA First check only that they should not work with service users unsupervised until the ECRB has been acquired and evidence from the rota indicated this had not be adhered to by the home. Finally, for two staff members there was no evidence of appropriate identification documents and for another a health declaration that they were mentally and physically able to do the job had not been completed. Due to the identified concerns an immediate requirement was issued at the inspection that specified that the home needed to submit evidence to CSCI of all the missing documentation and checks identified for individual staff and that none of the staff should be permitted to work at the home until this information had been sent to and checked by CSCI. The immediate requirement was addressed by the home within the timescale given. All documents apart from an ECRB for one of the staff were forwarded to CSCI. The home was instructed that until this ECRB was obtained and sent to CSCI the staff member should not be allowed to work at the home unsupervised. In respect to the application forms for the four staff members that needed to be completed these were sent to CSCI but gaps in employment were noted that the home had not taken any action to address (See Requirements). Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 23 There was evidence for three staff members one who had started work at the home approximately 10 months ago prior to the inspection and the other two staff 6 months ago that they had completed a work booklet that addressed Common Induction Standards (CIS). It was noted that for one of the staff the health and safety section of the booklet had not been completed whereas for the two other staff it had. The deputy manager who had signed off the induction standards acknowledged they were not qualified to assess staffs’ knowledge and competency in this area and it is recommended that action be taken to bring in a qualified external person to assess staff. At the last inspection the appropriateness of the deputy manager completing any of the CIS work booklet with staff was raised as they did not have a background in care or a qualification but they reported they had sought advice and instruction to enable them to work through the standards with staff. At this inspection, this issue was raised again but the deputy manager considered they had built up a sufficient level of knowledge and had also commenced a NVQ Level 4 in care since the last inspection (See Standard 31 for further details). The three other staff had only very recently started working in the home and as a result had yet to start the work booklet. However, concerns were raised with the deputy manager that there was no evidence that an initial basic induction in which staff are introduced to important polices and procedures for the home and matters relating to the care of the residents had not been completed with any of the newly recruited staff. Two of the care workers were spoken to about the induction they had undertaken and both were vague about what this had involved. One of the care staff had yet to receive instructions about fire procedures for the home. In addition, it was noted from the home’s fire book that only one of the six staff recruited since the last inspection had signed this to state that they had read and understood the home’s fire procedures. This needs to be addressed and a record of the basic induction completed with staff should be maintained. At the last inspection there was evidence that all care staff apart from one working at the home at that time had completed a comprehensive health and safety course that covered all mandatory training topics including manual handling, hygiene and food handling, fire safety, first aid amongst others. The course was accredited but the deputy manager was not aware for how long it was valid and apart from manual handling, which, requires updating annually, when refresher training for the other subjects covered by the course, may be needed. It was recommended at the last inspection that this be clarified. However, at this inspection this had not been addressed and there was no evidence that manual handling had been updated. In respect to the other staff recruited all had some gaps where mandatory training had not been completed or needed to be updated and for those staff that had worked at the home for in the last 6 – 10 months there was no evidence that these training needs had been looked at through supervision or measures taken to ensure this training was completed. Finally subject to a previous requirement there was evidence that all staff apart from one had received an annual appraisal where required. However, training needs to be completed over the forthcoming year had not been identified as part of the appraisal process and an annual training plan had not been drawn up. The Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 24 home has failed to address this requirement for the past six inspections. Enforcement action is being considered by CSCI. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 &38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all areas of the home have been effectively managed. The home has not implemented all quality assurance mechanisms to ensure the home is run in the best interest of service users. The home’s procedures for managing service users’ finances are still not robust enough. Staff have still not received sufficient supervision. Some aspects relating to health and safety were in need of attention. EVIDENCE: The registered manager has delegated the day to day running of the home to the deputy manager who is also her son with the aim that she would eventually resign from the position and the deputy manager would take over the position. It was recommended at the last inspection that a timescale should be set for when the registered manager would resign and the deputy manager would submit an application to become the registered manager as Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 26 the long term arrangements for the management of the home needed to be clarified. This had not been addressed at this inspection although the deputy manager reported they were considering submitting an application for registration by May 2008. The deputy manager has achieved a NVQ Level 4 in management and was advised by CSCI that they should also obtain a NVQ Level 4 in care as a way of addressing gaps in knowledge and skills as apart from working at the home they have not had any other experience of working in the care field. Positively, at this inspection the deputy manager reported that they had started the course in November 2007. The deputy manager has taken some measures to address identified shortfalls in respect to the service provided by the home to ensure the home meets with National Minimum Standards, for example details provided within care plans have improved and the home has more comprehensive policies and procedures in place. However, the home has continued to fail to address previous requirements that have been specified in relation to Standards 1, 7, 12, 20 , 30, 33, 36 &38. In respect to the home’s poor recruitment practice (See Standard 29 for further details) this compromises service users’ safety and welfare. Until the deputy manager becomes registered the responsibility to address all shortfalls remains with the registered manager who needs to ensure that the home is managed effectively and appropriately in all areas (See Requirements). Subject to a previous requirement that the home should implement quality assurance tools that had been put in place had still not been addressed at this inspection. A self- auditing tool that covered all NMS had still not been used and customer satisfaction surveys for service users, relatives and professionals involved in the home had not been done. The home’s Annual Quality Assurance Assessment (AQQA) completed in January 2008 provided adequate information about the home although could have been more detailed in parts. In the main the document was accurate but some discrepancies were identified in relation to the inspection process, for example in terms of recruitment practice. The requirement specified in this area has been outstanding for the past two inspections. Enforcement action is being considered by CSCI. The last inspection found the home had addressed concerns about how records were maintained for those service users for whom the home had been given formal responsibility via the local authority to manage their finances. However, where the home had agreed informally with service users to support them with managing their finances, specifically that they would issue them with a daily allowance that although following a requirement from CSCI records had been kept for one of the service users detailing how much money was given and this was signed by a staff member and the service user, for another service user where a similar arrangement was in place no records had been kept. In addition, the home had still not drawn up a policy and procedure that detailed how the home managed service users’ finances. At this inspection, it was found that the home had continued to ensure that for those service users where the home was acting as appointee that individual records had been maintained detailing transactions and receipts had been kept. A policy and procedure had Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 27 also been drawn up by the home, which was adequate meeting a previous requirement. However, concerns were raised with the deputy manager who reported that rather than service users’ money being withdrawn from the pooled account and a float of money for each of them kept within the home to purchase items either the deputy manager or the owner of the home would use their own money/debit card and then use the account to pay themselves back the money. Also, for a service user who had recently been admitted to the home and was waiting for the local authority, to put in place more formal arrangements to manage their finances, the deputy manager was using their own debit card to purchase items, which the service user had to pay them back from their bank account. The deputy manager did have receipts for purchases made and copies of bank statements detailing withdrawals made by the service user but no itemised records detailing these transactions were in place. This is not good practice and although the integrity of the deputy manager and owners was not in question, the management of service users’ finances should be kept completely separate from their own and transparency and a clear audit trail maintained at all times. This practice needs to be reviewed (See Requirements). In relation to staff supervision, it was evident from staff files checked that care staff had still had not received sufficient supervision. Two staff had not received any supervision since they had started work at the home 6 months previously whilst in respect to four more established care staff although they had received supervision at more regular intervals in 2007 none had received at least six sessions as specified within NMS. Furthermore there was no evidence that these four care staff had received supervision since December 2007. The home has failed to address a previous requirement to address this for the past four inspections. Enforcement action is being considered by CSCI. In respect to health and safety at previous inspections the home did not have an up to date maintenance certificate for electrical equipment, there was no evidence of water temperatures having been checked to prevent the risk of scalding to service users and the home did not have a risk assessment for the building or for fire. At this inspection there was evidence that water temperatures had been tested and a fire risk assessment had been drawn up that was adequate. The home still did not have an up to date certificate for the testing of electrical appliances (PAT) although the deputy manager reported this had been carried out. As a result a previous requirement is not to be restated in this report but it is advised that a certificate is obtained confirming that the testing has been done. However, a building risk assessment or regular health and safety checks of the home’s environment had not been carried out. The home has failed to address a previous requirement to ensure this matter is addressed for the past three inspections. Enforcement action is being considered by CSCI. Furthermore, although there was evidence of an electrical wiring certificate this stated that the electrical system was ‘unsatisfactory’. There was some evidence to indicate the home had had the Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 28 work specified on the certificate to make the system safe carried out but a new certificate stating the system was ‘satisfactory’ was not in place. This needs to be obtained and a copy sent to CSCI. In addition, it was evident from records that fire drills had not been undertaken on a regular basis with the last drill having been done in October 2007. It is advised these be done at least quarterly. Also, as mentioned in respect to Standard 30 there was a lack of evidence that newly recruited care staff had been provided instruction on the home’s fire procedures and gaps in mandatory training topics had not been addressed (See Requirements and Recommendations). Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 29 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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 2 X 2 Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 30 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 OP12 Regulation 16(2)(m) Requirement The registered person must ensure that residents 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 and that more information is gathered about their personal backgrounds/life history to inform what activities should be provided. Also, that records are kept on those group and individual activities residents are engaged in. (Previous timescales of 31/07/06, 31/10/06, 28/02/07 & 31/10/07 partially met) Continued failure to comply with this requirement will result in enforcement action to be taken. The registered person must ensure that information regarding whether or not service users have any allergies to medications is addressed on the DS0000025608.V361900.R01.S.doc Timescale for action 30/09/08 2. OP9 13(2) 31/08/08 Beaumont Version 5.2 Page 31 3. OP9 13(2) 4. OP18 13(6) 5. OP29 19 & Sched 2 6. OP29 19. 7. Beaumont OP31 10(1) medication record sheet as part of ensuring service users’ health and welfare is maintained. The registered person must ensure that a controlled drugs cupboard that meets with requirements is purchased by the home. The registered person must ensure that all staff working at the home including management receives training in adult protection and the mental capacity act as part of increasing awareness and knowledge about safeguarding service users from abuse. The registered person must ensure that all required documents as specified within Schedule 2 of the NMS are obtained prior to allowing staff to commence working in the home. (Immediate Requirement issued 09/05/06 partially met. Timescale of 28/02/07 partially met. Timescale of 31/10/07 not met). Immediate requirement issued at inspection 24/04/08 timescale of 28/04/08 met apart from ECRB check still to be sent to CSCI for one staff member. Continued failure to comply with this requirement will result in enforcement action to be taken The registered person must ensure that in respect to vetting procedures any gaps in employment are fully explored with applicants and reasons for any gaps recorded. (Previous timescale of 31/10/07 not met) The registered manager must ensure that all areas of the dayDS0000025608.V361900.R01.S.doc 30/09/08 31/10/08 30/09/08 30/09/08 30/09/08 Page 32 Version 5.2 8. OP35 9. OP38 to-day running of the home are safely and adequately managed to ensure the welfare of service users is maintained. 16 (2) (l) The registered manager must ensure that the procedures used by the home in relation to supporting service users to manage their finances are reviewed to ensure any transactions undertaken or items purchased on behalf or with service users that these are carried out directly using service users’ own money to maintain complete transparency and a clear audit trail. 23(2) & The registered person must 23 ensure that service users’ health (4)(d)&(e) safety and welfare is maintained by; - Obtaining a certificate regarding the home’s electrical wiring system to confirm that it is ‘satisfactory’ and sending a copy to CSCI. -Providing staff with instructions on the home’s fire procedures and a record of this is maintained as soon as possible after they commence working at the home. 30/09/08 30/09/08 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 OP7 Good Practice Recommendations The registered person should consider introducing a key worker system that allows staff to take responsibility for drawing up care plans and risk assessments for individual service users. DS0000025608.V361900.R01.S.doc Version 5.2 Page 33 Beaumont 2. OP9 3. 4. 5. OP10 OP11 OP12 6. 7. 8. 9. 10 OP18 OP24 OP31 OP38 OP38 The registered person should try to make sure that weekly stock checks of all medication that is not kept in blister packs are carried out as recommended in the last pharmacist’s report. The registered person should try to make sure that ways are identified to support service users in need of new or additional clothing to obtain this. The registered person should try to sensitively consult with all service users about their wishes around death and dying and obtain more information on this matter The registered person should consider introducing a key worker system to be used to ensure that individual time is spent with service users and to engage service users in both individual and group activities. The registered person should consider obtaining a copy of Lewisham’s Interagency Guidelines for Adult Protection for staffs’ information. The registered person should consider ways that service users can be supported to make their bedrooms more personalised. The registered person should consider setting a timescale for when they will resign and the deputy manager will submit an application to become the registered manager. The registered person should try to ensure that an up to date certificate for the testing of electrical appliances is obtained and kept on the premises. The registered person should try to ensure that fire drills are carried out at least quarterly with staff and service users. Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beaumont DS0000025608.V361900.R01.S.doc Version 5.2 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. 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