Inspection on 03/05/07 for Beaumont

This inspection was carried out on 3rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Beaumont 09/10/08

Beaumont 23/04/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beaumont 2 Church Rise Forest Hill London SE23 2UD Lead Inspector Ornella Cavuoto Unannounced Inspection 3rd May 2007 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.V336105.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.V336105.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 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.V336105.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 14th September 2006 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 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.V336105.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day. The inspection involved speaking to both the registered manager and the deputy manager although it was the deputy manager who was mainly involved in assisting with the inspection process and who is responsible for the day-to-day management of the home. This is matter is addressed within the report. Two service users who were case tracked, two relatives and two care staff members were also spoken to. Other inspection methods included inspection of care records and a tour of the premises. The inspection identified that the home has made some improvements in particular in respect to care plans. Overall six of the previous requirements had been met. Some requirements have now been outstanding for a number of previous inspections. The home needs to take action to address these as continued non -compliance will lead to enforcement action being taken. What the service does well: What has improved since the last inspection? The home has obtained full needs assessments prior to admitting individuals to the home to make sure they can meet their needs. Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 6 Improvements in care plans and risk assessments have been sustained with there being more detail included to ensure that residents’ health, personal and social care needs are more effectively addressed. The home has begun to involve care staff in the care planning process. Changes have been made to the complaints policy to ensure individuals’ right to complain is upheld and to encourage people to raise any concerns they may have. An adult protection policy and procedure has been drawn up by the home to further support staff to protect residents and to take appropriate action in situations where abuse maybe identified or suspected. Care staff have completed training in mandatory topics and also some specific training is being addressed to ensure that staff can meet the specialist needs of people living at the home. There have been more improvements around the record keeping for those service users whom the home supports with managing their finances although for individual residents this is still an area that needs to be looked at. 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.V336105.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.V336105.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 has a comprehensive service user guide but the statement of purpose still did not include all the information required by regulation. A full needs assessment had been obtained by the home for the resident that had recently moved into the home. EVIDENCE: The home has a comprehensive service user guide that includes all the information required by regulation and by National Minimum Standards. However, at the last inspection it was identified that the home’s statement of purpose did not include all the necessary information, specifically it had not addressed the relevant qualifications and experience of the registered manager, the number and relevant qualifications and experience of the staff nor did it include the home’s organisational structure. At this inspection it was found this had still to be addressed (See Requirements). Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 9 Previous inspections have identified inconsistencies in the home obtaining full needs assessments for people who have moved in. However, at this inspection it was reported that there had been one new admission since the last inspection. The personal file belonging to the resident was looked at and found to include a recent Care Programme Approach (CPA) and a report from their psychiatrist outlining their needs. There was also evidence that the home had carried out their own assessment prior to a place being offered. Beaumont DS0000025608.V336105.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements in care plans had been sustained although monthly reviews had not been carried out for all residents to ensure changes in need were clearly addressed. Health care needs of those living at the home had been met. The home has an efficient medication system that staff had consistently adhered to. Generally residents’ privacy was maintained and they were treated respectfully but some inconsistencies were observed in this area. More details still needed to be obtained around individuals’ wishes around death and dying. EVIDENCE: Previous inspections had identified concerns around residents not having an up to date and comprehensive care plan in place. The home uses the Standex format for care plans. However, at the last inspection a marked improvement was identified in the detail contained within care plans drawn up for people living at the home although some were still to be completed. Also, as the home was in the process of trying to ensure that the care plans were put in place and that they met with National Minimum Standards (NMS) monthly reviews still had to be done. At this inspection the personal files of five residents were Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 11 looked at and all had a care plan in place. Overall, it was evident that the previous improvements that had been made in this area had been sustained meeting a previous requirement. The care plans had addressed residents’ personal, social care and health care needs. There were also risk assessments in place that paid particular attention to falls as well as general risk assessments that identified risks presented by individual residents’ needs. Action to be taken by staff to minimise risks had been specified. Care plans had been signed by residents and at the time the inspection was held some of them were being completely updated. However, apart from one of the care plans where there was evidence that monthly reviews had taken place the others had not been reviewed on a regular basis as specified within the National Minimum Standards (NMS) neither had risk assessments. As a result they did not always reflect individuals’ changing needs, for example for one person living in the home concerns were identified within a Care Programme Approach (CPA) review held in the last few months about their eating and drinking and that they were losing weight. This had been written up in their care plan but reviews had not been carried out to update the care plan and specify any changes in their situation. Yet, on discussing this with the deputy manager they reported that as a result of measures taken by the home the problem was being addressed and had improved. This is an area that still needs attention. Previous inspections have recommended that as part of a key worker system care staff should be involved in the drawing up of care plans as opposed to the deputy manager taking sole responsibility. At the last inspection, there was an improvement in this area in that one of the senior carers had been involved in the drawing up care plans. At this inspection, the deputy manager reported that although a key worker system had not been put in place other carers had begun to be given responsibility for writing up and reviewing individual care plans. This is a positive change for the home. However, it was noted that some care plans had been written in a way that did not always encourage residents’ independence where appropriate. Also, their specific cultural needs needed to be addressed more comprehensively. It is advised this is looked at with carers. (See Requirements and Recommendations). There was evidence within the care plans looked at and also within individual notebooks that had been maintained for each resident in which contact with a range of health professionals had been written up including GP, mental health professionals, district nurses, chiropodists and dentists that the health needs of people living at the home had been addressed. Monthly weight monitoring had also taken place. The home has a comprehensive medication policy and procedure in place. A blister pack system is used by home. None of the residents presently living at the home take complete responsibility for their own medication although one individual does collect their own medication from the pharmacy. A sample of medication records for people living at the home was checked and these were all found to be accurate. There was evidence that six monthly medication Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 12 reviews had been carried out. Also, the home has regular visits from the local community pharmacist. The reports of the last two visits were seen and the feedback was very positive in how the home manages medication and also demonstrated that the home has addressed any points raised from the visits promptly. A previous inspection did raise concerns about staffs’ awareness about ensuring the privacy and dignity of residents was maintained. At this inspection care staff were observed knocking on people’s doors before entering and the issues of privacy and dignity were addressed within individuals’ care plans. However, it was observed during the inspection that two family members of those responsible for the running the home were sitting in one of the shared rooms on the ground floor with the door open. Neither of the residents whose room they were sitting in were in the room at the time. This is not acceptable. The home must ensure the privacy and dignity of people who live at the home is respected at all times by all those working or visiting the home. A previous requirement that residents who had refused a key to their rooms should sign a form clearly stating this was their choice had been met (See Requirements). There was some evidence that information had been obtained from those living at the home about their wishes on death and dying but this was only specifically whether they wanted to have a burial or a cremation. It is advised that other information concerning any personal instructions or wishes they would like to be taken into account are also obtained from people (See Recommendations). Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 13 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. The home had made efforts to gain personal information about residents to be able to provide activities that they prefer and are of interest to them but the information had yet to be used to address this matter fully. People living at the home had been supported to maintain contact with family and friends and had generally been able to exercise choice and control over their lives. Residents have enjoyed a varied and nutritious diet. EVIDENCE: Previous inspections have identified a lack of structure within the home and that more activities and entertainment needed to be provided to residents. At the last inspection the home did employ an activities co-ordinator whose role initially was to try and gather more information about individuals’ backgrounds and personal interests to enable activities to be organised that they would be interested in becoming involved. However, this did not work out and the coordinator left shortly after being employed. The home also arranged some reminiscence sessions with a worker from the Pump House but this was not continued by the home despite those residents that became involved enjoying the sessions. At this inspection, it was evident that not much progress had been made in this area. The home had finished obtaining more detailed Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 14 information about residents’ lifestyles, personal histories and how they like to spend their day but this had not resulted in any changes to activities offered. The home still did not have a weekly activities schedule in place. Individual activity logs maintained for people living at the home indicated that they had been involved in watching DVDs mainly old films of their choice, playing board games, listening to music and singing, doing quizzes and playing bingo. However, apart from the DVDs these had not been held on a regular basis. On the day of the inspection apart from watching an old film after lunch individuals spent the day mainly watching television and there was little one to one interaction between residents and the staff on duty. It is still advised that the home consider developing a key worker system to facilitate more involvement of care staff in spending time with residents. In terms of providing residents with more opportunities to be stimulated and to interact socially the deputy manager did report that they had recently spoken to a local acting group that perform plays and musicals and had also looked into an aroma therapist coming in to see people who live at the home. However, these were only possibilities being considered and more measures need to be taken to develop this area. This has been an outstanding requirement for the past three inspections. Continued non- compliance will lead to enforcement action being taken (See Requirements and Recommendations). There was evidence from residents’ care plans and also in speaking to relatives after the inspection that contact with family and friends was supported by the home. One individual living at the home regularly spends weekends with their brother. In addition, links with the local community are maintained. One of the resident’s works locally using local transport facilities whilst another regularly goes out in the local area to meet friends. A local catholic priest regularly visits the home and following a previous recommendation and after consultation with individuals the deputy manager had contacted a Church of England minister. Overall people living at the home do have a lot of autonomy and choice in respect to how they spend their time within the home and also being able to come and go from the home as they please. Previous inspections had raised concerns about the risks this presented for certain individuals and that this needed to be managed more effectively by the home. At this inspection as mentioned in relation to Standard 7 general risk assessments that addressed risk factors presented by individual needs of residents had been drawn up. There was information on advocacy services on the notice board in the communal lounge area making it accessible to people. It was also reported that individuals who move into the home could bring in personal belongings although many of the bedrooms seen were quite sparse apart from the required furniture (See Standard 24 for further details). Furthermore, there was evidence that residents meetings had been held giving them an opportunity to give feedback and views about different aspects of living at the home. The home has a comprehensive confidentiality policy that makes reference to the fact that residents are allowed access to their personal records. Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 15 In respect to meals the home ‘s menu was varied and nutritious. Subject to a previous recommendation choice of meals was clearly written up on the menu and no repetition of meals was identified. There was also some evidence that individuals’ specific cultural needs had been catered for. A lunch -time was partly observed and people appeared to enjoy the food and were given time to eat in a relaxed and unhurried way. Individuals requiring assistance to eat were supported by staff in a respectful and appropriate manner. Residents spoken to stated they were satisfied with the food with one commenting, “The food is good”. Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 16 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 &18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a robust complaints policy but information still needed to be added to it to ensure people living at the home were fully informed of their rights of where to seek independent advice and support if required. Individuals living at the home had not been fully protected from abuse. EVIDENCE: At the last inspection despite the home having drawn up a very detailed and robust complaints procedure a previous requirement that information should be added to the policy about how complaints against the management of the home will be dealt with objectively, given that the home is a family run concern and where residents can obtain independent advice and support to pursue their complaint had not been met. At this inspection, this had still not been addressed. However, following the inspection an amended copy of the home’s complaint policy was sent to CSCI that satisfactorily addressed this matter. The complaints log for the home was checked and there had not been any complaints made since the last inspection. A previous requirement that the home needed to draw up a procedure on adult protection that included signs of different types of abuse and action to be taken by care staff in circumstances where abuse was identified or suspected had still not been drawn up at this inspection. However, following the inspection a copy of a policy regarding adult abuse and adult protection procedures that was comprehensive was sent to CSCI meeting this Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 17 requirement. Interagency Guidelines on adult protection had also been obtained as previously recommended but not from the local borough and it is advised a copy of this document from the London Borough of Lewisham is secured by the home. All care staff apart from one that had been employed by the home in the past year had completed training in adult abuse. However, it was reported that the care staff member who had yet to complete the training was presently completing their National Vocational Qualification (NVQ) Level 2 in which issues of adult abuse would be addressed. No adult protection investigations involving the home have been undertaken since the last inspection. Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 18 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): 19,20,22,24 &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. The home still needs to make provision for a communal area within the home for non- smoking individuals. There are aids and adaptations in place that meet the presenting needs of individuals currently living at the home. Some renewals in residents’ bedrooms were still required as well as looking at ways to make bedrooms more comfortable and personalised for people living at the home. The home was clean and hygienic. EVIDENCE: The home has generally been well maintained and it provides a homely environment for residents. It is located near to shops and amenities in near by Catford and Forest Hill and Lewisham is also easily accessible. The home is not suitable for wheelchair users and does not have a chair lift or a passenger lift and therefore first floor rooms would not be suitable for anyone with restricted Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 19 mobility. Access restrictions had been specified within the home’s service user guide. The home has a large communal open lounge / dining area on the ground floor. The layout of the room had been changed since the last inspection with the dining tables moved to the far end of the room and lounge chairs moved nearer the kitchen. The deputy manager reported this had been done to address a previous recommendation that the room should be arranged to try to encourage more social interaction amongst residents. Previous inspections had raised concerns about individuals being allowed to smoke in the lounge and that non- smokers did not have an area where they can sit and socialise other than their own bedrooms where smoking is prohibited. At the last inspection the deputy manager had reported that consideration was being given to build a conservatory onto the lounge that would be made in to a smoking area leaving the lounge and dining area non -smoking. However, at this inspection the deputy manager reported that after discussing this with people they had stated they would all like to be able to use this and so did not like the idea of it only being for smokers. As an alternative arrangement and to fit in with the new smoking legislation to come into force in July 2007 that bans smoking in public places the deputy manager reported that it is now being considered making the whole home non smoking. In terms of guidance for care homes in respect to the legislation this states as long as a smokers have a dedicated space within the home this would still be permissible. The timescale for this requirement had not exceeded at the time the inspection took place. It is still advised that until this situation can be resolved consideration is given by the home to purchase a smoke extractor (See Requirements and Recommendations). The home does have specialist equipment and minor adaptations and aids have been put in place such as grab rails being placed in toilets, bathrooms and corridors. A previous requirement that the home should seek professional advice specifically that an Occupational Therapy (OT) assessment of the building be carried out to ensure the home was suitably equipped to meet the needs of all the people living there had not been met. This was discussed with the deputy manager who reported that the home had experienced difficulty organising an OT assessment of the building and that the GP linked to the home had advised that usually an OT assessment was only carried out in respect to concerns about a particular individual. As there were no issues identified about the physical environment of the home posing a problem for any of the residents presently living at the home and placement reviews carried out in the past few months with all individuals had not highlighted any problems in this area, a decision was taken that this requirement is not to be re-stated at this time. The majority of residents’ bedrooms were inspected. The home has five bedrooms on each floor, two of which are shared. Since the last inspection one of the residents who shared a room had been moved into a room of their own Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 20 after the person they shared with was moved to a different home as their needs could no longer be met by the home. The two individuals presently sharing this room both made a positive decision to do so. Subject to a previous requirement that in two of the bedrooms the carpets needed to be replaced with one being badly stained and the other damaged by cigarettes burns this had not been met although the specified timescale given to address this had not been exceeded at the time the inspection was held. In addition, at the last inspection it was advised that residents be supported to help them look at ways of making their rooms more personalised and comfortable as some rooms were quite sparse due to some of them having very few personal belongings. At this inspection, it was identified this was still to be addressed (See Requirements and 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.V336105.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 although an accurate rota was not in place. Care staff working at the home have been supported to achieve relevant qualifications. The home’s vetting and recruitment procedures have still not ensured that people living at the home have been fully protected. Staff had completed training to ensure the needs of people living at the home can be met. EVIDENCE: It was evident through observation that there was sufficient care staff on duty but on checking the rota it was identified that this did not accurately reflect the care staff that were on duty. One care worker had been off sick for the whole week but this had not been noted on the rota neither had the arrangements made to cover their hours. At the last inspection following a requirement that an accurate rota should be maintained the home did take action to address this issue. However, the home needs to ensure that this is carried out consistently. The home still uses volunteers who are in the process of completing their National Vocational Qualification and enrolled with a recruitment agency that carry out all the necessary recruitment checks. The deputy manager also reported that they do not support residents with personal care or assist them without a permanent care staff member being present. It was checked that volunteers working on the day of the inspection were surplus to the rota (See Requirements). Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 22 Four of the seven care staff had achieved a NVQ Level 2 and one of the care workers had also completed a NVQ Level 3. In addition, two had commenced studying for the NVQ Level 2. This means the home has met the required target specified within NMS that 50 of staff working at the home should have obtained a relevant qualification. The home had not recruited any new staff since the last inspection. The previous inspection did identify in respect to a care staff member that was newly recruited that they were allowed to commence working in the home without a new Enhanced Criminal Record Bureau ECRB check being obtained nor had a check against the Protection of Vulnerable Adults (POVA) list been carried out. An immediate requirement was issued for the home to rectify this and some evidence was sent to CSCI that this had been addressed. At this inspection the staff file was checked again. This confirmed that the home had obtained a new ECRB check and a POVA check was completed in the interim period that this was waiting to be received. However, there was no evidence that appropriate identification had been obtained as required by regulation. There was also no up to date photograph and in relation to vetting procedures gaps in employment had not been fully explored (See Requirements). Previous inspections have identified concerns about care staff having gaps in their skills and knowledge with training in mandatory topics such as manual handling, food hygiene amongst others not having been completed as well as training in other specific areas to ensure the needs of those living at the home could be met effectively. An induction programme was also not in place and annual appraisals had not been completed to identify training needs. At the last inspection some improvements in this area were identified with some care staff under taking some mandatory training whilst it was reported that four of the care staff had started a six- month course to obtain a certificate in “Positive Dementia Care”. An induction programme that met with Skills for Care specifications had also been put in place. At this inspection there was evidence that all care staff apart from one had undertaken a comprehensive health and safety course that covered all mandatory training topics manual handling, hygiene and food handling, first aid, fire safety, risk assessment amongst others. The course was accredited but the deputy manager was not aware of when staff may be required to undertake refresher training. It is advised this is clarified. One of the care staff spoken to reported they had completed the dementia course but the deputy manager was not aware about the other care staff who had started the course. Subject to a previous requirement that all care staff working at the home should complete the Skills for Care induction programme this had not been addressed although there was evidence that the most recently employed care worker had been inducted with the deputy manager going through the programme with them. Although the deputy manager does not have a background in care they reported that they had sought advice and instruction about the areas covered in the induction programme to enable them to be able Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 23 to provide the necessary information. In relation to those care workers who had worked at the home for some time undertaking the induction programme particularly for those that have completed the NVQ Level 2 the validity of this was discussed with the deputy manager and it was agreed this requirement should not be re-stated. However, a previous requirement that care staff should have an annual appraisal carried out with them and a training plan drawn up outlining training needs for care staff for the forthcoming year, it was evident from records that this had still not been completed. This requirement has been outstanding for the past five inspections. Continued noncompliance will lead to enforcement action being taken (See Requirements and Recommendations) Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 &38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The long- term arrangements for the management of the home still need to be clarified. The home still needs to implement the quality assurance mechanisms that have been put in place. Not all residents’ finances are being fully safeguarded by the home. Staff need to receive regular supervision. The health, safety and welfare of service users are still not being fully protected and promoted. EVIDENCE: The registered manager continues to be responsible for the day- to -day running of the home although the aim has been for her son who is the deputy manager to take over as registered manager. The deputy manager has completed the NVQ Level 4 in management and has been advised by CSCI to also obtain the NVQ Level 4 in care as a way of addressing gaps in knowledge Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 25 and skills as apart from working at the home they have not had any other direct experience of working in care. At this inspection the deputy manager reported they were still to enrol onto a course and had no timescale for when they were to submit an application for registration. However, it is evident that the deputy manager is taking overall responsibility for the home and in order to establish clear lines of responsibility for staff and residents it is advised that a timescale for when an application to CSCI for registration is to be submitted is put in place (See Recommendations). In respect to quality assurance the home had put in place a self -auditing tool that covered all National Minimum Standards (NMS) and also customer satisfaction surveys had been drawn up for residents, relatives and professionals involved in the home to complete. However, at the last inspection only three surveys had been completed. At this inspection, no further action had been taken to ensure surveys were issued and completed neither had the self- auditing tool been implemented (See Requirements). Previous inspections had raised concerns about the way that the home had maintained records for those residents for whom support was being provided to manage their finances. At the last inspection improvements had been made in this area. In respect to those people for whom the registered owner and manager act as appointee a breakdown of each individual’s finances had been recorded so the exact amount of money they had in the pooled residents’ account could now be identified. Receipts were now kept for transactions carried out although details of what the money had been spent on were not specified. At this inspection this had been addressed. All receipts of transactions that had taken place were attached to a petty cash voucher that was dated and details given about what had been purchased with the money. For two other residents that were supported with managing their personal allowance with an amount being issued to them on a daily basis, following a requirement for one of them a notebook was put in place that detailed how much money was given and when, which both the resident and staff member responsible for issuing the money signed. However, this had not been put in place for the other resident where an informal arrangement between themselves and the deputy manager had continued. At this inspection it was identified that the deputy manager had still not taken measures to ensure that records were maintained in respect to this arrangement despite advice from the placing authority about the procedure that should be used. This is not acceptable practice. The home has a responsibility to safeguard the personal finances of people living at the home and this must be addressed. Also, the home had still not drawn up a policy and procedure that fully details how the home manages residents’ finances (See Requirements). In respect to supervision, the deputy manager reported that they had destroyed some copies of supervision notes after changing the method for recording the sessions. It is advised that the deputy manager clarify how long such records need to be kept under Data Protection and Freedom Of Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 26 Information laws prior to disposing of any future records. As a result of this action being taken there was insufficient evidence to indicate that care staff had received sufficient supervision to ensure that they had had at least six sessions within the year as specified within NMS. This has been outstanding for the past five inspections. Continued non - compliance will lead to enforcement action being taken (See Requirements and Recommendations). A previous requirement that all portable electrical equipment (PAT) should be tested, water temperatures checked regularly to prevent scalding and a fire risk assessment and building /environment risk assessment be completed had not be met. These matters must be addressed to ensure the health, safety and welfare of people living in the home are fully promoted and protected (See Requirements). Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 2 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 3 3 2 X 3 X 2 X 3 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 3 X 2 X 2 2 X 2 Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 & Sched 1 Requirement Timescale for action 30/09/07 2. OP7 15(2)(b) 3. OP10 12(4) (a) 4. OP12 16(2)(m) The registered provider/person must produce an up to date statement of purpose which includes all the information required by the standard and Schedule 1 of the regulations. (Previous timescale of 31/08/06 partially met & timescale of 28/02/07 not met). The registered person must 31/10/07 ensure that all residents’ care plans and risk assessments are reviewed monthly and any changes in need reflected within individual care plans and risk assessments. (Previous timescale of 28/02/07 partially met) The registered person must 30/09/07 ensure that all staff working within the home and all persons visiting the home respect and maintain residents’ rights to privacy and dignity. The registered person must 31/10/07 ensure that residents are consulted on and are given opportunities to partake in DS0000025608.V336105.R01.S.doc Version 5.2 Beaumont Page 29 5. OP20 23 (2) (a) &(e) 6. OP24 23(2) (b) 7. OP27 18(a) 8. OP29 19 & Sched 2 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 partially met) Continued failure to comply with this requirement will lead to enforcement action being taken. The registered provider/person must ensure that non-smoking residents are given access to a communal space that is free from smoke. (Previous timescale of 31/03/07 not met and timescale of 31/12/07 not exceeded). The registered person must ensure that the carpets for the two residents that were stained and damaged by cigarette burns are replaced. (Previous timescale of 30/05/07 not exceeded). The registered person must ensure that an accurate rota is maintained at all times that reflect the staffing arrangements of the home to ensure the health safety and welfare of residents is maintained. The registered person must ensure that all required documents as specified within Schedule 2 of the NMS are obtained prior to allowing staff to DS0000025608.V336105.R01.S.doc 31/12/07 31/10/07 30/09/07 31/10/07 Beaumont Version 5.2 Page 30 9. OP29 19. 10. OP30 18(1) (c) 11. OP33 24 12. OP35 16 (2) (l) commence working in the home. (Immediate Requirement issued 09/05/06 partially met. Timescale of 28/02/07 partially met). 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. The registered person must ensure that all staff have an annual appraisal carried out with them and that through the outcome of these and also supervision that the individual training needs of staff are established and this is reflected in an annual training plan. (Previous timescales of 01/04/05 & 01/11/05 not met. Timescale of 31/07/06 & 31/08/06 partially met. Timescale of 31/03/07 not met). Continued failure to comply with this requirement will lead to enforcement action being taken. The registered person must ensure that all quality assurance tools the home has developed such as the self-auditing tool and customer satisfaction surveys are completed. The results of the surveys should be produced in a report and made accessible to service users, relatives and other stakeholders including CSCI. (Previous timescale of 31/12/06 not met) The registered person must ensure that the system used for the management of service users’ finances is reviewed. Individual records must be maintained for those service DS0000025608.V336105.R01.S.doc 31/10/07 31/10/07 31/10/07 31/10/07 Beaumont Version 5.2 Page 31 13. OP36 18 (2) 14. OP38 13 (4) (a) & 23 (2) (c) users for whose personal finances the home takes responsibility detailing all transactions carried out and receipts must be kept. The home must also ensure that there is a detailed policy in place covering how service users are supported with managing their personal finances and how these are safeguarded. (Previous timescales of 31/08/06 & 31/03/07 partially met). 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 and all staff should have at least six sessions per year. (Previous timescales of 30/05/05 and 30/10/05 not met Timescale of 30/06/06 partially met. Previous timescale of 30/06/06 partially met. Previous timescale of 28/02/07 not met). Continued failure to comply with this requirement will lead to enforcement action being taken. The registered person must ensure that service users health safety and welfare is maintained by; - Having up to date maintenance certificates in place for all electrical equipment - Water temperatures are checked regularly - Comprehensive risk assessments are in place for fire and the environment of the home and these are reviewed regularly. DS0000025608.V336105.R01.S.doc 31/10/07 31/10/07 Beaumont Version 5.2 Page 32 (Previous timescales of 31/10/06 & 28/02/07 not met) 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 try to ensure that care plans are written in a way that encourages residents independence and also addresses their cultural needs more comprehensively. 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. 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 placing a smoke extractor in the communal lounge /dining area until such time that the provision of a separate communal area can be looked into being provided for non-smoking service users living in the home. 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 consider clarifying exactly how long under the law records such as supervision notes need to be kept before they can be destroyed. 2. OP7 3. 4. OP11 OP12 5. 6. OP18 OP20 7. 8. 9. OP24 OP31 OP36 Beaumont DS0000025608.V336105.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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. 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