Inspection on 09/05/06 for Beaumont

This inspection was carried out on 9th May 2006.

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 03/05/07

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 9th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beaumont Address 2 Church Rise Forest Hill London SE23 2UD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 6992310 Mr P S Rekhi Mrs T K Rekhi Mrs T K Rekhi Care Home 12 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0), Old age, not falling within any other category (0), Physical disability over 65 years of age (0) Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home is registered for 12 persons of whom up to 12 may be elderly, up to 2 may have a mental disorder and be over 55 years, Up to 5 may have dementia, up to 1 may have a physical disability and be over 55 years and up to 1 may have a physical disability and be over 65 years old 12th January 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 2006. Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out over a day and a half. Although the registered manager was present working at the home on the day the inspection took place, it was the deputy manager who was involved in the inspection process. The inspection involved speaking to five service users and one member of staff. Other inspection methods included inspection of records and a full tour of the premises. What the service does well: What has improved since the last inspection? An external consultant to assist with the development of policies and procedures and other practices within the home has been introduced. The home has drawn up a service user guide and a statement of terms and conditions for present and prospective service users giving information about support and services provided by the home. The home has made some improvements around activities and ensuring time is spent with service users. Information about how service users can access advocacy services has been obtained for service users. The complaints policy has been improved. The home has improved standards of cleanliness to ensure the home is free of all offensive odours. The service has improved systems and practices around recruitment to ensure that new staff are vetted properly. An improved induction programme for staff has been introduced to be implemented with present and future staff. The home has introduced a self-auditing tool and customer satisfaction surveys as part of self-monitoring and to ensure the home is run in the best interests of the service users. Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 6 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. Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 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.V293258.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home has drawn up a comprehensive service user guide for prospective and current service users but the statement of purpose is still to be reviewed and updated. A revised contract/statement of terms and conditions is now available but is still to be issued to all service users. Although there is evidence that full needs assessments have been obtained for service users moving into the home, these are still not presently being used to draw up a care plan. The home is not clearly able to demonstrate its capacity to meet the assessed needs of individuals admitted to the home. EVIDENCE: At the six previous inspections it was identified that there was insufficient information available for prospective and current service users in that neither the statement of purpose nor the service user guide included all the information required by regulation and the relevant standards. Due to the Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 9 ongoing difficulties experienced by the home to draw up these documents and also effective policies and procedures, a recommendation was made that the registered manager should consider engaging the services of an external consultant to gain advice and assistance in this area. It was reported at this inspection that an external consultant has recently been recruited by the home and it was evident that this has resulted in an improvement in this area. Although a statement of purpose has yet to be completed and was not available for inspection, a service user guide has now been drawn up that covers all the information required by regulation (See Requirement 1). Subject to a previous requirement a contract has now been drawn up that meets with regulation. Yet, to date the amended contract has only been issued to one service user whose next of kin signed the document on their behalf and was given a copy. The deputy manager reported that for those service users who may have difficulty understanding the contract and do not have any next of kin it may take longer for the contracts to be issued whilst appropriate representatives are identified to sign on their behalf (See Requirement 2). In respect to standard 3 the previous requirement could not be assessed and therefore remains unmet. There have not been any new admissions to the home since the last inspection to be able to assess whether or not a full needs assessment is obtained by the home prior to new service users being admitted. Previous inspections have identified inconsistencies in addressing this matter. At the last inspection it was identified that for the most recent admission to the home an assessment had been obtained although the information contained in the assessment was not up to date and neither had the assessment been used as a basis for drawing up a care plan and risk assessment. This has still not been addressed (See Requirement 3 and details in respect to standard 7). The home is still not fully demonstrating that it has the capacity to meet the assessed needs of individuals admitted to the home. There was some evidence to indicate that needs and preferences of specific ethnic minority communities are understood in respect to food and religious needs. However, this is not being fully reflected within care plans, which are still not adequately addressing service users’ individual needs including any specialist needs they may have. In addition, there are still gaps in staff’s knowledge and training needs that have yet to be addressed to ensure they individually and collectively have the skills and experience to deliver the services and care which the home offers to provide (See Requirements in relation to Standards 1, 7 & 30 that encompass this outcome area). Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 &11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There are still service users for whom a care plan has not been drawn up whilst the care plans that are in place are inadequate and do not address in sufficient detail service users’ health, personal and social care needs. Although there is some evidence that health care needs are being addressed improvements are still required to ensure that service users’ health care is more comprehensively met. The medication system used by the home is effective although the medication policy used by the home needs to be reviewed and made more robust. Staff still need to be instructed on the importance of maintaining service users’ privacy. Service users have not been consulted on their personal wishes around death and dying. EVIDENCE: Previous requirements in respect to care plans and risk assessments have not been met. Although the timescale given to address these had not fully expired Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 11 at the time the inspection was held there have not been any improvements in this area. This needs to be given priority to address ongoing concerns. The home uses the Standex format for care plans and risk assessments. Despite concerns raised at the last inspection about the deputy manager not presently having the necessary assessment and care planning skills to ensure service users needs are met, he is still taking overall responsibility for the completion of care plans rather than introducing a key worker system as previously recommended. This would enable the care staff, most of whom are studying for their NVQ Level 2, to have input into the care planning process for individual service users and would also help care staff to become more knowledgeable about service users’ needs, a shortfall in this area having been identified at the last inspection. This was discussed with the deputy manager who reported that after giving the matter consideration and discussing this with care staff it was felt it would not be beneficial. It would be advised that this decision is reviewed (See Recommendation 1) Four service user plans were inspected. The “long term assessment” section of the Standex had been completed for all service users. This gave some details of individual service user’s personal, social care and health care needs although overall the information included was limited and not always completely accurate. For example, in respect to personal care it simply stated, “requires assistance with bathing” or “dressing” with no other details provided. For one service user despite concerns being outlined within a local authority review that had taken place some time ago, that due to suffering from a debilitating condition and requiring a zimmer frame to mobilise this placed them at risk of falling, information given in the long term assessment regarding history of falls simply stated “none” with no additional details given. Three service users did not have a completed care plan in place in that they were completely blank. The remaining care plan had addressed the service user’s needs in respect to personal hygiene, social interests and religious needs only. One risk assessment had been partially completed. This belonged to a service user whose care plan was inspected at the last inspection and where it had been identified at a local authority review that their mobility needs had substantially increased. Although these concerns had been addressed within the risk assessment since the last inspection in terms of walking and standing with details given that two carers were required to assist the service user, in respect to bathing, toileting and other transfers no details were specified about action to be taken to reduce risks to the service user. Also, there was still no evidence that a manual handling risk assessment had been completed (See Requirements 4 & 5). Service user plans had still not been signed by service users or where appropriate family members or a representative to indicate their involvement. There was no evidence of monthly reviews having taken place since the last inspection with the format of reviewing care plans which was identified at the Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 12 last inspection as ineffective no longer being used. Only two of the service user plans inspected contained evidence that an annual review undertaken by the local authority had taken place recently. It was reported this has recently been followed up by the registered manager who has contacted local authorities to request reviews for other service users living at the home although there was no evidence available to confirm this. Once care plans are in place the home will need to ensure that reviews are completed monthly by the home and annually by the placing authority. Personal care charts had been completed and there was evidence to indicate that service users are having baths and showers regularly as opposed to body washes as identified at the last inspection. However, service user plans still lacked information about service users’ preferences in respect to personal care routines which must be included in all care plans as part of Requirement 4. In respect of health care needs there was some evidence within service user plans that individual needs of service users are being addressed by the home. For example, for one service user whose mental health had deteriorated there had been close liaison with the mental health team with a psychiatrist visiting the home. For another service user a referral had been made to the Speech and Language team regarding concerns about choking. There was also some evidence of monthly weight monitoring. However, for one service user with a mental health problem who is on an enhanced care programme approach (CPA) the community based care plan drawn up by mental health services in conjunction with other services involved in their care, a review had not taken place for over a year. Overall, there was still insufficient information available within care plans on how health care needs such as nutrition, incontinence, pressure area care and access for service users to chiropodists, dentists and opticians are addressed by care staff. Details of contact with health professionals such as G.Ps have been placed in notebooks allocated to each individual service user. The deputy manager reported that this is an interim measure until the care plans are looked at and the shortfalls addressed (See Requirement 5). The deputy manager has declined to use an alternative care plan format introduced by the consultant recruited to provide advice on practices within the home. Instead, he reported that advice from Standex the company who supply the care plans and risk assessments has been sought and they are due to visit the home at the end of May 2006. Concerns about care planning were discussed at length with the deputy manager in respect of the adverse impact service users not having a comprehensive care plan in place potentially has on their welfare with needs and risk factors not being addressed and possibly overlooked. Furthermore, it is still not clearly evident how the care plans are to be improved when there is not anyone currently working within the home that has the necessary experience, skills and knowledge to address the problems identified. The Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 13 option of the deputy manager enrolling to do a NVQ Level 4 in care was discussed and not considered practical at this time whilst the option of introducing a staff member who has substantial experience in care to work at the home to enable these issues to be more effectively addressed and support care staff in their duties was said to be one the home cannot financially accommodate. The home’s medication system was inspected. The home uses a blister pack system. None of the service users presently living at the home take responsibility for their own medication. A sample of Medication Administration Record sheets (MARs) were checked and were all found to be accurate. It was reported that staff have received training in medication and the staff member with whom the medication was checked had a good general knowledge of the medication being dispensed to service users. However, the home’s medication policy was not comprehensive and is in need of review. It only covered basic procedures for administration and storage and there was separate information on homely medicines. However, areas such as self-administration of medication, drug errors, controlled drugs, disposal of medication amongst others had not been addressed within the policy (See Requirement 6). At the last inspection concerns were identified that not all staff working at the home are fully aware of the importance of maintaining service users rights to privacy and dignity. The home has drawn up a policy that addresses this issue. An induction programme that meets with “Skills for Care” specifications has also been introduced in which issues of privacy and dignity are addressed. The deputy manager reported that all staff presently working within the home are to be inducted using the new programme and will be expected to read and become familiar with the home’s policy. Generally service users were observed during the inspection as well dressed and groomed and being treated respectfully by care staff (See Requirement 17 and Standard 30). Although the home does have a policy on death and dying, consultation with service users about their personal wishes on death and dying have still not been completed as part of individual care plans (See Recommendation 2). Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 the service. Although the home has made efforts to try to ensure that activities are arranged for service users that meet their expectations and preferences improvements are still required. Contact with family and friends are supported by the home. The home needs to ensure that service users are fully informed of their rights to exercise personal choice and autonomy. Service users have access to a healthy diet that reflects their preferences and cultural needs. EVIDENCE: There was some evidence that service users living within the home are able to exercise their choice in relation to some aspects of daily living. For example, in terms of religious observance one service user attends the church of their preference every Saturday whilst a catholic priest comes to the home once a month. Also, it was observed that service users are given a lot of autonomy in respect to daily routines with service users being able to spend time in their rooms or watch television in the communal lounge. Furthermore, service users can leave and enter the home as they please. However, as identified at the last inspection this still needs to be risk managed effectively for individual service Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 15 users. For example, one service user who regularly goes into Catford to visit friends is known to be potentially vulnerable to financial abuse. This needs to be addressed in a risk assessment to ensure their personal safety and welfare is maintained (See Standard 7). In respect to the home providing structured activities and entertainment for service users on a group and individual level, some efforts have been made to address service users’ needs in this area. Since the last inspection the responsibility for carrying out activities with service users has been allocated to one of the care staff. They reported that service users have been engaged in playing board games such as dominoes and snakes and ladders, painting and playing softball at least once to twice a week and that up to four to five service users have got involved including those that generally do not interact with others. A record of the activities held and who was involved has not been maintained but two service users spoken to confirmed that they enjoy the painting and playing dominoes. In addition, the home recently organised for a worker from the Pump House to come into the home and do some reminiscence sessions. The deputy manager reported that generally it was quite difficult to engage the service users in the sessions although one service user who spends most of their time in their bedroom did get involved and in total up to six of them attended. The written evaluations of the sessions provided by Pump House indicated that service users did benefit with a lot of personal information being shared by individual service users about their past interests and particular preferences which could be used by care staff to further involve service users in individual activities. It is evident that service users have benefited from structured activities being organised and the efforts made to spend time with them. However, it is an area that still needs improvement. Service user plans still do not contain sufficient information about service users’ backgrounds/life history to ensure activities are offered that meet service users’ individual social and cultural needs. Records need to be kept about activities provided, who is involved and feedback obtained from service users about activities organised. Also, a key worker system would facilitate the involvement of all care staff in spending time with service users rather than one staff member and enable them to become more familiar with their needs. This needs to be given consideration (See Requirement 7 & Recommendation 1). The home has a visitor’s policy and it was reported that service users are encouraged to maintain contact with family and friends. There were not any visits to the home by family or friends during the inspection to confirm this although evidence was seen of a letter that had been sent to the home from a relative of one of the service users living at the home that expressed they had found staff very welcoming and helpful when they recently visited. One of the service user confirmed friends from the church they regularly attend have visited them at the home. Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 16 The home has a policy on advocacy in place and subject to a previous requirement information about an independent advocacy service has been obtained. Furthermore the home has a comprehensive policy on confidentiality, which makes reference to the fact that service users can access their personal records. However, measures should be taken to ensure that service users are fully aware of their rights in respect to these two areas and that information is now available to enable them to access external advice and support if required (See Recommendation 3). The home has a three-week rolling menu, which is changed in the summer. The menu was inspected. It was sufficiently varied, offers a choice of meals, which are nutritious, and caters for the specific cultural needs of service users living at the home. A mealtime was observed. The atmosphere was relaxed and unhurried with service users given sufficient time to eat. Staff were also available to offer assistance in eating where necessary. Service users spoken to stated they liked the food provided by the home and that if they did not like what was on the menu they could always have an alternative. Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a developed a robust complaints policy but information still needs to be provided to fully inform service users about their rights to complain and where to seek redress if dissatisfied with the process. Although the home has developed an effective whistle blowing policy, a comprehensive adult protection policy and procedure is still to be drawn up. EVIDENCE: At previous inspections it was raised with the home about the way the complaints policy had been drafted; that it was not comprehensive, included inaccuracies and needed to include different avenues open to service users if they were not satisfied with the response from the home. Concerns were raised that the fact the home is a family concern might hinder service users from making complaints. Since the last inspection the home has drawn up a very detailed and robust complaints procedure that includes timescales and stages for the process. Details of the local CSCI office have also been included. The deputy manager acknowledged that the policy still does not adequately address how complaints will be dealt with objectively if a complaint is made against a family member This is due to experiencing problems in identifying a third party that is independent form the home who could be involved in overseeing the investigation process in these circumstances. This was discussed. It was considered that if details of avenues that are open to service users where they Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 18 can seek independent advice or representation to support them to make a complaint or where they can seek redress if they are not satisfied with the home’s response such as the advocacy service that has been identified by the home or the local Citizens Advice Bureau and these are added to the procedure to ensure service users’ rights are maintained this would be satisfactory (See Requirement 8). Simplified copies of the policy so service users understand it more easily and which are written in larger print should also be displayed around the home where they are visible to ensure accessibility to service users, relatives and representatives (See Recommendation 4). The complaints log was inspected. A new complaints form for all complaints formal and informal has been developed. There have been no complaints made since the last inspection. Service users spoken to expressed they were happy with the home and did not have any complaints but that they would report complaints to either the registered manager or the deputy manager if necessary. Subject to previous requirements the home has drawn up a new whistle blowing policy that is comprehensive. However, although information is in place about the Protection of Vulnerable Adults (POVA) register and the home’s responsibility to refer staff unsuitable to work with vulnerable adults, a procedure on adult protection that includes signs of different types of abuse and action to be taken by staff in circumstances where abuse is either identified or suspected is still to be developed. This needs to be addressed. It is also advised that the home obtain a copy of Lewisham’s Interagency Guidelines on Adult Protection for staffs’ information (See Requirement 9 and Recommendation 5). All staff at the home have undergone adult protection training. There have been no adult protection investigations held in relation to the home since the last inspection. Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,24 &26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is generally well maintained. Communal areas need to be kept tidy and the home still needs to provide a non-smoking area for those service users who do not smoke. The home does have some specialist equipment and adaptations but professional advice needs to be obtained to ensure that the physical environment of the home meets all service users needs. Generally service users own rooms meet their needs but items that are broken need to be replaced. The home is clean and free from offensive odours. EVIDENCE: The home generally provides a well- maintained and homely environment for service users. At the last inspection a fire inspection of the home had taken place in which a number of recommendations were made including the Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 20 installation of new smoke detectors and the adjustment of two bedrooms doors which did not shut properly. These have been addressed as required. The home is not wheelchair accessible. The accommodation is on two floors and access to the first floor is by stairs. The home does not have a chair lift or a passenger lift. Therefore, the first floor rooms are not suitable for anyone with restricted mobility. The home is also awaiting a new amended registration certificate in recognition that the home cannot specifically cater for people with a physical disability, which is presently included in their conditions of registration. Access restrictions of the home have been specified within the home’s service user guide. The home has a large communal open plan lounge/dining room on the ground floor that is light and spacious and has furnishings, which are domestic in character. However, service users are allowed to smoke in this area. Although, this is restricted to the lounge as it is open plan this still impinges on nonsmoking service users who maybe sitting in the dining area. Concerns were raised at the last inspection about the fact that service users who are nonsmokers do not have access to a communal area that is smoke free. This has yet to be addressed but needs to be given consideration in terms of how the home can accommodate this. In the interim, the use of a smoke extractor to make the environment more pleasant and to try to minimise the problem is advised. (Previously stated as a recommendation this is to be made a requirement). There is a large garden at the rear of the property that has a table and chairs for service users to sit. This area needs to be kept tidy and an old sofa and bags of garden waste that have been left in the garden need to be removed (See Requirement 11) In a tour of the premises it was noted that in a number of areas of the home there were insufficient grab rails, for example along the stairs, in one of the toilets/bathrooms on the ground floor and in both the toilets/bathrooms on the first floor. Furthermore although the home uses high toilet chairs, has a walk in bath and shower on the ground floor and use of a bath chair on the first floor the home needs to ensure that these aids and equipment are appropriate and adequately meet the needs of all service users living at the home. Professional advice needs to be sought about this and an OT assessment of the building being carried out looked into (See Requirement 12). All service users bedrooms were inspected apart from one. There are five bedrooms on each floor, two of which are shared. None have en-suite facilities. Subject to a previous recommendation, the home has developed a clear policy for the sharing of rooms to ensure those who share make a positive decision to do so. This has been included in the statement of terms and conditions recently drawn up by the home that is to be issued to all present and prospective service users. Screening is provided in double rooms to ensure privacy for personal care. Service user bedrooms inspected did contain all required furniture items except it was identified that in one of the shared Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 21 rooms one of the bedside cabinets was broken. This needs to be replaced. Also, some of the rooms were quite sparse with some service users having very few personal belongings. Support should be offered to service users to help them look at ways in which their rooms could be personalised and made more comfortable (See Requirement 13 and Recommendation 7). The home was clean on the day of the inspection. The bedroom belonging to a service user on the ground floor that was identified as smelling quite strongly of urine at the last inspection was free of any malodours as was the rest of the home. Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There were sufficient staff on duty to meet the needs of service users but a copy of the rota must be available at all times and any changes to the rota recorded. Over 50 of the staff team are now undertaking a NVQ Level 2 qualification to enable them to be able to work safely with service users The home is in the process of introducing new systems and policies to ensure its recruitment practices support and protect service users. Training needs of staff still need to be addressed to ensure they are able to fully meet the needs of service users. EVIDENCE: It was evident through observation that there were sufficient staff working at the home to meet service users’ needs during the inspection. However, the rota was not initially available as it was reported it had been mislaid. Another rota was drawn up during the inspection. As identified at the last inspection the rota did not accurately reflect who was on duty. The deputy manager also reported that the same rota is used on an ongoing basis and it is not altered to include changes as a result of staff sickness or annual leave. This is not appropriate practice. The home must, for health and safety reasons and to evidence that appropriate staffing levels are being maintained at all times within the home, ensure there is an up to date and accurate weekly rota in place and any changes that have to be made due to sickness or leave that Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 23 these are clearly recorded. A copy of past rotas must also be kept for reference. It was reported that the home do not use bank or agency that extra cover is provided by those part time staff already working at the home and the managers of the home (See Requirement 14). Five of the seven care staff are still in the process of studying for the National Vocational Qualification (NVQ) Level 2 in care. This meets the required target set within the national minimum standards that at least 50 of staff should have completed or be working towards achieving this qualification. It was reported that the registered manager is also presently undertaking the qualification. In relation to recruitment there have not been any new staff recruited to work at the home. The majority of the staff team have been employed by the home for many years. However, at the last inspection it was identified that one of the more recently employed care staff had been allowed to start working at the home on the acceptance of an Enhanced Criminal Record Bureau (ECRB) check from a previous employer. An immediate requirement was issued that a new ERCB should be completed and a POVA First check carried out as soon as possible. After the inspection written notification was received from the home to inform CSCI this had been addressed. At this inspection the staff member’s file was checked and although the home is still waiting for notification of the new ERCB there was evidence that a POVA First check had been completed. It was also evident at the last inspection that the home did not have adequate systems or procedures for recruiting and vetting staff. This has now been addressed with a new application form, interview checklist reference request forms and job descriptions for care staff and domestic staff put in place. It was identified at the last inspection from discussions with care staff that were gaps in their skills and knowledge particularly around the specific needs of service users such as those with mental health problems. Also, looking at individual staff files it was evident there had been a lack of induction and training provided to staff around mandatory topics such as manual handling, infection control, food hygiene and others as well as specific training to ensure individual needs of service users can be met. The deputy manager reported at the last inspection that the aim was to allow staff to complete the NVQ Level 2 before arranging any further training. However, subject to a previous requirement that the additional training needs of staff need to be looked at as part of the annual appraisal process and supervision and a full induction programme and training plan needs to be put in place, there was evidence at this inspection that some developments have been made to address these issues. For example although annual appraisals for staff have not all been completed the form used by the home has been modified as the one previously in place did not address the identification of training needs with staff and a personal development plan has been included. In addition a work force development plan has been introduced that includes all the mandatory training courses to be undertaken by staff. As previously mentioned a new induction Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 24 programme that meets “Skills for Care” requirements has been put in place, which, it was reported, all staff are to complete (See Requirements 15, 16 & 17). Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 the service. The home still needs to identify the long-term arrangements for the day-to-day management of the home. Although quality assurance systems have been developed these are still to be fully implemented. Records for service users whose finances are being managed by the home are not fully evidencing that their financial interests are being safeguarded. Staff are still not receiving regular supervision. The health, safety and welfare of service users and staff are not being fully promoted and protected. EVIDENCE: Since the last inspection it has been confirmed in writing to CSCI that the registered manager who had with all intent and purposes relinquished her Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 26 position to her son who was acting manager has now fully resumed her responsibilities for the day to day management of the home. This follows the withdrawal of the acting manager’s application to become the registered manager due to concerns that he may not be ready to undertake the position. At present, there is no clear timescale in place for when he may decide to resubmit an application to take up the position. He continues to work in the home in the position of deputy manager/administrator. The registered manager is experienced having run the home for 12 years but she does not have a NVQ Level 4 in care or management. She is currently completing a NVQ Level 2 in care. The deputy manager does hold a diploma in management. This does hold implications for the long- term arrangements for the management of the home, which will need to be reviewed and discussed further with the registered manager and deputy manager at future inspections. In respect to quality assurance, since the last inspection the home has introduced a self- auditing tool that covers all the national minimum standards although this is has not been implemented. Customer satisfaction surveys have also been drawn up for service users, relatives and professionals. It was reported these are to be made available shortly. There was evidence that resident meetings have recently been commenced and the minutes for meetings held in March and April were seen in which activities were discussed and service users were encouraged to discuss any concerns they may have about the home. The home manages the finances for three service users one of whom the registered manager acts as appointee. It was reported that their fees and personal allowances are directly paid by the local authority into a residents’ account which is non-interest bearing that is in the registered owner’s and registered manager’s names. Although there was evidence of bank statements for the account there was no evidence of details of how each individual service user’s personal allowance has been spent with no records or receipts being kept. Instead, it was reported that items such as cigarettes and tobacco are purchased in bulk as well as other personal items for the service users by the registered owner and manager from their own money for which they then reimburse themselves from the residents account. For another service user there is an informal arrangement in place that has continued from where they were living previously and involves them handing over their personal allowance to the registered manager who then issues them with a daily allowance. No records are kept in relation to this arrangement either. It is evident that the way service users money is presently being managed by the home is not adequate and is not clearly evidencing that service users finances are being safeguarded. A system needs to be implemented in which individual records are kept for all service users whose finances the home takes responsibility. These need to detail all transactions carried out and receipts must be kept where items are purchased on their behalf. In addition, although the home’s policy on autonomy specifies that service users are encouraged to look after Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 27 their own finances and there is a policy that addresses the acceptance of gifts /monies and bequests from wills the home needs to draw up a policy and procedure that fully details how the home manages service user finances (See Requirement 18). Subject to a previous requirement there was evidence that two care staff have received supervision. The deputy manager acknowledged that he has not yet arranged supervision for all care staff. Also, the deputy manager needs to ensure that there are set agenda items for supervision including looking at issues or problems working with service users, training, practice/performance issues (See Requirement 19). The home has drawn up comprehensive policies and procedures covering all aspects of health safety practice. In respect to fire maintenance the home has met recommendations set out in the recent fire inspection report. There was evidence that fire drills and fire alarm call points have been tested weekly. However, staff have not been fully inducted or completed mandatory training in areas such as food hygiene, infection control, first aid and manual handling and other safe working practices (See Requirement 16 and details in relation to Standard 30). Maintenance certificates for the gas boiler and electrical wiring were in place although a certificate for electrical equipment was not available. There was also no evidence that water temperatures have been regularly tested and a comprehensive fire and building risk assessment had not been completed (See Requirement 20). Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 28 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 2 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 X 2 X X 2 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 2 X 2 Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 29 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 & Schd 1 Requirement 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. This is an updated requirement. The registered person must ensure that all service users are issued with a statement of terms and conditions which needs to include all services and care provided by the home which are covered by the fees and this needs to be signed by service users. (Previous timescale 31/05/06 not exceeded, partially met) The registered person must ensure that the full needs assessment obtained prior to the admission of a service user is as up to date as possible. Also that the assessment forms the basis of the care plan that is drawn up with the service user. (Previous timescale of 31/03/06 not met although DS0000025608.V293258.R01.S.doc Timescale for action 31/08/06 2. OP2 5 (1) (b) 31/08/06 3. OP3 14(1) & 15(1) 31/08/06 Beaumont Version 5.1 Page 30 4. OP7 12(1)(2)& (3) & 15(1) 5. OP8 13(5) & 15(1) 6. OP9 13 (2) 7. OP12 16(2)(m) could not be fully assessed as there have not been any new service users admitted to the home) The registered person must ensure that all service users have a completed comprehensive care plan and risk assessment in place and that this details all the personal, health and social care needs of the service user and fully addresses how these needs and risks will be met. Also that the care plans should be signed by service users, their relatives or a representative to evidence their involvement in the care planning process. (Previous timescale of 30/05/05 not met Standard not fully assessed 02/08/05 Previous timescale of 30/06/06 not exceeded) The registered person must ensure that all the health care needs of service users are comprehensively met and these are recorded as part of the care plan. Also, that a manual handling risk assessments are carried out for service users where appropriate. (Previous timescale of 30/06/06 not exceeded) The registered person must ensure there is a robust medication policy in place that covers all areas for the safe handling, storage and administration of medication and staff are made fully aware of its content. The registered person must ensure that service users are consulted on and are given opportunities to partake in recreational and leisure activities DS0000025608.V293258.R01.S.doc 31/08/06 31/08/06 31/03/07 31/10/06 Beaumont Version 5.1 Page 31 8. OP14 20(3) 9. OP18 13(6)& 21(1) 10. OP20 23 (2) (a) & (e) 11. OP20 13 (4) (a) 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. (Previous timescale of 31/07/06 not exceeded, partially met) The registered person must ensure that the home enters an agreement with a suitable organisation that provides advocacy for service users and makes information available on advocacy to all service users. (Previous timescale of 31/07/06 not exceeded, partially met) The registered person must ensure that the home has a comprehensive policy and procedure on adult protection and whistle blowing. The policies and procedures need to be reviewed to ensure that they are appropriate, effective and that the adult protection policy is consistent with the expectations of the placing authority. Also, that the whistle blowing policy is written in a way that avoids actively discouraging whistle-blowing practice. (Previous timescale of 30/04/06 partially met whistle blowing policy completed) The registered provider/person must ensure that non-smoking service users are given access to a communal space that is free from smoking. The registered person must ensure that the old sofa left in DS0000025608.V293258.R01.S.doc 31/08/06 31/03/07 31/03/07 31/08/06 Beaumont Version 5.1 Page 32 12. OP22 13(4) & (5) 13. OP24 23 (2) (b) 14. OP27 18 (1) 15. OP30 18(1)(c) 16. OP30 18 (1) (c) the garden and the bags of garden waste are removed. The registered person must ensure that where service users needs increase and their mobility becomes restricted that advice/an assessment is sought from a GP and an OT about the suitability of the aids and adaptations currently in use in the home to ensure that service users needs can be fully met and staff are able to provide the required support effectively. (Previous timescale of 31/05/06 not exceeded). The registered person must ensure that the broken bedside cabinet in one of the service user’s bedroom is replaced. The registered person must ensure that the rota accurately reflects the staff that are working within the home with any changes in the rota being recorded. (Previous timescale of 31/03/06 not met) The registered person must ensure that the specific needs of all individual staff are established through the use of appraisals and supervision and that an annual training development plan is drawn up. Also, that the home ensures that a comprehensive induction programme is developed. (Previous timescales of 01/04/05 and 01/11/05 not met, Timescale of 31/07/06 not exceeded, partially met) The registered person must ensure that staff receive training in mandatory topics such as manual handling, food hygiene, infection control etc and that these are regularly updated as DS0000025608.V293258.R01.S.doc 31/10/06 31/08/06 31/08/06 31/08/06 30/11/06 Beaumont Version 5.1 Page 33 17. OP30 18 (1) (c) 18. OP35 16 (2) (l) 19. OP36 18 (2) 20. OP38 13 (4) (a) & 23 (2) (c) required. The registered person must ensure that all staff presently working at the home and any new staff recruited are fully inducted using the new induction programme the home has introduced with particular focus on the importance of respecting service users’ rights to privacy at all times. 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 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. The registered person must establish regular, formal supervision for care staff covering at least all aspects of care, philosophy of care in the home and career development. (Previous timescales of 30/05/05 and 30/10/05 not met Timescale of 30/06/06 not exceeded, partially met). 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 DS0000025608.V293258.R01.S.doc 30/11/06 31/08/06 30/06/06 31/10/06 Beaumont Version 5.1 Page 34 assessments are in place for fire and the environment of the home and these are reviewed regularly. 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 the care staff to take responsibility for drawing up care plans and risk assessments for individual service users. The registered person should try to sensitively consult with all service users about their wishes around death and dying. The registered person should ensure that all service users are aware and understand that they have access to their personal records held by the home. The registered person should consider writing the complaints policy in a more simple format so service users more easily understand it, in larger print and display it in places within the home that are easily visible to increase its accessibility to service users, relatives or representatives. 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 at the home. The registered person should consider ways that service users can be supported to make their bedrooms more personalised. 2. 3. 4. OP11 OP14 OP16 5. 6. OP18 OP20 7. OP24 Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 35 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beaumont DS0000025608.V293258.R01.S.doc Version 5.1 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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