Inspection on 16/03/09 for Beaumont House

This inspection was carried out on 16th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beaumont House 23/02/10

Beaumont House 29/09/09

Beaumont House 29/09/08

Beaumont House 22/04/08

Beaumont House 05/12/07

Beaumont House 25/06/07

Beaumont House 04/07/06

Beaumont House 12/12/05

Beaumont House 03/05/05

Beaumont House 08/12/04

Beaumont House 04/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

CARE HOMES FOR OLDER PEOPLE Beaumont House 26 Church Lane Whitefield Manchester M45 7NF Lead Inspector Julie Bodell Unannounced Inspection 16th March 2009 07:15 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 House DS0000008399.V374524.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 House DS0000008399.V374524.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beaumont House Address 26 Church Lane Whitefield Manchester M45 7NF 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) 0161 796 9666 0161 796 7722 glenysgardner@bankfield.org Bankfield Premier Care Ltd Manager post vacant Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the maximum of 37 there can be up to 37 OP Old Age. The service should at all times employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 29th September 2008 Date of last inspection Brief Description of the Service: Beaumont house is a residential care home for up to 37 older people. The home is part of a group of four homes (Bankfield Premier Care) in the Bury/North Manchester area. The current fees are £380.00 per week. Beaumont House is a detached home and set in its own well-maintained grounds. It is situated close to local amenities and accessible for local transport as well as the Metro and major bus routes between Manchester and Bury. The home comprises of four large lounges and a smaller lounge and two dining areas. There are also 37 single bedrooms all with en-suite toilet. They are individually decorated and furnished and include a nurse call. The home is two storeys with an extension to the rear and side. It is divided into two units, one on the ground floor and one on the first floor. Communal areas are found on each floor and access is available via a passenger lift. Respite/short stay care may also be provided if a place is available. Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. An inspector and a pharmacist carried out this key inspection visit, which took place over ten hours. The home did not know that we (the commission) were going to visit. During the visit time was spent, talking to the head of care, the acting manager, two carers, the activities organiser, a relative and a cook. We also talked to people living at the home, looked at paperwork, parts of the building and watched what was happening. We also received information that we requested from the service called an AQAA (Annual Quality Assurance Assessment) that gives us information about what the home thinks that it does well and what needs to improve. We received eight surveys from people who live at the home and one from a staff member. At our last key inspection visit we had concerns about how well the home was managed and how people were being cared for. We asked the owner of the home to make improvements to the service and a plan was sent to us telling us what action was to be taken. We then carried out three random inspection visits to check that improvements had been made and sustained. We also carried out three random inspections and issued legal notices about medication practices. There had been a change in manager and slow and steady improvements were noted at our random visits. There had also been two safeguarding alerts as a result of whistle blowing by staff members. A key inspection is our assessment of the quality of outcomes for people who use the service. It was clear at this inspection that the progress we saw during the random inspections has not been sustained in areas of personal and health care and particularly medication and management. The quality outcomes for people living at the home remain poor. What the service does well: Beaumont House provides a comfortable and homely environment for people to live in. The home also provides an enclosed, well-maintained and private back garden with seating for people to use. The home provides all single private bedrooms, each having an en-suite toilet and wash hand-basin. People are able to bring their own items of furniture and other belongings, which have in some cases been used to good effect to create a home from home atmosphere. Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Communication and teamwork need to improve to ensure that people get the healthcare support they need. For example if a doctors visit or a prescription is requested this needs to be followed up as quickly as possible by those responsible so that people are not left waiting which could lead to a deterioration in their health. Although the recording format used by the home is good, records are not kept up to date and do not always reflect peoples changing needs. All records regarding medicines must be clear and accurate and show that medicines can be accounted for and that they have been administered as prescribed. All medication must be administered to people exactly as prescribed by the doctor. Steps must be taken to make sure medicines do not run out to make sure peoples health is not at risk and to ensure that treatment is continuous. The manager must make sure that systems which work well are in place for the recording, handling, safekeeping, self-administration and disposal of all medication received into the home. Controlled drugs, strong medicines that may be misused, must be stored in a cabinet, which meets the current law. The staff team needs to receive all the training they need to ensure that they are competent and are able to meet peoples needs in a safe and effective way. The owners of the home must ensure that the home is effectively managed at all times by senior staff members who are competent to carry out their roles. Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 7 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 House DS0000008399.V374524.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. No new people have come to live at the home since our last visit so we have been unable to make a thorough assessment of this standard. EVIDENCE: At our last key inspection visit we were concerned about the lack of detail in the assessments undertaken on behalf of the home for people that were selffunding. Since our last random inspection, no new people have come to live at the home. We have therefore been unable to make a thorough assessment of this standard. The reason that no new people had come to live at the home was because local authorities were not placing there because of the poor quality rating. And also because the owners had made the decision not to accept new people who were self funding until the service had improved. Beaumont House DS0000008399.V374524.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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using the service were at risk as their healthcare needs were not always met and did not receive their medication as and when needed. EVIDENCE: We started our inspection visit at 7.15am. The acting manager was leaving the premises as we arrived following a sleep in so that she was available to give out medication. A senior carer had come in early to cover the shift and there were three night carers on duty including one outside agency worker. We spoke briefly to a night carer. People were getting up at a relaxed pace. We looked at the handover sheets that had been completed over the weekend and identified five tasks that required action relating to peoples healthcare needs, including a person needing to see a GP and requests for prescribed medication and creams. It was noted that there had been an outbreak of a Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 11 gastric virus the week before that had affected many people including staff. There was no record that we had been formally notified of this outbreak. At 8.00am there was a change over of staff and the three night carers were replaced by three daytime carers. One carer had been sent to work at the home from a sister home within the organisation and had been working at the home for a few months and two new carers who had worked at the home for a very short time. All three carers were observed to be polite and very attentive to the needs of people encouraging people to eat their meals and drink and ensuring that people had access to activities. The interactions between people and the carers was seen to be frequent and friendly. One carer commented that she was taking time to get to know people and their individual needs and ways. Although capable, the two carers who had been working at the home for a short time and had not completed their induction training and were deployed on the upper floor without support. This situation was rectified when the head of care arrived at 9.00am and staff were swapped round to ensure the new staff were matched with an experienced member of staff. We looked at the care plans and risk assessments of the people identified on the handover sheets and most had not been reviewed for two months and did not reflect changing needs to ensure consistent practice and that carer’s have all the information to support people safely and effectively. This is a recurring problem that appeared to improve, but that has not been sustained. One person was lethargic and unresponsive. At 2.30pm we asked the staff member who was in charge of the shift, who had been in the home since 9.00am, what action had been taken to address the five tasks identified on the handover sheets. The staff member informed us that they had not read the handover sheets and that no action had been taken. The staff member then proceeded to check the handover sheets and rather than use the second office she took the phone and peoples care records into the lounge and made the necessary arrangements whilst surrounded by residents. The files where later found left in the lounge area unattended. Not only does the lack of action to follow up requests from other staff to seek healthcare attention mean that peoples health could be put at risk, no thought either appeared to be given to respecting peoples right to privacy. At previous visits we observed that people were being moved in wheelchairs without footplates. Again many of the wheelchairs seen were without footplates. The staff member in charge of the shift was observed moving a person in a wheelchair without footplates. This person had problems with their feet and their risk assessment clearly states that they must use footplates. Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 12 During this inspection the pharmacist inspector looked at the way medicines were handled and to make sure people were not at risk from harm due to poor medication handling. At previous inspections there had been some very serious concerns that residents health had been put at risk due to poor medicines handling. After these inspections we had made some requirements, which told the manager what must be done to improve safety for people living at the home. At the last random inspection, in February, we saw that some efforts had been made to make improvements. However we still found that people were not being given their medicines properly and their health could be at risk. The pharmacist inspector looked a variety of records about medicines together with the medication in the home for residents. The pharmacist inspector spent nine hours in the home and spoke to two senior care workers about medicines and the manager. At the end of the inspection the manager was given full feedback on what we had found and what out concerns were. There was evidence that regulation 13(2) Care Homes Regulations 2001 had been broken and a legal notice, Code B notice, was served during the inspection so that evidence of these breaches could be collected. When we arrived at the home the morning medicines had not been given and the medication room was in chaos. The deputy manager explained to us that this is changeover day, the day on which the new monthly medicines start. She told us that medicines could not be given to people until they had changed every thing over. It is important that arrangements are made so that people can have their medication when it is prescribed rather than when it is convenient for the staff. If medicines are not given at the correct times residents health could be at risk. We also saw that staff responsible for administering medicines had not checked to see if the new medication administration record sheets (MARs) contained all the information about peoples medicines to make sure they could be given properly. We found that a number of people were not given some medicines on the day of the inspection because of this very poor record keeping. We found that the standard of record keeping had fallen and was poor. The records were not dated properly so it was very difficult to tell exactly how much medicine had been given to people on specific dates. Some records showed that medicines had been given at a date in the future. Sometimes there were gaps and crossed out signatures on the records so it was not possible to tell if the person had been given their medicine or not. There were multiple records of the same medicine being given to a person and again it was Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 13 not possible to tell if the person had received too many doses or whether staff had just signed records without any thought. During the inspection staff altered records about medicines administration. The altered records showed that medicines had been given to people either at a time that they had not been given or showed that medicines had been given when stock checks revealed that had not been given at all. We concluded that in some instances little reliance could be placed on the records, as they could not accurately show that people had been given medicines as prescribed by their doctors or that medicines could be accounted for. We found people were not always given their medicines properly for a number of reasons. Some medicines were not available in the home to give, other medicines were not listed on the administration record charts so staff failed to give them, or the wrong dose was written on the chart so the incorrect dose was given. We also saw that staff failed to administer medicines even though they were available to be given. One person had been prescribed a cream for a rash on their back, it had not been applied for three days, after it was delivered to the home. It had been noted in the handover records that this persons back was very red and sore. Hand over notes for another person showed they were crying and upset because of an irritation in their private parts. Some staff thought there was no cream available for this person, another member of staff found the cream in the persons bedroom. The manufacturer directs that this cream should be stored in a fridge. When medicines are not stored correctly, they may become ineffective, and peoples health may be at risk. Another person was not given some vital tablets because staff thought there was none available. The manager found the tablets and asked for it to be given to the person. On checking the pack a little while later the manager found no tablets had been given, they had been put with all the unwanted medication to be returned to the pharmacy for destruction. If medicines are not given as prescribed peoples health could be placed at serious risk from harm. We also saw that some people had been given laxatives during a recent out break of diarrhoea and vomiting, this action could have also put peoples health at risk from harm. At previous inspections we have been shown certificates that staff have been trained to handle medicines safely, we have also seen evidence that senior care staff have been assessed as competent to administer medicines safely. It is of serious concern that staff failed to demonstrate that they are competent in any aspect of medicines handling. After the last inspection we made a requirement that Controlled drugs, strong medicines that may be misused, must be stored in a cabinet, which meets the current law. We found that no arrangements had been made to store these powerful drugs in a legal way. Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most people are able to take part in activities that suit their lifestyles and maintain their interests. EVIDENCE: An activities organiser from within the organisation visits the home two days each week. We observed her spending one-to-one time with people throughout the day. Her role is also to encourage care staff to become more involved in activities with people. The activities lounge had been tidied up and individual records of activities show more activity. The activities organiser told us that the home now ensured that people received a present and had a birthday cake on their birthday. A newsletter was now being produced to keep people informed about what was happening at the home. A resident had contributed to the newsletter and shared a past experience. The activities organiser now had their own budget and was involving people in themed activities such as Valentines Day, Pancake Tuesday and Easter. A music and movement man was visiting the home once a month and children were coming in to sing. The Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 15 activities organiser said that they felt that activities available to people had improved but there was still more to do. Some people living at the home have there own hobbies and interests and highly personalised rooms that they enjoy spending time in mainly reading, listening to music or watching television. One person told us that Holy Communion had recently been reintroduced and five people had taken part in the service and they were hoping very much that this would continue. At previous visits we had been concerned about the lack of interaction between people living at the home and care staff. Our findings at the random inspections was mixed from being very good at one visit and then concerns again at the next visit. At this visit we were particularly pleased to see new care staff being very attentive towards people and ensured that they were either occupied in an activity or chatting to them when they were not busy. Dining rooms were provided on both floors. Tables were nicely set with napkins and cruet sets. People were served a substantial breakfast including prunes, grapefruit and porridge. One person was seen to enjoy a cooked breakfast and five people had their meals taken to their rooms on trays. Hot and cold drinks are served with meals and throughout the day. Each of the floors has a small kitchen where drinks and snacks can be prepared, particularly around suppertime. At dinnertime people had a choice of shepherds pie or cheese pasty followed by cherry sponge and custard. At teatime there was a choice between scrambled eggs on toast or tuna sandwiches. Discussion with some people at previous visits said that the main meals i.e. breakfast and dinner were served close together and then it was a small meal or snack supper over a sixteen-hour period. It was suggested that it might be better to serve the main meal at teatime. This would balance the intake of meals out over the day and might help some people sleep better. A copy of the rotating menu was seen as well as a record of individual choices made. In the returned survey responses that we received people indicated that they usually or sometimes liked the meals provided by the home. One person commented that they had requested porridge and had been told no one knew how to make it. The manager had sorted this out and the person had received porridge for breakfast since that time. Beaumont House DS0000008399.V374524.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to help ensure that people are protected from abuse but some members of the staff team still need safeguarding awareness training. EVIDENCE: There had been no formal complaints made to us since our last key inspection visit though a number of concerns had been raised. There have been no complaints or concerns recorded since our last key inspection visit. In the returned surveys we received everyone confirmed that they knew who to make a complaint to with the exception of one person. One person commented that they knew who to speak to if they were not happy, But nothing gets done. There had been two allegations of abuse at the home since the last key inspection. The home followed the safeguarding procedures and the proper course of action was taken, with investigations being carried out by the local authority. The home had a copy of the new local safeguarding procedures. The registered manager and deputy manager attended training in safeguarding procedures at an investigation level in January 2008. A staff training matrix for the home was made available to us, which shows that many members of the staff team have yet to receive safeguarding awareness training. Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 17 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 21 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Beaumont House generally provides a safe, clean and comfortable home that is decorated and furnished to a good standard. EVIDENCE: Beaumont House is a large detached property offering very pleasant accommodation for the people who live there. The home also provides an enclosed, attractive and well-maintained private back garden with seating for people. The lounge and dining areas were homely and comfortably and generally furnished to a high standard. People can make use of all communal areas. The lounge areas were seen to be comfortable and the living flame fires made them feel homely, as did the fresh flowers. But the seat cushions were missing Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 18 from some chairs or they were turned up so that people were unable to sit on them. This was particularly confusing for people with dementia who sat on seats at times with out seat cushions, which were uncomfortable. We have previously had concerns about levels of cleanliness in the serving areas. Improvements were seen at this inspection visit, however the planned refurbishment of this area still needs to be carried out because some doors were hanging off the hinges. A window restrictor needs to be put on the window on the rear staircase to ensure peoples safety. The home provides all single private bedrooms each having an en-suite toilet and wash hand-basin. A decorator was in the home decorating some bedrooms. A lockable space is provided for peoples personal use. Bedrooms had been highly personalised in some cases, with belongings and furniture brought from home by those people who wished to. All fire doors that we checked at this visit closed to the rebate to help ensure that people were protected should there be a fire at the home. There are a number of toilets and two bathrooms on each floor. The two smaller bathrooms were unused due to the lack of space to support people safely in and out of the bath. One has recently been refurbished into an assisted shower room and both bathrooms have been repainted to good effect. Improvements in hand-washing facilities for staff in bathrooms had been made. The water temperature to one bath was checked and found to meet the required temperature of 43°C. Incontinence pads were no longer being stored in toilet areas to promote peoples dignity. Malodours have been reduced in toilet areas because airtight clinical waste bins were now being used. Generally we observed that there had been an improvement in the levels of cleanliness. The storage of chemicals was better and the kitchen and laundry were being kept locked when not in use. New fridges had been purchased for the kitchen. The kitchen appeared clean on our visit but we talked to a kitchen assistant about the need to ensure that a record of what cleaning had been undertaken needed to be included in the Safe Food Better Business record. Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 19 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. A staff team who had been safely recruited supported people but they had not received all the training they needed to ensure that people were safe from possible harm or poor practice. EVIDENCE: There are generally five care staff members on duty in the morning, five in the afternoon and four in the evening, including the acting manager and the deputy. There were three carers on duty at night. Cooks, kitchen and laundry assistants, domestics and business administration, support care staff members. There has been a high staff turnover at the home since our last visit, particularly on nights and an increase in the use of agency staff. The home has experienced difficulties in recruiting experienced senior staff members, particularly on nights. We were concerned that although they appeared capable, two carers who had been working at the home for only a short time and who had not completed their induction training were deployed on the upper floor without support. This situation was rectified when the head of care arrived at 9.00am and staff were swapped round to ensure the new staff were matched with an experienced Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 20 member of staff. We talked to the two new members of staff. They said that they had spent time shadowing other staff and were learning all the time. We looked at the recruitment files for the two new carers working at the home and found that they were generally in good order, with a Povafirst being undertaken prior to a person being offered employment and a CRB (Criminal Records Bureau check), being undertaken. References had also been taken up. The organisation is a member of the local training partnership, which provides training through Skills for Care. At our last key inspection training information could not be located following the departure of the registered manager. We were given a copy of the current staff training records, which show that many members of the staff team have not received mandatory health and safety training they need to carry out their roles safely. We were not able to establish how many staff members held an NVQ (National Vocational Qualification) Level 2 or above, a recognised qualification for staff involved in the care profession. Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The providers must ensure that the staff team is closely managed and supervised to ensure the heath and safety of the people living at the home is promoted at all times by a competent management team. EVIDENCE: Since our last key inspection the registered manager for the home had left and a manager from another home within the organisation has taken over responsibility for the home. The manager has submitted an application to become the registered manager for the home. The head of care for the service is based at the home most of the time. It was noted that the acting manager had done a sleep in that night to give out medication but prior to that Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 22 had been on holiday for a week. There had also been an outbreak of vomiting and diahorrea the previous week, which had caused some disruption to the day-to-day running of the home. At our last key inspection visit the acting manager and the head of care agreed with us that there was a lot of work to do to bring the home up to standard, particularly around healthcare and personal support, health and safety practices and management. Discussion with the head of care and the acting manager confirmed that there were good days when the home ran smoothly but as we had seen on the day of this visit, it was not always sustained. In a returned survey one person commented, There has been a noticeable improvement since the acting manager took over as manager. Since that time we had carried out three random inspection visits to the home, which indicated that steady progress was being made to make improvements at the home. However, we did express concern that the acting manager was working an excessive amount of hours to acheive the improvements. This appeared to be necessary because she was not able to confidently delegate tasks to some members of the management team at the home. That theory appeared to be accurate, because at this visit the senior staff at the weekend had identified a number of healthcare issues that needed to be followed up by senior staff coming on duty on Monday morning. No action was taken to request a GP visit for one person, get prescriptions for medication for two people or check out concerns about the health of two other people. It was clear that the head of care and the manager know where the problems lay but no evidence was available to show us what action had been taken to address the issues about competence amongst some members of the senior team. We looked at the supervision records for one senior staff member, which showed that the person had not received regular supervision, though did show that a disciplinary issue had been addressed. The registered providers must ensure that the staff team is closely managed and supervised to ensure the heath and safety of the people living at the home is promoted at all times by a competent management team. We were informed that the head of care and the acting manager had started to mentor some senior staff members but there was no evidence to support this. Improvements were seen at this visit in the interaction between care staff and people living at the home, as well as cleanliness and overall health and safety practices around the building, with the exception of the use of wheelchair footplates. Certificates and records were seen in relation to the health and safety of the environment and equipment and were found to be in good order. However the information we were given about what training the staff team have undertaken shows a significant shortfall in health and safety training, including some senior staff. Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 23 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X X X 2 Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 24 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 OP8 Regulation 13 Requirement Timescale for action 30/04/09 2. OP8 12 3. OP9 13(2) 4. OP9 13(2) All risk assessments for nutrition, moving and handling, falls and pressure care must be reviewed to ensure that they are accurately completed to ensure people are being supported safely. (Outstanding 05/12/08 and 03/02/09) The registered person must 30/04/09 promote and maintains peoples health and ensures access to health care services to meet their needs. All medication administration 18/05/09 records must be completed, to accurately record medication administered to service users and to show that all medicines can be accounted for. To ensure that residents health is not placed at risk of harm All medicines must be 18/05/09 administered in exact accordance with the prescribers directions in order that residents health is not placed at risk. (Outstanding 29/09/08, 05/12/08, 13/12/08, 15/01/09 and 04/02/09). DS0000008399.V374524.R01.S.doc Version 5.2 Beaumont House Page 25 5. OP9 13(2) 6. OP9 13(2) 7. OP9 13(2) 8 OP9 13(2) 9. OP10 12 10. OP16 13 11. OP19 23 12. OP30 OP38 18 (1) (a) 13 OP31 18 (1)(a) All medication must be obtained in a timely manner to make sure that residents do not go without their prescribed medicines. (Outstanding 04/02/09) Controlled drugs must be stored in a cabinet, which meets current legislation. To ensure the safe keeping of such medicines so that residents health is not placed at risk. (Outstanding 04/03/09) All medicines are stored safely and securely at all times and are stored at the correct temperatures. Poor storage of medicines could damage the way medicines work or harm residents health. Effective systems must be in place for the recording, handling, safekeeping, self-administration and disposal of medicines received into the home. The registered person must ensure that peoples right to confidentiality and privacy are maintained at all times. The registered person must ensure that members of the staff team receive safeguarding training to ensure that they know what action to take in the event of an allegation of abuse. The cupboards in the serving areas need to be replaced so that they are safe to use and can be kept clean. The registered provider must ensure that the staff team receive all relevant mandatory health and safety training they need to ensure they are competent to carry out their roles and responsibilities safely. (Outstanding 30/10/08 and 03/02/09) The owners of the home must DS0000008399.V374524.R01.S.doc 18/05/09 18/05/09 18/05/09 18/05/09 30/04/09 30/06/09 31/05/09 30/06/09 31/05/09 Page 26 Beaumont House Version 5.2 ensure that the home is effectively managed at all times by senior staff members who are competent to carry out their roles. 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 OP15 Good Practice Recommendations That mealtimes are reviewed to see if they suit the needs of people using the home and address comments made by people that there was a long period of time from tea to breakfast were people had only small amounts of food. It is recommended that members of staff ensure that there are cushion seats to chairs in the lounge areas in place to ensure the comfort of people living there. It is recommended that over 50 of the staff team hold an NVQ Level 2 or above and that this can be evidenced. 2. 3. OP19 OP28 Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beaumont House DS0000008399.V374524.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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