Inspection on 22/04/08 for Beaumont House

This inspection was carried out on 22nd April 2008.

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

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

Other inspections for this house

Beaumont House 23/02/10

Beaumont House 29/09/09

Beaumont House 16/03/09

Beaumont House 29/09/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beaumont House 26 Church Lane Whitefield Manchester M45 7NF Lead Inspector Julie Bodell Unannounced Inspection 22nd April 2008 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.V362405.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.V362405.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 Mrs Glenys Enid Gardner Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Beaumont House DS0000008399.V362405.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. 5th December 2007 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.V362405.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. Two inspectors carried out this inspection, which took place over ten hours. The home did not know that we (the commission) were going to visit. During the inspection time was spent, talking to the new head of care, the business manager, briefly to the registered manager, the deputy manager, a night senior carer and night carer, a senior day carer, a carer and two cooks. We also talked to people living at the home, looked at paperwork, at parts of the home environment and watched what was happening. We received five surveys from relatives and friends of people living at the home. They confirmed that people were satisfied with the service provided. What the service does well: What has improved since the last inspection? Medication risk assessments are reviewed and kept up-to-date to make sure people always receive the support they need to manage their medicines safely. Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 6 To ensure the health and safety of people living at the home the kitchen staff now complete the Safer Food Better Business diary documentation to give a clear record of temperatures of fridges and freezers, meat temperatures when using a probe and what cleaning has been undertaken. The majority of the staff team have received training in safeguarding to increase awareness about their responsibilities in protecting vulnerable adults in their care. The staff team have access to up-to-date training in health and safety. There is a new head of care to support the registered manager. What they could do better: Sufficient information must be made available to people about the home so that they are clear about what service they will receive. Attention to detail is still needed to care plan and healthcare risk assessment so that the staff team have accurate information to ensure that people living at the home are safely cared for. People living at the home need to be properly supported and supervised at all times and opportunities for people to become involved in activities to encourage stimulation and interaction with other people need to increase. The provision of meals needs to be reviewed to improve at the home so that people receive a better variety of food. Consideration to moving the main meal of the day to teatime to balance food intake over the day, needs to be given. Identified areas of improvements to the home need to be carried out to maintain good standards at the home, particularly the bathrooms and toilets. More attention is needed to safe practice and levels of hygiene and cleanliness around all areas of the home. The registered manager must ensure that the staff team is closely supervised through formal sessions with individual staff members and through observation of practice. This must be done to ensure that good practice learnt during heath and safety training is adopted as day-to-day practice and utilised in the best interest of the people living there. Particular attention needs to be paid to safe use of cleaning chemicals, control of infection practices, the use of footplates on wheelchairs, ensure that all fire doors close properly and the arrangements for defrosting meat in the main kitchen fridge are addressed. Beaumont House DS0000008399.V362405.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.V362405.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.V362405.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): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A thorough assessment is undertaken before a person moves into the home so that they can be confident that the home can meet their needs. Sufficient information needs to be available to people about the home so that they are clear about what service they will receive. EVIDENCE: The statement of purpose needs to be reviewed and revised to reflect recent changes to the service. A service user guide needs to be developed that gives clear relevant information about what people can expect if they choose to live at the home. It should be in a format, which people will easily understand, for example appropriate language, large font, pictures etc. People are not admitted to the home until a community care assessment has been undertaken by a qualified social worker. An experienced member of staff Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 10 also undertakes an assessment on the part of the home. The assessment involves the individual and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements, the home receives a copy of the assessment. Since the last inspection five new people have come to live at the home. We checked the care records for two of these people and a copy of a community care assessment was on file and had been carried out by a placing social worker prior to admission. The assessment format used by the home covers all personal care needs including, physical wellbeing, personal hygiene, breathing, mobilisation, eating and diet, elimination, continence, vision, hearing, dentures, chiropody, history of falls, personal safety and risk, weight, hobbies and orientation. The service also offers respite care. Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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 must be properly supervised and more attention is needed to risk assessment records to ensure that people are supported in a safe way. EVIDENCE: From the assessment information a care plan is developed. A new care planning system has been introduced at the home. The new system has helped to improve the written information available to carer’s supporting people. We looked at the records of four people. Care plans were signed by a relative and kept under regular review by the staff team. We had concerns that some important information on one person’s assessment had not been transferred onto the care plan. For example, diet states, needs encouragement, but there was no information about the fact that the person has diabetes and the nutritional (MUST) plan had not been undertaken. The same person also had MRSA but how this was to be managed was not on the care plan or risk Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 12 assessment. A district nurse was visiting the person in regard to pressure areas to the leg/heels. The pressure area risk assessment had not been fully completed and so did not demonstrate an accurate risk rating. No weights had been recorded and this meant that the moving and handling risk assessment had not been completed accurately. There was no information in the plan that the person was allergic to penicillin. There were examples of discrepancies in risk scores in all four of the care files looked at. In a second file the pressure care risk assessment special factors such as neurological/major trauma was not scored and if it had it would have indicated a very high level of risk. The moving and handling assessment for this person score high risk but there was no plan to minimise risk. There was no information on the risk of falls assessment or of a recent fracture. More attention to detail is needed on care plans and risk assessments to ensure consistent practice and that carer’s have all the information to support people safely and effectively. This matter has been ongoing for sometime and we will be considering what action to take against the home. District nurses are involved in treating the pressure sores and other healthcare professionals such as doctors and opticians also supported people. It was not clear what the arrangements were for chiropodist visits. We observed that people were being moved about in wheelchairs without footplates being used. We also had concerns about how little some people moved about the home. There also appeared to be a lack of a toileting regime, which clearly had left one person in obvious discomfort. Three people who had had disturbed nights were seen to have slept in chairs most of the day. At the last inspection the pharmacist inspector noted that there were several versions of a medication policy available for staff to read for guidance on the safe administration of medicines. The ‘homely remedies’ policy was still not in use so non-prescribed medicines, like Paracetamol, which can be bought in a chemist shop, were not kept in the home in case a person living at the home should need them and that people would be safer if there was just one clear set of medication policies for staff to follow. This is still the case. Good record keeping showed that in general people were given medicines as prescribed. However, we were concerned that one person who was prescribed Promazine PRN was given it routinely every night with no reason given why. It was advised that all hand written transcribes need to be double signed to ensure that they are accurate. The deputy manager and two senior carers’ were making regular checks and audits to make sure that medication was being handled safely. For people who were self- medicating monthly checks were being undertaken to make sure people always receive the right support when their needs change. Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 13 Medicines are stored safely, however the medication storage room upstairs was very warm. It was recommended that the temperature be monitored to make sure that medicines are not spoilt by poor storage conditions. One relative on a returned survey stated, “I have always been happy with the care my aunt receives. The staff are helpful, caring and approachable. My aunt has been poorly on and off recently and I am very pleased with the level of care.” During this visit we spent time after lunch watching what went on in the main downstairs lounge. We were concerned that during a period of an hour, none of the care staff on duty entered the room where seven people were sitting. A carer then came in with a cup of tea for people and when the task was done left the room. No one came back into the room for another half hour and then the staff member only interacted with one person and not in a discreet manner. We went out periodically to check what care staff members were doing during this time and they were either seen chatting in the office or standing round the reception area. It was also noted that there was no attempt made to change a lady whose jumper was badly soiled at lunchtime and another person needed the toilet. This is poor practice as without appropriate supervision and support people were being placed at risk. We stressed at the last inspection that improvements in this section must continue to be made and maintained to ensure that the quality rating does not go down again. This does not appear to have happened. Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are few opportunities for people to become involved in activities to encourage stimulation and interaction with other people. EVIDENCE: At the last inspection the manager told us that there were more opportunities for people to become involved in activities, with entertainers coming into the home more regularly and an activities organiser had been identified. Unfortunately this has not been sustained as the activities organiser has been off due to ill health for some time. The planned activities lounge is still being used as a storage room. Individual records of activities show very little activity other than people having their hair done. The hairdresser was in the home doing people’s hair on the day of this visit. Some people living at the home have there own hobbies and interests and highly personalised rooms that they enjoy spending time in. One person leads a very active life through church and pursuing a love of art at a local centre. Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 15 This person has many friends visiting, one stated, “Visitors are known to visit my friend from 9am until 9pm or later. They are always made welcome.” Dining rooms are provided on both floors. Tables are nicely set with napkins and cruet sets. Following a number of complaints about the food the menus have recently been reviewed and a new three-week menu is to be put into place. A copy of the new menu was seen. Week one needs to be looked at again to see if the variety can be improved as chicken appears four times as the main meal of the day. People were served a substantial breakfast and dinner. Discussion with some people said that these meals 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. The cooks said that they had considered this in the past. 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. The kitchen staff members have received training in basic food hygiene and one cook has just completed NVQ Level 2 in Food Processing and Cooking and the other is undertaking it at this time. The cooks are now using the Safer Food Better Business documentation. The cooks are to attend the MUST nutritional training and were advised to ask for the moulds that would make the appearance of soft food more appetising should they need to use them in the future. The cooks said that they had expressed concerns about the fridge in the kitchen being too small and that they were defrosting meat over salad foods, which is not appropriate. Action is needed to address this problem. Beaumont House DS0000008399.V362405.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 good. This judgement has been made using available evidence including a visit to this service. People know who to speak to if they had a complaint and the majority of the staff team have received training in safeguarding to increase their awareness about their responsibilities in protecting vulnerable adults. EVIDENCE: There have been no formal complaints made to CSCI, though we are aware through conversation with people living at the home and from staff that a number of internal complaints have been made. Unfortunately we were not able to access the complaints log at this inspection. There is a complaints policy and procedure in place. People said that they would speak to the registered manager if they had any problems. There have been no allegations of abuse at the home since the last inspection. The home has 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. For staff members who have not yet been on the safeguarding awareness course, training is planned on a rolling programme basis. This must be completed. There is an internal safeguarding policy and procedure that makes the link to the local authority procedure. Beaumont House DS0000008399.V362405.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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Beaumont House provides pleasant homely and comfortable accommodation, with all single en-suite bedrooms, but more attention is needed to ensure safe practice and levels of cleanliness. 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. At this visit we found that the small downstairs lounge was being used to store wheelchairs and that in two lounges the seat cushions were in an upright position, which did not make the rooms feel as welcoming as usual. Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 18 Unwanted items were also found in the downstairs lounge areas. We were also concerned about the condition of both meal serving areas but particularly the one upstairs. The fridge was found to be dirty, as were the cupboards. There were many unwanted items being kept in the cupboards. There were no handwashing facilities and bleach was found under the sink. The home provides all single private bedrooms each having an en-suite toilet and wash hand-basin. Some of the locks to bedroom doors were not working. A lockable space is provided for peoples’ personal use. Rooms had been highly personalised in some cases, with belongings and furniture brought from home by those people who wished to. We checked the bedroom doors, which also act as fire doors. Many did not close to the rebate and would not protect people should there be a fire at the home. The home has a maintenance and refurbishment plan, and work to make improvements within the home is scheduled to take place in May. There are a number of toilets and two bathrooms on each floor. The two smaller bathrooms are unused due to the lack of space to support people safely in and out of the bath. At the last inspection plans were in progress to upgrade the bathrooms, which were generally found to be basic, to improve the experience of having a bath. This work has yet to be started. Improvements in hand-washing facilities for staff in bathrooms had also started to be made and the necessary equipment had recently arrived but had yet to be fitted. This must be done as soon as possible as it is essential to ensure good control of infection practices and reduce the opportunity for cross infection. The water temperature to the baths was checked and found to meet the required temperature of 43°C and thermometers were available. Thermostatic mixer valves have been fitted to many hot water outlets around the home. The bathrooms were in need of cleaning. Incontinence pads were not being discreetly stored in toilet areas and there were some malodours because the bins being used for the disposal of clinical waste were not airtight. Health and safety practices in the laundry were looked at. To ensure good control infection practice, the red bag system of handling soiled items had been introduced and the sluice cycle on the washing machines was now being used, as appropriate. The laundry assistant had recently received control of infection training and protective disposable gloves and aprons are now provided. We checked the laundry in the afternoon and it was found to be unlocked and there was access to chemicals. The home was not as clean and tidy as it had been at previous inspections. Following concerns made to us by someone whose relative had previously lived at the home we looked behind the a bed in one bedroom at random, where we found evidence to support this concern. We also observed cleaning materials left unattended for over four hours. Beaumont House DS0000008399.V362405.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to recruitment practices at the home and the staff team are receiving up-to-date training. EVIDENCE: There are generally six care staff members on duty in the morning, six in the afternoon and four in the evening, including the registered manager and the deputy. There are three carers on duty at night. Cooks, laundry assistant, domestics and business administration, support care staff members. There is a low staff turnover at the home and limited use of agency staff. We looked at the recruitment files for two people working at the home and found that they were generally in good order. However, the reference from a persons file from a previous employer was not on file. The business administrator said the registered provider had a copy of the reference and she would ask for it to be returned. The head of care has recently reviewed recruitment practices for the organisation. She has introduced a set of questions for registered manager’s to use when interviewing new staff. Questions include the prospective employees understanding of the importance of good health and safety practices, confidentiality, a scenario where a service user has fallen and what action would need to be taken, control of infection Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 20 etc. For existing staff the head of care has put in place for carer’s who have been absent to due to ill health a return to work interview. For those staff leaving the home an exit interview to find out why the person is leaving with the intention of looking at ways to improve retention of staff in the future. At the last key inspection in December 2007, of the 25 care staff employed at the home we were informed that 5 hold NVQ Level 3 and 12 hold NVQ Level 2 with a further 3 currently undertaking NVQ Level 2. This gives a percentage of over 50 and therefore exceeds the national minimum standards. The organisation is a member of the local training partnership, which provides training through Skills for Care. Training information for each staff member is planned from May 2008 through to August 2008 and displayed on the notice board. Training includes infection control, medication, dementia, death and dying, first aid health and safety and safeguarding vulnerable adults. We have requested an up-to-date training skills audit to identify any gaps in mandatory health and safety training. As this training is completed, it is essential that what has been learnt by staff is adopted as good day-to-day occupational practice for the benefit of people who live at the home. For example staff told us that they found the dementia training very useful and had made them more aware of individuals different needs. They also said that they were more aware of practice issues and implications relating to control of infection, however there was no evidence to show that this was being put into practice. Beaumont House DS0000008399.V362405.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 33 35 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered manager must ensure that the staff team is closely supervised to ensure that heath and safety training is adopted as good day-to-day practice and in the best interest of the people living there. EVIDENCE: The registered manager of the home has many years of experience of working with older people. She has completed the Registered Manager’s Award NVQ Level 4. The registered manager is supported by a middle management team, which includes a new head of care, a general manager and business administrator and an external consultant. The senior management team are clear about their roles, responsibilities and accountability. We did not get the Beaumont House DS0000008399.V362405.R01.S.doc Version 5.2 Page 22 opportunity to speak to the registered manager at length during this visit but we did speak to the new head of care. The head of care started to work with the organisation recently and has spent time at the home. Feedback from staff spoken with was positive and that she was approachable and listened to any concerns and acted upon them. She was clear about what the shortfalls were at the home and what action she intends to take to support the registered manager to make improvements in the day-to-day running of the home. We discussed with the head of care the Inspecting for Better Lives process and how the overall quality rating is determined. The new head of care has started to undertake the monthly Regulation 26 monitoring visits. She has also introduced new quality monitoring questionnaires for people living at the home and their relatives and friends. We checked the personal finance records for two people. There was a record to show what money each person had held in their account. Although the cooks were now using the Safer Food Better Business documentation and the registered manager has introduced a night staff checklist we remain concerned about a number of areas of health and safety practice at the home. There are still gaps in the recording of risk assessment documentation that should have been identified by the registered manager through monitoring. We were very concerned about the lack of support and supervision provided during the early part of the afternoon, despite the fact that we were observing carers’ practice. Wheelchairs were being used without footplates. We were concerned about the levels of hygiene and cleanliness in some areas of the home and the lack of adherence to good control of infection and COHSS practices. Fire doors did not close to the rebate on many of the bedroom doors making them ineffective in a fire. The way meat was being defrosted in the main kitchen fridge was a cause of concern. The registered manager must ensure that the staff team is closely supervised through formal sessions with individual staff members and through observation of practice. This must be done to ensure that good practice learnt during heath and safety training is adopted as day-to-day practice and utilised in the best interest of the people living there. It was clear from discussions with members of the staff team that formal supervision and staff meetings did not happen very often. Given our findings during observation of practice this area must be addressed with some urgency. The registered providers must assure themselves of the registered managers competency in areas of health and safety by training or other means to ensure safe management and monitoring of the service at all times. 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. We asked for clarification that work identified on the NICEIC certificate had been carried out. Beaumont House DS0000008399.V362405.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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 1 X 1 Beaumont House DS0000008399.V362405.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 OP1 Regulation 5 and 6 Requirement Timescale for action 31/07/08 2. OP7 15 3. OP8 13 4. OP10 12 The statement of purpose needs to be reviewed and revised to reflect recent changes. A service user guide needs to be developed that gives clear relevant information about what people can expect if they choose to live at the home. It should be in a format, which people will easily understand, for example appropriate language and pictures. Care plans must be accurately 31/07/08 completed to ensure people are being supported consistently and safely. Risk assessments for nutrition, 31/07/08 moving and handling, falls and pressure care must be accurately completed to ensure people are being supported safely. (Outstanding requirement of 31.07.05, 31.01.06, 31.08.06 30.04.07, 31.08.07 and 31.01.08) To promote the privacy and 31/05/08 dignity of people living at the home, incontinence pads should be discreetly stored. DS0000008399.V362405.R01.S.doc Version 5.2 Beaumont House Page 25 5. OP10 12 6. OP12 16 7. OP15 16 8. OP19 23 9. OP19 23 10 OP21 13 and 16 11. OP26 16 12. OP30 18 13. OP31 13 The registered manager must ensure that people receive appropriate levels of care and supervision at all times. The provision of activities needs to be reviewed to improve the present arrangements for people living at the home. The provision of meals needs to be reviewed to improve the present arrangements for people living at the home. The rolling programme of work must be completed to ensure that good standards are maintained. Fire doors must be adjusted to ensure that they fully close to the rebate to offer protection to people should there be a fire. The bathrooms need to be upgraded. This should include safe hand washing facilities and clinical waste bins that promote good hygiene practices and prevent malodour. The registered manager needs to review the present cleaning arrangements at the home to ensure that all parts of the home are hygienically clean and then closely monitor to ensure that standards are being maintained. The registered manager needs to send us an up-to-date training matrix for the staff team that includes planned training that shows what mandatory health and safety training has been completed to ensure that all the staff team have receive the necessary training relevant to their roles and responsibilities. The registered providers must assure themselves that the registered manager competency in areas of health and safety by training or other means to DS0000008399.V362405.R01.S.doc 31/05/08 30/06/08 30/06/08 30/09/08 30/05/08 30/06/08 31/05/08 30/06/08 31/07/08 Beaumont House Version 5.2 Page 26 14. OP38 13 15. OP38 13 16. OP38 13 17 OP38 13 ensure safe management and monitoring of the service at all times. (Outstanding 31/01/08) The arrangements for defrosting meat in the main kitchen fridge need to be addressed to ensure safe practice. That in the interests of health and safety, footplates must be used on wheelchairs unless assessed as not appropriate. The registered manager must ensure that staff members adhere to COHSS to ensure the safe handling of chemicals around the building. Clarification that work identified on the NICEIC certificate has been carried out is needed. 30/06/08 31/05/08 30/05/08 30/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Policies and procedures must be revised and reviewed and combined into a single comprehensive document to make sure guidance to staff is clear and the health of people living at the home is protected. (Outstanding) The temperature of the medication room should be monitored to maintain it at a safe temperature for medicines storage. (Outstanding) 2. OP9 Beaumont House DS0000008399.V362405.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.V362405.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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