Inspection on 25/06/07 for Beaumont House

This inspection was carried out on 25th June 2007.

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

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

Other inspections for this house

Beaumont House 23/02/10

Beaumont House 29/09/09

Beaumont House 16/03/09

Beaumont House 29/09/08

Beaumont House 22/04/08

Beaumont House 05/12/07

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 25th June 2007 09:30 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.V334116.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.V334116.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 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.V334116.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. 25th January 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. 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. The home 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.V334116.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day. The home did not know the visit was going to take place. Three inspectors were involved in the inspection including a CSCI pharmacist inspector who examined the medication system. Two inspectors spent time talking to the registered manager, the newly appointed head of operations, residents, five members of the staff team and a visitor. They looked at paperwork and at parts of the home as well as watching what went on, including a period of observation of residents who were unable to communicate effectively with us. On 24th May 2007 a meeting took place with the registered providers and we shared are concerns with them about the lack of action being taken to address longstanding requirements at the home. We made it clear to the registered providers that this situation could not continue. The registered providers accepted our findings and had already taken action to address the issues. A new middle management team has now been formed and there are plans in place to improve service delivery at the home. CSCI are, at this time, confident that the registered providers will make every effort to comply with CSCI findings. This inspection report reflects the beginning of this process. CSCI will visit the home again to check that improvements are being undertaken and that good practice is being maintained. As part of the inspection process the registered manager completed a preinspection questionnaire, however some important information was missing. This was requested at the inspection, but was not received. No feedback surveys were received from residents or relatives in respect of the home. What the service does well: Relationships between staff and service users are friendly and relaxed. Residents spoken with said of the staff team that, “they are lovely”, and that “the quality of care is smashing.” A visitor also expressed that “she couldn’t praise them enough”, and that “staff were very caring and supportive.” Beaumont House provides a comfortable and homely environment for the residents to live in. The home also provides an enclosed, well-maintained and private back garden with seating for residents. The home provides all single private bedrooms each having an en-suite toilet and wash hand-basin. Locks are fitted to the bedroom doors and a lockable space is also provided for the residents’ personal use. There are enough staff members on duty to meet the needs of the residents. They make sure that the residents are clean, comfortable and well dressed. Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Admission assessment, care plans and risk assessments still need some improvement so that staff have clear information about the needs of residents and how they are to support them safely. Suitable training is also needed for those staff members who are responsible for completing the new documentation to ensure that they are competent to do so. The accuracy of the medication records needs to improve to support the safe administration of medication and ensure medicines are administered as prescribed. Risk assessments need to be kept up-to-date to make sure residents always receive the support they need to manage their medicines safely. The home needs to be able to show what opportunities the residents have to be involved in activities, what are available to all residents and record when this happens. The security, cleaning and control of infection arrangements in the kitchen need to be looked at to ensure that they effectively protect the health and safety of residents. Those staff yet to receive adult protection training must do so to ensure that they are aware of the procedure to follow in cases of alleged abuse. To ensure the health and safety of residents the hot water temperature to the baths must be checked regularly and action taken immediately to rectify problems, if they arise. Control of infection measures in the bathrooms need to be improved. Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 7 Control of infection arrangements in the laundry must be improved, particularly around the handling of soiled items. Items need to be washed at temperatures that will ensure that they are thoroughly cleaned and disinfected. A full staffing list stipulating every member of staff, volunteer etc, their role, start date, date of POVA check, if applicable, and date CRB received and reference number must be sent to CSCI to evidence that all staff hold a satisfactory CRB. Some of the staff recruitment files still need more information making sure that all checks have been carried out and that residents are protected by best practice. A training skills audit of the whole staff team must be undertaken to ensure that they have received all the necessary training relevant to their roles and responsibilities including staff induction. This is necessary to ensure that residents are in safe hands and they are competent to carry out their role safely. The registered providers must ensure that there are clear lines of accountability within the home and with any external management ensure that the home is run smoothly and in the best interest of residents. The new pack of policies and procedures must be reviewed to ensure that they give staff members’ correct guidance and are legally correct. A number of matters need to be addressed around health and safety. includes checks of the homes gas supply and hoist equipment. This 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.V334116.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.V334116.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. In the absence of an assessment by a placing authority the home must ensure that they carry out an assessment to establish the full needs of individuals referred to the home to ensure that they can be safely met by the staff team. EVIDENCE: Beaumont House is a popular home and is usually full with a waiting list for people wanting to come and live at the home. The registered manager said that the staff put a pack of toiletries and information in new resident’s bedrooms, at the time of their arrival, as a welcoming gesture. An inspector examined the admission documentation for the most recent resident to move into the home. The resident was privately funded, and had Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 10 moved directly from their home with no involvement of the local authority. The assessment form and personal details were all completed on day of admission. The documentation gave very little written information about the resident because it involved the use of tick boxes i.e. needs assistance with personal care, answer, yes or no? No other details added with regards to what needs and how these may be supported i.e. if aids are required etc, were evident. There was no personal background even though two close relatives had previously visited the home to look round, spoken with staff, chosen a room, but no evidence of any information being gathered was recorded. This is a recurring area of poor practice at the home and was discussed with the registered manager and the new head of operations. The head of operations is aware of the problems and has the agreement of the registered providers to purchase a new spandex system, which will include a new pre-assessment document. The head of operations will ensure that the staff team are given training to ensure that those who will be responsible for completing the form are competence to do so and that good quality information is gathered. The newly appointed head of care is currently reviewing and revising the policy and procedure for admissions to the organisations group of homes. Once completed it must be introduced at the home in a way that ensures that the staff team have a clear understanding of what is expected of them when a new resident is admitted to the home. There was no respite placement’s at the time of the visit. Standard 6 does not apply to Beaumont House, as they do not provide an Intermediate Care Service. Beaumont House DS0000008399.V334116.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. Care plans and comprehensive risk assessments still need to be improved to ensure the safety and protection of residents as well as providing staff with clear information about the level of support to be provided. EVIDENCE: The care records of two residents were examined. The first record was for the resident who had the highest level of need at the home, who was being nursed in bed due to poor health. Information included, personal details, an assessment profile, which was done on admission, a life history, which was incomplete although family regularly visit the home, care plan, risk assessments, covering pressure care, nutrition and moving and handling, weight records, professional visits from GP, district nurse, chiropodist etc, additional information including hospital discharge papers, pressure relieving equipment info, dietician assessment and a resident contract Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 12 The resident had had a previous admission to hospital, placed on a pathway plan and returned to the home. District nurse visits had increased due to deteriorating health and increase in pressure care management. Care plan and assessments were looked at. The care plan and risk assessments stated, in bed as poorly, no mobility, district nurse visiting three times a week, appetite poor although will have fluids, monitor fluid intake and weight stable. The pressure care assessment also stated district nurse was visiting three times a week however, from the district nurse visit information, visits were increased in May and then again in June and for the previous three weeks they have been visiting on a daily basis. Pressure care mattress and cushions were in place. The moving and handling assessment states that the resident is to be turned two hourly due to being cared for in bed. No records have been made to evidence this. The nutritional assessment also states that staff are to monitor intake and check changes in weekly weight records, however from the weight record checks, had only been made once in January, February, March and June. The registered manager stated that the gap in April and May was due to the resident going into hospital and being unwell. There is no information evidencing why they had not been able to weigh the resident or why this had not been done weekly as stipulated on the assessment. Also noted was that fluid intake charts had not been completed as previously instructed by the dietician in September 2006, to monitor for one week and review. Charts were seen for a consecutive nine-day period but there was no further information recorded. A separate sheet is completed stating that the plan and assessments have been reviewed, however no changes are identified. Assessments are still old documents, with outcomes based on low, medium or high risk with no information to demonstrate how the outcome decision was made or measured. Also one resident has an ‘arm’ (not full rail) fitted to the bed and it is not clear why, as according to documentation the resident has no mobility, does not move and is fully supported by staff. No information is recorded on the care plan or assessment in relation to why this is needed. The care plans and risk assessments for the new resident, as identified in standard 3 was also looked at. Records also included, a social profile, next of kin, GP etc. and the resident’s weight. There was a care plan, which was hand written as resident had just moved into the home and was still in the process of being developed. It contained and basic information about the level of support required, risk assessments for nutrition, moving and handling and pressure care and record sheets for any professional visits. The moving and handling assessment was incomplete even though the resident walks with two sticks but is unsteady and needs support from one staff member. Nutritional assessment and pressure care assessment stated outcome low but it was unclear how this decision was reached. None of the assessments had been signed and dated by the person completing the assessment. This is a reoccurring issue that the head of operations is aware of. The head of operations believes that following a thorough induction to ensure competence that the new spandex system of recording will address all the above issues. Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 13 Staff spoken with had read the home’s medication policy and it was available for reference at all times. The ‘home remedies’ policy was not in use so nonprescribed medicines, like paracetamol, that can be bought in a chemist shop, were not kept in case a resident should need them. Advice would need to be sought from the community pharmacist and GP’s before this policy was used. Several residents were supported to manage their own medicines. Risk assessments had been completed but staff felt that one resident now needed more help to manage her medicines safely. A new risk assessment had not been completed and there was nothing about this in her care plan. Risk assessments need to be reviewed to make sure residents always receive the right support when their needs change. The medication administration records were generally up-to-date and the monitored dosage system, that many medicines were supplied in, was used correctly. But, it was of concern that medicines were not always administered as prescribed. One person had not been given a recently increased dose of painkillers because staff wrongly thought there were none in stock. One member of staff said that the resident really needed them because she was in a lot of pain. Another person had ‘run out’ of one of her capsules for 8 days. Records wrongly showed one persons eye drops had been given when they were still sealed and could not have been used. Records of the receipt of medication into the home and of unwanted medication sent for disposal were maintained. Controlled Drugs handling was recording in a CD register but one tablet was unaccounted for. The manager needs to find out where this mistake happened to show that this type of medicine is safely handled. Trained care staff administered most medicines and there were regular checks audits of medication handling. But, these had not picked up the type of mistakes in the record keeping and administration of medication seen at the inspection. An effective audit is needed to help the manager see where improvements could be made to the handling of medication. Medicines were normally securely stored within the medicines rooms but at teatime, the room and medicine trolley was left open while the carer was away administering medicines. This practice was observed for a second time later in the day. For residents safety medicines need to be kept locked away. Residents spoken with said of the staff team that, “they are lovely”, and that “the quality of care is smashing.” A relative said her mother had passed away a couple of months ago. She stated that the staff had been “wonderful and very caring”, they had sat with her mother so she was not alone, which was very “reassuring and kind”. She also expressed that “she couldn’t praise them enough”, and “staff were very caring and supportive.” Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Records to show that residents have had the opportunity to be involved in stimulating activities need to be kept. Health and safety practices in the kitchen need to be checked out to ensure that good practice is in place in respect of security and control of infection to protect the health and safety of residents. EVIDENCE: There is a games room on the first floor, which is a room set out with table and chairs and games etc which are available. However, it appeared unused and is also used for storing other items. It was not clear if residents are aware that they can use this space. No other activity other than the nail care downstairs in the morning was seen to take place. Several residents spend time in their own rooms watching TV or reading. One resident spoken with said that he preferred this and that staff had arranged for him to receive his daily paper. At the last inspection the registered manager also stated that one of the carers has taken on responsibility for developing the activities within the home. More Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 15 evidence of what activities are available and undertaken by residents needs to be recorded. Feedback received from residents and relatives was positive with comments like, “the food always seems nice”, and “generally there seems to be enough staff on duty”. Others said that there was “good food”, “I have no complaints”, “able to do what I want when I want”, “I’m quite happy and settled”, “the food is so so,” and “I like the staff”. An inspector, spent time observing a group of four residents who were unable to give their view and opinion on the service and was carried out in the large downstairs lounge and dining room. At the start of the observation a member of staff was caring for the nails of several of the residents, then finished to prepare for lunch. General observations were very positive over the lunchtime period, residents were encouraged to eat their meals independently and were allowed plenty of time to eat at a relaxed pace. Dining rooms are provided on both floors. Tables are nicely set with napkins and cruets. Menus have been reviewed and detail vegetarian options, diabetic option and additional fibre. 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. Inspectors spent time looking at the kitchen and spoke briefly to one of the two cooks and the kitchen assistant. When asked to see the Safer Food Better Business documentation the cook was not aware of the existence of the documentation even when shown a blank copy that was held in the office. Discussion with the registered manager later confirmed that the second cook, who worked fewer hours, took responsibility for this documentation. In line with a recent environmental health officer visit both cooks need to be completing the document. The cook confirmed that she had undertaken basic food hygiene training but could not remember the date or whether a refresher was due. The cook had been asked by the registered manager to bring in her certificate so that this could be checked and a copy could be taken and kept at the home. Neither the cook nor the kitchen staff member had been on any mandatory training courses since they started work at the home over six months ago and had not attended a control of infection course. Inspectors asked the registered manager to check out the cleaning products provided in the kitchen as they were marked as office cleaning products in some cases and may not be suitable for commercial kitchen cleaning. It was not clear from discussion with the registered manager what arrangements were in place for wearing protective aprons e.g. when a carer changes tasks and serves food. Three residents were seen wandering in and out of the serving area and the kitchen after the evening meal had finished and when staffing was reduced, which is a potential health and safety hazard e.g. access to cleaning products. Beaumont House DS0000008399.V334116.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. Training is still required to ensure that all members of the staff team know what action to take to protect residents from abuse. Policies and procedures for complaints and the protection of vulnerable adults are under review. EVIDENCE: Information provided within the pre-inspection questionnaire identified that no complaints have been received by the home since the last inspection. The head of operations for the organisation is currently reviewing and revising the complaints policy and procedure to ensure that it complies with legislation. The registered manager has downloaded a copy of the local authority protection of vulnerable adults procedure. The head of operations is currently reviewing and revising the current vulnerable adults policy and procedure to ensure that it complies with legislation and makes links to the local authority procedure. No further action has been taken to ensure that training in this area has been completed by all the staff working within the home, as identified at the last inspection. Beaumont House DS0000008399.V334116.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 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 bedrooms en-suite. Control of infection arrangements and checking hot water temperatures was found to be poor, which puts the health and safety of residents at risk. EVIDENCE: Beaumont House is a large detached property offering pleasant accommodation for the residents. The lounge and dining areas were clean, homely and comfortably furnished to a good standard. Residents make use of all areas. The home also provides an enclosed, well-maintained and private back garden with seating for residents. Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 18 The home provides all single private bedrooms each having an en-suite toilet and wash hand-basin. Locks are fitted to the bedroom doors and a lockable space is also provided for the residents’ personal use. Rooms had been nicely personalised with belongings and furniture brought from home by those residents who wished to. All bedrooms have recently been re-painted. The home has a maintenance and refurbishment plan. The kitchen, hall, stairs and serving areas are all to be repainted in the near future. This should also include the small first floor lounge, which has some damp and damage to the ceiling and the wallpaper is peeling back. Plans to carry out necessary work have been hampered because of a lack of maintenance staff. A door alarm has now been fitted to the side door near the kitchen to improve security. There are a number of toilets and two bathrooms on each floor. The two smaller bathrooms are unused due to them having little space to support residents safely in and out of the bath. The manager said that quotes have been sought to change the ground floor room into a shower room. Bathrooms were generally found to be very basic. There were no hand-washing facilities for staff, including paper towels and liquid soap. The downstairs bathroom does not have a sink. Some pipe work was unguarded. The water temperature to the baths was checked. There was no water thermometer available, as it had gone missing. A temperature probe was used instead. Both the upstairs bath and the sink were found to be running at 50 degrees centigrade, which is 9 degrees higher than required. This situation was conveyed to the registered manager and the head of operations for their urgent attention. Thermostatic mixer valves need to be checked to ensure that they have not failed. An inspector looked at health and safety practices in the laundry. All appliances were working. The laundry assistant confirmed that as part of her induction training she had been shown how to operate the washing machines and dryers. On closer inspection of the washing machines instructions were in place to use two washing cycles. These did not include the sluice cycles and it was confirmed that they were not used when washing soiled items such as bedding. The laundry assistant explained the process for the handling of soiled items from bedrooms/bathrooms to the washing machine. The registered manager was asked to look at the possibility of using the red bag system to reduce the possibility of the transfer of infection when moving soiled laundry around the home. Marigold type gloves but not disposable gloves or aprons were available to the laundry assistant. The laundry assistant had not received control of infection training. Beaumont House DS0000008399.V334116.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 poor. This judgement has been made using available evidence including a visit to this service. Sufficient staffing levels are provided. Some improvements are needed to staff recruitment files and a training skills audit needs to be undertaken to ensure that all the staff team have undertaken the mandatory training that they need, to ensure the safety and protection of the residents. EVIDENCE: The rota for the week was examined and showed that 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. Rota’s are a document that should be retained for three years. It is advised that surnames are included on the rota to ensure a clear audit trail and that the names of agency workers are added, where appropriate. The registered manager advised us that there had only been one new member of staff since the last entry on the CRB list of staff. From discussion with other staff it was noted that there were several other staff members working at the home that were not recorded on the CRB list. A list of current staff working at Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 20 the home was requested from the registered manager. Information requested should stipulate every member of staff, volunteer etc, their role, start date, date of POVA check, if applicable, and date CRB sent and received and the reference number. This had not been received two weeks from the date of the site visit. The recruitment records for a recently employed carer were examined. A photograph was needed, as well as a full employment history and there was no documentary evidence of the qualifications held by the person. As stated recording around criminal record checks for the home is poor. It is unclear who has had a check and who has not and the original documentation is not available. The registered manager and the head of operations were advised that original documents must be held until the inspectors have seen them, in future. The head of operations is currently asking staff members to bring in their copy of their CRB to be checked against the information already held. Some discussion also took place about who was the most appropriate person within the organisation to hold the countersignature role. Of the 25 care staff employed at the home inspectors 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. However, it is clear that some areas of training are not being adopted as good day-to-day occupational practice. In terms of staff training there were a number of lever arch files full of training certificates for staff. But there was no clear method in place that showed which staff had undertaken what training. Given some of the findings at this inspection, inspectors are unable to satisfy themselves that are trained and competent to do their jobs. A training skills audit needs to be undertaken and information put into a spreadsheet to ensure that there are no shortfalls in mandatory training within the staff team. Any identified shortfalls in mandatory training must be addressed as soon as possible. The skills audit should also include induction training, NVQ training and other areas of specific training e.g. diabetes, death and dying, etc, that can be evidenced by a certificate. The organisation is a member of the local training partnership, which provides this type of training through Skills for Care but has yet to utilise this facility. Beaumont House DS0000008399.V334116.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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered providers have become more involved in the operation of the home to ensure that it is being run in the best interests of the residents. Policies and procedures must be individually reviewed by the organisation to ensure that they give the staff team clear guidance. EVIDENCE: The registered manager of the home has many years of experience of working with older people. She has recently completed the Registered Manager’s Award NVQ Level 4. At the last inspection concerns were raised about the management of the home. Weekly meetings were being held with the then Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 22 group matron and action plans developed offering the registered manager more direction and support in carrying out her duties. Since that time there has been changes to the middle management of the organisation, which now include a head of operations, general manager and business administrator, who are there to support and advise the registered manager. Although vital to the operation of the running of the home they need to be clear about their roles, responsibilities and accountability to ensure that they do not unwittingly compromise the registered providers, registered managers’ and their legal responsibilities in respect of their registration. The head of operations has been very clear about the fact that she is there to support and advise, the registered manager but not to manage the home. Clarity is also needed in this case about the roles and responsibilities of the registered manager and the deputy manager. Where responsibilities have been delegated to the deputy manager then the registered manager must be able to evidence that she is monitoring that task. The registered manager has met with the head of operations on a number of times. She was positive about the new care plan system and that the registered providers had kept everyone at the home informed of the changes within the organisation. The registered manager has recently attended employment law, MUST and medication training. We spent time talking to the registered manager and the head of operations about the process for Inspecting for Better Lives, including KLORA, quality ratings, annual reviews and AQAA. The home has a good computer and information was downloaded and saved on the homes system. All areas were printed off for future discussion at the monthly management meetings. The registered providers are now undertaking the monthly Regulation 26 monitoring visits and a copy of the report completed is being sent to CSCI. A quality review of the service provided by the home now needs to be undertaken. It was noted that the home had recently achieved an Investors In People award. Concerns about the organisations pre-printed pack of policies and procedures have been discussed previously with the head of operations. The head of operations agrees with the concerns and has started the process of reviewing and revising key policies and procedures. It was advised also that care needs to be taken by staff when completing Regulation 37 notification as one had been received stating that a resident had died, but this was not the case. Certificates and records were seen in relation to the health and safety of the environment and equipment. Several areas need to be addressed to ensure that the environment and equipment are safe to use. This includes servicing of the 3 bath hoists and a hoist and the weighing chair. The NICEIC check was overdue as of 19.03.07. The registered manager said that the necessary work had been done and the home was awaiting the certificate. The gas safety check was just overdue. Confirmation is also needed, that the wrong size chimney pot that is evidence on a gas warning notice served on 24.07.06, has been replaced. Beaumont House DS0000008399.V334116.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 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 1 X X 3 X 1 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Beaumont House DS0000008399.V334116.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 OP3 Regulation 14 Requirement Timescale for action 31/08/07 2. OP7 15 3. OP7 15 4. OP8 13 A comprehensive assessment must be completed for new residents coming into the home that gives clear details to the staff team as to what care and support is required to ensure that the residents needs are fully and safely met. Care plans must accurately 31/08/07 reflect the support needs of residents and how these are to be met by staff, ensuring the health and wellbeing of residents. (Requirement of 31.07.05, 31.01.06, 31.08.06 and 30.04.07 not met.) Residents or their 31/08/07 representatives must be involved in drawing up care plans. (Requirement of 31.1.06, 31.8.06 and 30.04.07 not met.) Risk assessments must 31/08/07 developed for areas such as nutrition, bed rails and pressure care and reviewed and updated on a monthly basis ensuring residents are supported safely. (Requirement of 31.07.05, DS0000008399.V334116.R01.S.doc Version 5.2 Beaumont House Page 25 5. OP8 12 6. OP8 13 7. OP9 13(2) 8. OP9 13(2) 9. OP15 13 10. OP16 22 11. OP18 18 12. OP21 13 31.01.06, 31.08.06 and 30.04.07 not met.) The nutritional needs of service users must be fully assessed and monitored. (Requirement of 31.07.05, 31.1.06, 31.8.06 and 30.04.07not met.) All staff completing risk assessments must be adequately trained and assessed as being competent to do so. (Requirement of 30.09.06 and 30.04.07 not met.) Medication must be administered as prescribed and accurate records maintained to make sure residents’ medicines are handled safely and given correctly. Medication Risk assessments must be reviewed and kept upto-date to make sure residents’ always receives the support they need to manage their medicines safely. Arrangements for security, control of infection and cleaning regimes in the kitchen must be checked out to ensure the health and safety of residents. Mandatory training to all staff that work in the kitchen, where appropriate must be provided. The complaints procedure must be reviewed and revised to ensure that people are clear about how to complain about the service provided. Training in adult protection must be provided to all members of the staff team. The internal policy and procedure for the home needs to be reviewed and revised and ensure that it makes clear links to the local authority procedure. Water temperatures and thermostatic mixer valves must DS0000008399.V334116.R01.S.doc 31/08/07 31/08/07 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 25/06/07 Page 26 Beaumont House Version 5.2 13. OP21 13 14. OP26 13 15. OP29 19 16. OP29 19 17. OP30 18 be checked regularly, in particularly the bathrooms, to reduce the risk of residents being scalded by hot water. Adequate provisions must be available to reduce the risk of cross infection. Staff hand washing facilities must be provided in the residents’ bathrooms. Adequate provisions must be available to reduce the risk of cross infection for staff handling soiled items. Soiled items must be washed at the required temperatures and protective disposable gloves and aprons provided. All those people handling soiled items and those working in the laundry must undertake training in control of infection. A full staffing list stipulating every member of staff, volunteer etc, their role, start date, date of POVA check (if applicable) and date CRB received and reference number must be sent to CSCI to evidence that all staff hold a satisfactory CRB. Requirement of 31.8.06 & 30.04.07 not met in part. The registered person must ensure that staff files include all relevant information in line with the Regulation, including a photograph, a detailed employment history documentary evidence of any qualifications. Requirement of 31.8.06 & 30.04.07 not met. The registered person must ensure that a training skills audit is undertaken to ensure that all the staff team have received the necessary training relevant to their roles and responsibilities DS0000008399.V334116.R01.S.doc 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 Beaumont House Version 5.2 Page 27 18. OP31 12 19. OP33 24 20. OP33 13 21. OP38 13 including staff induction. A copy must be sent to CSCI. Requirement of 30.12.06 & 30.04.07 not met. To ensure that the home is run smoothly and in the best interest of residents, the registered providers must ensure that there are clear lines of accountability within the home and with any external management. To ensure that the home is run in the best interest of residents, the registered providers must undertake a quality review of the service. The pack of policies and procedures must be reviewed in accordance with legislation and good practice to ensure the health, safety and protection of residents. To ensure the health and safety of residents’ the gas supply needs to be checked and hoisting equipment must be tested. 31/07/07 30/09/07 30/09/07 31/07/07 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. 2. 3. Refer to Standard OP9 OP9 OP12 Good Practice Recommendations The medication audit should be reviewed to make sure it provides information that will help to improve the handling of medication. With pharmacist and GP advise consideration should be given to implementing the home remedy policy. More evidence is need in relation to what activities are made available to residents and how often they take part. Beaumont House DS0000008399.V334116.R01.S.doc Version 5.2 Page 28 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.V334116.R01.S.doc Version 5.2 Page 29 - 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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