Inspection on 29/09/09 for Beaumont House

This inspection was carried out on 29th September 2009.

CQC 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 16/03/09

Beaumont House 29/09/08

Beaumont House 22/04/08

Beaumont House 05/12/07

Beaumont House 25/06/07

Beaumont House 04/07/06

Beaumont House 12/12/05

Beaumont House 03/05/05

Beaumont House 08/12/04

Beaumont House 04/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Beaumont House 26 Church Lane Whitefield Manchester M45 7NF Lead Inspector Julie Bodell Key Unannounced Inspection 29th September 2009 07:00 DS0000008399.V377751.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Beaumont House DS0000008399.V377751.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beaumont House Address 26 Church Lane Whitefield Manchester M45 7NF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 796 9666 0161 796 7722 glenysgardner@bankfield.org Bankfield Premier Care Ltd Manager post vacant Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Beaumont House DS0000008399.V377751.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. 16th March 2009 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.V377751.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 stars. This means the people who use this service experience poor quality outcomes. An inspector and a pharmacist inspector carried out this key inspection visit, which took place over ten hours. The home did not know that we (the commission) were going to visit. During the visit time was spent, talking to the new acting manager, a night senior and a cook. We also talked to people living at the home, looked at paperwork, checked parts of the building and watched the care and support people were receiving. At our last key inspection visit we had concerns about how well the home was managed and how people were being cared for. We asked the owner of the home to make improvements to the service and an improvement plan was sent to us telling us what action was to be taken. Medication practices were again a particular cause for concern. For a second time we issued legal notices in relation to medication practices. A random unannounced pharmacist visit took place on 3rd June 2009 to check that compliance had been made and sustained. The pharmacist found that no improvements had been made. Following a management review meeting on 9th June 2009 it was decided to formally interview the owners of the company who are responsible for the home under PACE. The owners were represented by the then acting manager who agreed with our findings. The owners accepted a simple caution relating to the offences. At this key inspection visit the pharmacist again found shortfalls in medication practices. The home had a new acting manager who was present during the inspection. It was only the second day that the new acting manager had been in post. It was noted that the new acting manager had already identified weaknesses for example lack of direction, leadership and routine as well as levels of cleanliness and limited activities. The new acting manager had already held meetings with various groups of staff within the team and outlined what improvements she wanted to see. Plans were in place to hold further meetings. This was encouraging and information about what action had been undertaken is included in this report. However, our assessment of the home’s performance is based on the information we had in relation to the previous six months and our findings during this visit. We continue to be concerned that despite enforcement action no improvements had been made or sustained in safe medication practices and our observation showed once again that people do not always receive the support they need when they need it. It continues to be our view that until the new acting manager, deputy and senior care staff work together as a Beaumont House DS0000008399.V377751.R01.S.doc Version 5.2 Page 6 competent team there was no guarantee that the service was being run in the best interests of people that use it, at all times. Therefore the overall quality rating for the service remains poor. We will be holding a meeting to consider our next course of legal action in relation to the owners of the home. What the service does well: Beaumont House provides a comfortable and homely environment for people to live in. The home also provides an enclosed, well-maintained and private back garden with seating for people to use. The home provides all single private bedrooms, each having an en-suite toilet and wash hand-basin. People are able to bring their own items of furniture and other belongings, which have in some cases been used to good effect to create a home from home atmosphere. What has improved since the last inspection? What they could do better: Communication and teamwork continue to need to improve to ensure that people get the healthcare and personal support they need when they need it. For example ensuring that staff members are deployed around the home so that people who need support to receive their meals get it and they are not left waiting for a long time to have their support needs met like waiting to have a shower. Although the recording format used by the home is good, records again were not kept up to date and did not always reflect peoples changing needs. Risk assessments were not fully completed. All areas of medication handling must be improved to ensure that residents health and well being is not placed at risk from harm The activities organiser had left the home and opportunities for people to become involved in activities to encourage stimulation and interaction with other people have reduced. This situation needs to be reviewed. The staff team need to receive all the training they need to ensure that they are competent and are able to meet peoples needs in a safe and effective way. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.2 Page 7 The owners of the home must ensure that the home is effectively managed at all times by senior staff members who are competent to carry out their roles. We must be kept informed about any incidents that happen at the home, for example, if a person is admitted to hospital or they pass away. Staff must ensure they follow health and safety guidelines for example not leave containers of chemical cleaners out unattended that might harm people and keep doors to the laundry room, linen cupboards and store rooms locked to reduce the risk of fire. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 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.V377751.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admissions process does not always ensure that peoples’ care needs are properly assessed and people cannot be sure they will receive the care they need. EVIDENCE: At our last key inspection visit no new people had come to live at the home. This was because the local authority had been made aware of the home’s poor quality rating and also because the owners had made the decision not to accept new people who were self funding until the service had improved. At this key inspection we found that three new people had been admitted to the home. The local authority was aware of two of these admissions. The Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 10 owners had not informed us that they had changed their decision to stop admissions to the home until improvements had been made. We looked at the assessments of the three people most recently admitted to the home. Two people had local authority assessments on their files. Both people had significant health needs. The home had undertaken their own assessment of people’s needs but these were found to contain limited information about the person and one assessment was not dated. It is important that a thorough assessment is undertaken before a person moves in to ensure that their needs can be met. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 and 9 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were at risk as their personal support needs were not always met and they did not receive their medication as and when needed. EVIDENCE: We started our inspection visit at 7.00am. We spoke to a senior night carer on our arrival who updated us as to who was living at the home. People were getting up at a relaxed pace. We were informed that the upstairs lounge and dining room area were no longer being used and people were now using the downstairs dining room and lounge areas only. The new acting manager arrived and a handover was held with the senior night carer with a day senior carer and a carer present. A second senior carer arrived later and the team was joined by the deputy manager and a third senior carer at around 9.00am. In total on the morning shift there was an acting manager, a deputy manager, three senior care staff and a carer. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 12 At 8.45am the inspector sat in the downstairs lounge dining room and watched what went on and how people were being supported. Most people were having their breakfast at the dining tables receiving occasional assistance from the cook on duty in between preparing the meal. One person was sat close to the inspector in the lounge area. They were in their night clothes and were having their breakfast from a small table in front of them. The person had dementia. They were given the first course of their breakfast, which was a bowl full grapefruit segments’. They were gently encouraged to use a spoon but the staff member then left the person. Because the person had dementia they then forgot to use the spoon and proceeded to use their hands to eat the grapefruit segments and could easily have choked. There were no care staff in the lounge/dining area. The person was then given cereal and milk and the same thing occurred. After having tea and toast the person finished their breakfast at 9.15am. This person then sat patiently waiting. Although they had limited verbal communication the person regularly asked passing staff what was going to happen next. The person was repeatedly told by staff that she would be going for a shower “in a minute.” Despite the fact that we were still observing what was happening, the lady was still sat in the same place and still asking the same type of questions until 10.35am. The person started to become agitated and so we alerted the deputy manager. The person was then moved to the reception area where they sat for another 20 minutes before finally being taken for a shower at 10.55am. Throughout this period of observation the time spent by staff in the room was limited. No-one appeared to be deployed in this area to ensure that people were appropriately supervised and supported to eat their meals. At the last three inspections we have raised concerns about the lack of supervision, interaction and deployment of staff, particularly in the downstairs area of the home. At times it was difficult to locate staff. It was also noted that the table used at the end of the garden area by staff taking their breaks had now been moved around a corner of the building so that it was difficult to see which staff were sat there. The new acting manager said that she had already spoken to staff about taking their breaks together and that this would be monitored and the table removed. We looked at the care plans and risk assessments of the three people who had recently moved into the home. Care plans were generally well written but they did not always reflect the people’s changing needs e.g. one person’s health had deteriorated markedly in the two days prior to the inspection. The care plan had not been updated to reflect this. Again not all the risk assessments had been completed for people. None of the MUST assessments had been properly completed because the person’s height had not been taken and nor had their arm measurement as an alternative. This was particularly important as one person had a very low weight. Another person who was unable to walk and Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 13 used a wheelchair had not had a moving and handling risk assessment completed, they had not been weighed and the pressure area assessment had not been scored. Wheelchair footplates were seen to be being used throughout the course of the day. During the inspection the specialist pharmacist inspector looked at how well medicines were handled to make sure that people were being given their medicines properly and their health was not at risk. This was because at the previous inspection we found that people were not safe because requirements made in the Statutory Requirement Notice, regarding medication, had not been met. During our visit we looked a sample of records about medication together with the medicines currently available for those people. During our inspection we found further breaches of the regulations regarding medication. At the end of our inspection we asked the manager if she could explain the breaches we had found and mostly she could offer no suitable explanation for any of our findings. We looked carefully to see if the requirements we made in the Statutory Notice had been met. We made these requirements to help prevent people being at risk from harm from poor medication practices. The first requirement was to ensure that supplies of medicines are obtained in a timely fashion to make sure that people do not go without their prescribed medication. We found that this requirement was not met. We looked at the medication records and carers notes for a new person and found on the carer’s notes recorded on 14/9/09, that they had been unable to apply a cream because there was none in stock and they needed to order a prescription. There were more records made on the 16th, 17th and 20th September 2009 that the staff were unable to apply the cream because they were awaiting stock. We looked at the Medication Administration Record Sheets (MARS) and found no record of this cream being applied, or being available to apply, for a period of some 20 days. Two people were unable to have their prescribed dose of Senna tablets on the night before our inspection because there were none available in the home for them. The second requirement was to ensure that effective systems were in place for the recording, handling, safekeeping, safe-administration and disposal of medication received into the home. We found that this requirement was not met. We found that one person had been away from the home at a time that she needed to take some important medication. The MARS chart used the symbol Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 14 L, leave, indicating that she was away from the home. There was no information recorded to show if this medication had been taken or not. There was no information available to help staff administer medication, including creams, which had been prescribed when required or as directed. We found one tablet for a newly admitted person had been prescribed to be taken as directed. When we asked staff what the medication was prescribed for they could not tell us neither could they tell us in what circumstances they would need to give this medication. We found that creams were stored in people’s rooms and no checks had been made to show it was safe to do so. Some information about people looking after some of their own medicines was out of date and was no longer appropriate. The third requirement was to put in place effective arrangements at the home to ensure that all medication is administered to service users in exact accordance with the prescribers directions. We found that this requirement was not met. One person was prescribed a food supplement by their GP. The GP had written clear instructions on the MARS, on 15th September 2009, that at least one Fresubin should be given daily. There were no records available to show that this direction had been followed until almost 2 weeks later when on 28th September 2009 the MARS show that this supplement was given. Another person was prescribed Ranitidine 150mg tablets twice daily. Records for the 27th and 28th September showed that this medication had only been administered once in the mornings. Another person was not given her eye drops on the night before our inspection. The MARS had not been signed to show that the drops had been instilled and when checking the bottle the seal was still intact and had not been broken. The fourth requirement was to put in place effective arrangements at the home to ensure that all medication administration records are completed to accurately record medication administered to service users. We found that this requirement was not met. The standard of record keeping was poor and we found numerous examples where the records could not show that people had been given their medication properly. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 15 At the start of our inspection a care worker told us she had just applied some prescribed shampoo to a person, however the records were not signed to show that she had done so. Another person was prescribed one capsule to be inhaled each day. During the inspection a carer came into the medication room, placed a capsule into the inhaler and left the room. She did not sign the records at this time, when she had left the room the MARS were looked at and we saw that the capsule had already been signed as administered. It is not clear if the capsule had already been given to the person and a second capsule was administered or if the records had been signed in advance of the medication being administered. The manager found that there were a number of gaps on the MARS chart from the previous night. Gaps are when staff fail to sign whether medication has been administered or not. It was not possible to tell from the records if some medication had been administered that night. We observed a carer enter the medication room take one tablet for a person and sign the MARS that the tablet had been administered before she had offered or given it to the person. We found that there were a number of people who had prescribed creams applied to them about which there was no record either in their personal daily notes or in their medication administration records. We found that staff altered records regarding medication administration. During the early part of our inspection we found that one person’s MARS had not been signed to show whether or not eye drops had been instilled, a gap had been left. At six pm when we looked at these same records we found that they had been signed as if the drops had been administered, however earlier the manager had concluded that these drops had not been given because the seal on the bottle had not been broken. The fifth requirement was to put in place effective arrangements at the home to ensure that any omissions or variations in the administration of prescribed medication and the reasons for these are clearly, legibly and promptly recorded. We found that this requirement was not met. One person was prescribed eye drops to be used twice daily, records showed that on the 28th and 29th September 2009 there was no indication that the drops had been used more than once a day and there was no records as to why the drops had not been administered on those two mornings. A person was prescribed a cream to be applied two or three times each day. There was no information recorded as to why this cream had only been applied at night. He was prescribed another cream to be applied three times daily; Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 16 there was no record that any cream was applied on the day prior to our inspection or why it had not been used. Another person was prescribed drops to be used every two hours; however the MARS show that the drops were only administered four times daily. There was no record available to show why the frequency of administration had been altered. The sixth requirement was to put in effective arrangements to ensure that records of medicines received into the home are completed accurately. We found that this requirement was not met. We found there was no record of some medication brought into the home when one person moved in. There was also no record of some medication which arrived from the pharmacy for this person after they had moved into the home. Overall we found that little significant progress had been made to ensure that medicines were handled safely and peoples health was still potentially placed at risk from harm. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of provision of social activities that means people do not have opportunities to participate in stimulating and meaningful activities of their choice. EVIDENCE: The activities organiser from within the organisation no longer visits the home. Records of activities in people’s care files show little evidence of activities. The acting manager had already identified this as an area that needed to be improved. Some people living at the home had their own hobbies and interests and highly personalised rooms that they enjoy spending time in mainly reading, listening to music or watching television. The hairdresser was at the home on the day of our visit and many people had there hair cut throughout the morning. The new acting manager had planned a resident’s meeting to be held in mid October 2009. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 18 At previous visits we had been concerned about the lack of interaction between people living at the home and care staff. At this visit the new acting manager had asked staff to spend time in the lounge talking to people. We did not speak with visitors during this visit. Only the downstairs dining room is now in use. People were served a substantial breakfast including grapefruit, cereal and toast. Some people had their breakfast in their rooms on trays. Hot and cold drinks were served with meals and throughout the day. Each of the floors had a small kitchen where drinks and snacks can be prepared, particularly around suppertime. At dinnertime people had a choice of main meal either liver and bacon or fish followed by fruit and ice cream. At teatime there was a choice between sausage and chips or jacket potato and cheese. We sat with people at lunchtime and no complaints were made about the meal. One person we spoke with said that sometimes there was a lot of convenience type meals rather than home cooked food, but this depended on who was cooking. Discussion with some people at previous visits said that the main meals i.e. breakfast and dinner were served close together and then it was a small meal or snack supper over a sixteen-hour period. It was suggested that it might be better to serve the main meal at teatime. This would balance the intake of meals out over the day and might help some people sleep better. As detailed earlier we had some concerns about the level of support some people received to help them eat their meals and this must be reviewed. The staff did not appear to change their white plastic aprons for caring duties to blue when involved in serving food and supporting people to eat. We were told that this was because no blue aprons were in stock. We talked to the cook who said she was enjoying her job and the training she had attended. A copy of the four week rotating menu was seen. The cook said that the new acting manager held a meeting with the kitchen staff on 25th September 2009. Minutes of the meeting show that the manager had instructed the cooks to compile a new four week menu that both they and people living at the home were happy with. The cook said that she had recently introduced homemade soups and that people had really enjoyed them. We talked about people who were on soft diets. It was clear that in one case the cook had started to mash one person’s meals without checking with the care staff first. This was because the cook had seen that meals were being returned to the kitchen uneaten. This person had not had a speech and language assessment to confirm that they no longer had the capacity to chew or swallow and it was not clear what support they needed to eat their meal. This needs to be assessed by the new acting manager. To improve the appearance of soft diet food the manager said she was going to bring food moulds in for the cooks to use. The manager had shown kitchen staff how she wanted the tables to be set to ensure a good first impression and new table Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 19 clothes, mats and crockery had been ordered. The manager had also introduced new cleaning schedules in the kitchen. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were in place to help ensure that people were protected from abuse but some members of the staff team still need safeguarding awareness training. EVIDENCE: There had been no formal complaints made to us since our last key inspection visit though a number of concerns had been raised. There has been one serious complaint internally which was upheld by the former head of care that included concerns about levels of cleanliness, the person being inappropriately dressed, missing clothes etc. One person we spoke to confirmed that the new acting manager had come to see them and asked them if they had any concerns. There had been no allegations of abuse at the home since the last key inspection. The home had a copy of the new local safeguarding procedures. The new acting manager and deputy manager had attended training in safeguarding procedures at an investigation level. A staff training matrix was made available to us, which showed that some members of the staff team had recently received safeguarding awareness training with others waiting to Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 21 attend. None of the staff team had undertaken Mental Capacity Act or Deprivation of Liberty safeguarding training. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Beaumont House generally provides a clean and comfortable home that is decorated and furnished to a good standard. EVIDENCE: Beaumont House is a large detached property offering 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 good standard. People can make use of all communal areas on the ground floor. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 23 The lounge areas were seen to be comfortable and the living flame fires made them feel homely. We have previously had concerns about levels of cleanliness in the serving areas. Improvements were seen at this inspection visit but the planned refurbishment of this area still needs to be carried out. The home provides all single private bedrooms each having an en-suite toilet and wash hand-basin. A lockable space is provided for peoples personal use. Bedrooms had been highly personalised in some cases, with belongings and furniture brought from home by those people who wished to. All fire doors that we checked at this visit closed to the rebate to help ensure that people were protected should there be a fire at the home. There were a number of toilets and two bathrooms on each floor. One smaller bathroom had recently been refurbished into an assisted shower room. Malodours had been reduced in toilet areas because airtight clinical waste bins were now being used. The new acting manager said she wanted to see improvements in the levels of cleanliness throughout the home and had introduced a cleaning schedule and was to employ more staff. She had made arrangements for two extra domestics to come in to clean carpets, paintwork and furnishings to get them up to an acceptable standard. On the day of our visit there was only one cleaner on duty who was also covering the laundry and was very busy. We found a container of pink liquid carpet shampoo cleaner with the top off unattended to. We asked the cleaner to put the liquid away in a safe place but it was seen again later to be left unattended. Many of the linen store rooms which were marked “keep locked shut” as a fire warning were unlocked. The laundry was left open and unattended despite a notice on the door stating that it should be kept locked shut when unattended. The new acting manager had instructed the kitchen staff to ensure that the Safer Food Better Business documentation was completed. On checking this documentation no records had been kept for the previous three weeks about the cleaning of the kitchen. This was because they had run out of pre-printed sheets. These were said to have been re-ordered on 3rd September 2009. A blank copy was found and the cook agreed to photocopy it and continue to maintain the daily records. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team had been safely recruited but they had not received all the training they needed to ensure that people were safe from possible harm or poor practice. EVIDENCE: There were generally five care staff members on duty in the morning, five in the afternoon and four in the evening, including the acting manager and the deputy. There were only two carers on duty at night, which is a reduction since our last visit. The care staff team were supported by cooks, kitchen and laundry assistants, domestics and business administration. There has been some staff turnover at the home since our last visit, including the outgoing acting manager, a senior who was dismissed after they left their shift without permission as well as two people on long term sick. The new acting manager was in the process of appointing five new senior carers, three carers and a laundry assistant. We looked at the recruitment files for three staff members and found that they were generally in good order, with a Povafirst being undertaken prior to a Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 25 person being offered employment and a CRB (Criminal Records Bureau check), being undertaken. References had also been taken up. The organisation was a member of the local training partnership, which provides training through Skills for Care. We were sent a copy of the staff training records, which show that many members of the staff team had still not received all the mandatory health and safety training they needed to carry out their roles safely. Again we were not able to establish how many staff members held an NVQ (National Vocational Qualification) Level 2 or above, a recognised qualification for staff involved in the care profession. The new acting manager was asked to supply this information. The new acting manager had moved quickly to meet with all members of the staff team. She had already held a senior staff meeting and a kitchen and domestic staff meeting on 25th September 2009 and a night staff meeting was planned for 1st October 2009 and a care staff meeting on 15th October 2009. The acting manager had started to make clear her expectations around dress code, timekeeping and attitude. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 and 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The owners must ensure that the staff team is closely managed and supervised to ensure that heath and safety is promoted and that the service is run in the best interests of the people that use it at all times. EVIDENCE: The acting manager who was in place at our last key inspection was about to leave the home and a new acting manager from another home within the organisation had taken over day to day management of the home. This was only the second day that the new acting manager had been in post. There had been further changes to the group management team. The head of care for Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 27 the organisation had recently left and the general manager for the organisation was leaving in the coming week’s. We were told that it was unlikely that these posts would re-advertised and this would leave the manager of the home having a direct link with the owners. Arrangements had been put in place to meet with one of the owners on a monthly basis. At our last inspection visit we raised concerns about the number of hours the then acting manager was working in an attempt to maintain standards at the home. We made it clear to the new acting manager that there needed to be a competent team to run the home, which included both the deputy and seniors to ensure that the home was run in the best interests of the people using the service at all times. Without this there can be no guarantee of sustained improvements at the home. Evidence shows that some seniors did not demonstrate that they had the qualifications, skills or experience to undertake the role at the point of recruitment. The new acting manager must be able to evidence what action she has taken to ensure that all staff are competent to carry out their roles. There was evidence to show that the new acting manager had undertaken disciplinary action against some members of the staff team. One of the owners had carried out a Regulation 26 visit recently and we had received a copy of their report. This is a visit the owners must do to comply with the law. In future the owners must undertake a monthly visit and send us a copy of the report that shows their findings. We do not appear to have been notified about incidents that have happened in the home for example an admission to hospital and a number of deaths. As outlined in the summary of this report following continued poor practices in the administation of medication it was decided to formally interview the owners of the company who are responsible for the home. The owners were represented by the then acting manager who agreed with our findings. The owners accepted a simple caution relating to the offences. At this key inspection visit the pharmacist again found shortfalls in medication practices and we must now consider our next course of action on our enforcement pathway. The deputy manager was unable to locate the maintenance certificates on the day of our visit. However the acting manager sent the information out to us following the inspection and they appeared to be in order. We identified a number of health and safety concerns, apart from medication, at this visit. For example leaving cleaning materials unattended, leaving the laundry unattended with the door open, not changing white aprons from personal care to blue aprons when assisting people with meals etc. Information we were given about what training the staff team have undertaken was out of date and shows a shortfall in health and safety training, including the deputy manager and some senior staff. Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 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.V377751.R01.S.doc Version 5.3 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 Requirement All risk assessments for nutrition, moving and handling, falls and pressure care must be reviewed to ensure that they are accurately completed to ensure people are being supported safely. (Outstanding 05/12/08 03/02/09 and 01/06/09). The registered person must ensure that peoples personal support needs are met at all times. The registered person must put in place effective arrangements at the home to ensure that all medication is administered to service users in exact accordance with the prescribers directions. (Outstanding 29/09/08, 05/12/08, 13/12/08, 15/01/09 04/02/09 18/05/09 and 01/06/09). The registered person must put in place effective arrangements at the home to ensure that all medication administration records are completed to accurately record medication administered to service users. DS0000008399.V377751.R01.S.doc Timescale for action 30/10/09 2. OP8 12 30/10/09 3. OP9 13(2) 30/10/09 4. OP9 13(2) 30/10/09 Beaumont House Version 5.3 Page 30 5. OP9 12(1) 6. OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9. OP16 13 10. OP27 18 (Outstanding 18/05/09 and 01/06/09). The registered person must make effective arrangements to ensure that supplies of medicines are obtained in a timely fashion to make sure that service users do not go without their prescribed medication. (Outstanding 04/02/09 18/05/09 and 01/06/09). The registered person must make effective arrangements to ensure that effective systems are in place for the recording, handling, safekeeping, safeadministration and disposal of medication received into the home. (Outstanding 18/05/09 and 01/06/09). The registered person must put in place effective arrangements at the home to ensure that any omissions or variations in the administration of prescribed medication and the reasons for these are clearly, legibly and promptly recorded. (Outstanding 01/06/09) The registered person must put in effective arrangements to ensure that records of medicines received into the home are completed accurately. (Outstanding 01/06/09) The registered person must ensure that members of the staff team receive safeguarding training to ensure that they know what action to take in the event of an allegation of abuse. (Outstanding 30/06/09) The registered person must ensure that there are enough staff members employed at the home to ensure that people’s needs can be met. DS0000008399.V377751.R01.S.doc 30/10/09 30/10/09 30/10/09 30/10/09 31/12/09 30/10/09 Beaumont House Version 5.3 Page 31 11. OP28 18 12. OP30 18 (1) (a) 13. OP31 18 (1)(a) 14. OP31 Section 11Care Standards Act 2000 15. OP33 26 16. 17. OP33 OP38 37 18 (1) (a) The registered manager must provide us with up to date information that confirms how many members of the care staff team hold a relevant NVQ that can be evidenced by a certificate. The registered provider must ensure that the staff team receive all relevant mandatory health and safety training they need to ensure they are competent to carry out their roles and responsibilities safely. (Outstanding 30/10/08 03/02/09 and 30/06/09) The owners of the home must ensure that the home is effectively managed at all times by senior staff members who are competent to carry out their roles. (Outstanding 31/05/09 and 01/06/09) To ensure that the home is well run and complies with the law, we must receive an application from a competent and suitably qualified person to become the registered manager for the home. We must receive a monthly report from the registered providers in line with the regulation that gives evidence that they are monitoring the home. We must be kept informed of all events that take place at the home in line with this regulation. The registered provider must ensure as far as is reasonably practically possible the health, safety and welfare of people living at the home and staff members. 30/10/09 31/12/09 30/10/09 30/11/09 30/10/09 30/10/09 30/10/09 Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 32 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 OP3 OP12 OP15 Good Practice Recommendations That the manager ensures that a more detailed assessment is carried out before a person is admitted to ensure that their needs can be met. That the manager continues with her plans to review the provision of activities at the home and keep appropriate records to evidence when and how this was achieved. That the manager continues with her plans to review the provision of meals offered at the home and keep appropriate records to evidence when and how this was achieved. That the plans for the remaining staff to attend safeguarding training are followed through. That the staff team receive Mental Capacity Act training that includes deprivation of liberty. The cupboards in the serving areas need to be replaced so that they are safe to use and can be kept clean. That the manager continues with her plans to review the levels of cleanliness and keep appropriate records to evidence when and how this was achieved. 4. 5. 6. 7. OP18 OP18 OP19 OP26 Beaumont House DS0000008399.V377751.R01.S.doc Version 5.3 Page 33 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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