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Inspection on 13/06/05 for Beaumont Park Nursing & Residential Home

Also see our care home review for Beaumont Park Nursing & Residential Home for more information

This inspection was carried out on 13th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff team work hard to provide `homely` accommodation and care for all of the service users. The home is well decorated; a team of housekeepers and domestic staff keep it clean. One of the service users told the inspector `it is like living at home without any of the worries`. Another said ` the nursing care is fantastic. I have to give praise where it is due`. A dedicated team of activity co-ordinators provide a range of activities to suit all. These activities take place inside and outside, and range from the familiar game of bingo to gardening. Various speakers visit the home regularly talking about anything from the local fire service to the war years. The activity coordinators also arrange excursions out, and ensure that some of the service users attend the monthly lunch club held at the local church. This enables those service users who have lived in the village to keep in contact with old friends, and for others to mix with people who are happy to spend time with them, but would not necessarily make a visit to the home. A cat and a budgie also live happily at Beaumont Park. Before admission all service users are visited, in their own homes or wherever they are living, by the manager or a senior nurse, to ensure that Beaumont Park has the necessary equipment and staff experience to care for them. There is a core staff group that have worked at the home for some time, many of them live locally and have previous knowledge of the service users and/or their families if they come from the Biggleswade area.

What has improved since the last inspection?

At the last inspection it was noted that some of the medication charts had not been signed when a medication had been given. Although medication was not reviewed thoroughly as part of this inspection, the charts looked at suggested that this had been addressed. The handyman continued to keep the home and the garden well maintained. The gardens had been developed further since the last inspection, and a gazebo had been erected to provide the service users with shade during the summer and shelter during the spring and autumn.

What the care home could do better:

Staff should ensure that when they complete care plans or any other documentation they sign and date it. They should also be careful to write down agreed care changes and not just tell each other. In an ideal world the home would have a larger dining room, wider corridors and less shared bedrooms. As the manager said `to make the environment perfect it would be easier to start again, but here at Beaumont Park we all try to make the best of what we have and keep everyone happy.

CARE HOMES FOR OLDER PEOPLE Beaumont Park Nursing & Residential Home Shortmead Street Biggleswade Beds SG18 0AT Lead Inspector Sally Snelson Unannounced 13 June 2005 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 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 Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Beaumont Park Nursing & Residential Home Address Shortmead Street Biggleswade Beds SG18 0AT 01767 313131 01767 313181 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Abbott Healthcare James Sewards Care home with nursing 38 Category(ies) of OP Old Age - 38 registration, with number PD(E) Physical disability over 65 - 38 of places Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: To care for three named service users under the age of 65 years. Date of last inspection 20.01.05 Brief Description of the Service: Beaumont Park is a large detached property close to the town centre of Biggleswade, a Mid-Bedfordshire village within easy access of the A1 motorway. Service users are accommodated in a variety of single and double bedrooms on two floors. There is a lift or staircase connecting the two levels. The home was registered for 38 service users over the age of 65 needing nursing or residential care. One bedroom was currently being used as the office so a maximum of 37 service users would be in residence at any one time. The home was positioned off the main road in a large landscaped garden. There was ample car parking at the front of the property. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 7.15am on the 13th June 2005, over a seven-hour period. The manager, James Sewards, was available for the majority of the inspection. The focus of the inspection was to assess the progress made with the requirements from the last inspection, and to look generally at how Beaumont Park was meeting the needs of the service users accommodated. Two service users care files and their associated care was tracked in detail, specific parts of other service users care was tracked. Staff and visitors were also spoken to during the inspection. What the service does well: The staff team work hard to provide ‘homely’ accommodation and care for all of the service users. The home is well decorated; a team of housekeepers and domestic staff keep it clean. One of the service users told the inspector ‘it is like living at home without any of the worries’. Another said ‘ the nursing care is fantastic. I have to give praise where it is due’. A dedicated team of activity co-ordinators provide a range of activities to suit all. These activities take place inside and outside, and range from the familiar game of bingo to gardening. Various speakers visit the home regularly talking about anything from the local fire service to the war years. The activity coordinators also arrange excursions out, and ensure that some of the service users attend the monthly lunch club held at the local church. This enables those service users who have lived in the village to keep in contact with old friends, and for others to mix with people who are happy to spend time with them, but would not necessarily make a visit to the home. A cat and a budgie also live happily at Beaumont Park. Before admission all service users are visited, in their own homes or wherever they are living, by the manager or a senior nurse, to ensure that Beaumont Park has the necessary equipment and staff experience to care for them. There is a core staff group that have worked at the home for some time, many of them live locally and have previous knowledge of the service users and/or their families if they come from the Biggleswade area. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,6 All service users are visited and assessed prior to admission to ensure that Beaumont Park can meet their needs. All service users, including those who had been admitted outside the homes categories of registration, were having their care needs met by staff that were trained and experienced to deal with them. EVIDENCE: At the time of the inspection the certificate of registration did not accurately reflect the service users accommodated. This was partly due to a misunderstanding in the past between the home and the Health Authority. This error had subsequently been transferred to the Commission for Social Care Inspection (CSCI) via the National Care Standards Commission (NCSC). The inspector and the manager discussed the changes that need to be made to the registration certificate, and a new certificate will be issued. In the future failure to comply with the registration categories will result in the CSCI taking action. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 9 The inspector did not sample service users contracts as part of the inspection, but did talk to service users about their choice to live at Beaumont Park. It was confirmed that some of the service users, or their relatives, had made a pre-admission visit to the home. Many of the service users came from the local area, as the home was the only nursing home in the village. One service user said ‘ I always knew I would end up here’, another of the service users spoken to had been waiting nine months for a bed to become vacant as she particularly wanted a single room on the ground floor. The manager or a nurse assessed service users prior to admission. One of the service users tracked had been admitted for terminal care. It was noted that the manager, as part of her pre-admission assessment, had spent time with her discussing her fears for the future and reassuring her. Beaumont Park doe not offer intermediate care. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10,11 Staff worked on care plans to ensure that they included all the information necessary for any member of staff to provide the appropriate care to a service user. EVIDENCE: All the staff spoken to had a good understanding of the service users they were looking after. The night nurse had been on holiday for the past two weeks but had, on her return, familiarised herself with the new service users and any changes in the condition of those she knew. During the inspection service users were treated with respect and dignity. It was noted that service users were given the opportunity to inform staff of the name they wished to be called by. A carer mentioned, when discussing abuse, that calling a service user ‘lovey or duck’, without their permission, could be abusive to them. When the manager came on duty, he walked around the home, and stopped and spoke to most of the service users and staff. Two care files were tracked in detail, it was noted that one of the service users had been in the home 12 days and her care plans had not been finalised although a thorough pre-assessment had ensured basic information was in Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 11 place. It was noted that a decision to bath her daily had been made but was not reflected back to the care plan; however both the service user and staff caring for her were aware of this change. She confirmed that she was being offered a daily bath. There was no evidence in the care plans sampled that service users had been asked to agree their care plans. There was little information recorded as to the service users wishes, at the time of terminal illness. In one case this was particularly disappointing, as the staff had spent time with her discussing her fear of death. It was noted that risk assessments were in place for appropriate activities and reflected the assessments that had been carried out. For example a high Waterlow score had resulted in a pressure relieving mattresses being provided. Weights were recorded monthly; other observations were taken and documented as necessary. One of the plans sampled had documentary and photographic evidence of how staff had successfully healed a grade 3 pressure ulcer by seeking professional advice and using the correct pressure relieving devises and dressings. The home had a good relationship with the local GP and contacted specialist health staff for advice and support. Medication was not inspected as part of this inspection. Since the last inspection the manager had agreed with the supplying pharmacy, that for a trial period of one year, some medication would be supplied as stock. This had been something that the manager had wanted for sometime to ensure that the medication trolley was not full of numerous bottles of the same medication supplied to individual service users. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12.13,15 Activities provided, and the links with the local community, enriched the service users lives. Menu planning ensured that service users nutritional needs were met. EVIDENCE: Activities were given a high priority at Beaumont Park. In addition to the weekly activity programme, service users also enjoyed excursions out and visiting entertainers. The inspector was amused to see that the yearly planner for the gardening activity allowed service users to ‘sit and enjoy the garden’ during July. On the day of the inspection service users were playing lingo, a variation on the game of bingo that promoted discussion. Later in the week a speaker was booked to talk and show slides entitled ‘ cruising down the waterways’. All the activities and other events of importance such a service user’s birthday or the appointment of a new member of staff were circulated via the homes own newspaper, ‘Beaumont Park Bugle’. The inspector saw a copy that outlined all the activities that had occurred to celebrate VE day including personal memories recorded by many of the service users. It was noted that a housekeeper came on duty at 06.30am to ensure that water jugs were changed, newspapers delivered and that service users had an Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 13 early morning cup of tea upon waking. Breakfast was served individually to each service user from 8am onwards. Trays were prepared and taken to each of the service users either in their own rooms or, if they preferred, in the dining room. At lunchtime the majority of the service users sat at tables in the dining room; it was necessary for one table to be laid up in the conservatory to accommodate all of the service users. Lunchtime was an unhurried social occasion with a cup of tea and a chat afterwards. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed as part of this inspection and will be included in the next inspection. It was noted that the management had put a sign on the door used to leave the building. The sign requested visitors to speak about any problems or concerns they had to the manager or a senior member of staff before they left. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,23,25,26 The overall décor in the home and the continuous programme of refurbishment ensures that Beaumont Park is a comfortable and safe place for service users to live EVIDENCE: All areas of the home were clean and there were no odours The home had a lounge, known as the red room, a separate dining room and a conservatory. The red room had a TV, however the majority of the service users chose to use the conservatory. The conservatory had thermostatically controlled heating, allowing it to be used summer and winter. Neither the conservatory nor the dining room was large enough for all the service users; therefore at times these areas could appear ‘crowded’. 11 bedrooms were registered as double rooms and 16 as single rooms. This is a high percentage of shared rooms and is the one thing that some of the service users wished to change. One of the service users tracked was sharing a room and experiencing some problems. The manager stated that she had Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 16 wanted the admission and had therefore been promised the next available single room. The service users confirmed that she had not known her roommate prior to moving into Beaumont Park. There was no documentation to support how the agreement to share was reached or that she was promised the next available single room. All the bedrooms could be locked and were linked to a call bell system. A number of the bedrooms had been individualised, with small items of furniture or ornaments, by the service user. The home had large gardens front and back. The front was used mainly for car parking and had been planted with shrubs. The back garden had been landscaped and was accessible to all the service users. The back garden also had a pond that had been filled with fish. Those service users who were interested supported the handyman to keep the gardens tidy and planted. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29and 30 The high staff morale and the low turnover of the core staff group offered consistency to the service users. EVIDENCE: The inspector spent time talking to some of the care staff before they started the morning shift. Because of transport problems, or because they preferred it, many of the staff arrived at work early and had a coffee before starting their shift. All of the staff spoke positively of the training opportunities that they were given. One had completed NVQ level 2, another was in the process of completing level 2, and another was due to start the course soon. Staff who had completed or were in the process of doing the training said it could be difficult to fit the necessary time for study in around work. The manager confirmed, that at the start of NVQ training, staff agreed to give the time for study in return for the company paying any fees. Time spent with the assessor was usually arranged around the duty rota so that the staff could be on duty when he/she visited. All staff were supported to attend a minimum of three paid days training a year; much of this was organised by the company and covered more than one subject at a time. On the day of the inspection two new staff members were having moving and handling training; this training was being facilitated by one of the senior nurses who had the appropriate training qualifications. The training started with a video and then progressed to practical sessions. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 18 On the day of the inspection there were eight carers and one nurse, in addition to the manager, on duty. Staff confirmed that it was usual for there to be two nurses and six carers on duty in the morning, but as a nurse was involved in training an extra carer was working; one of the carers was due to escort a service user to the hospital during the morning. All the staff were dressed in trousers with a different coloured tunic denoting their particular status; for example care staff had yellow and white tunics and trained staff navy. Sampling of personal files confirmed that the home followed a robust recruitment policy. The files seen had two references and all the required documentation. All of the staff had an enhanced Criminal Record Bureau check before starting work. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 and 38 The manager provides clear leadership to the staff team. He has a clear vision and development plan for the home to enhance the lives of the service users. EVIDENCE: The manager is a very experienced nurse who has completed a management qualification. He is committed to achieving and maintaining high standards within the home. Nurses, many of who have their own areas of responsibility, support his position. For example one nurse takes the lead in training and another in nutrition. Staff said that they could go to the manager at any time to discuss work or personal problems. Staff meeting were held and documented. The trained staff also met regularly. On the day of the inspection the handyman was carrying out all the required testing of equipment and systems. He was able to describe the test and the Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 20 solutions to any of the problems found. It was noted that a range of emergency telephone numbers, including a mobile number for the manager, were displayed in the office. Records kept by the home were generally up to date and accurate and kept securely in appropriate areas of the home. The staff mentioned supervision but records were not inspected to confirm if it was happening at appropriate intervals for all the staff employed. Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x x 3 x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 x x x x x 3 Beaumont Park Nursing & Residential Home v233221 i51 s17665 beaumont park v233221 130605 stage 4.doc Version 1.30 Page 22 YES Are there any outstanding requirements from the last inspection? 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 23 Regulation 23 Requirement The home must have a written record of the process taken to ‘match’ service users who are to share a room. There must also be evidence that this has been an informed decision on the part of both of the service users. Timescale for action 01.08.05 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. Refer to Standard 7 11 Good Practice Recommendations Care plans should be completed as soon as possible following admission.. service users requests for their tretment at the time of sudden illnesss or death should be recorded. 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