CARE HOMES FOR OLDER PEOPLE
Beaumont Park Nursing & Residential Home Shortmead Street Biggleswade Bedfordshire SG18 0AT Lead Inspector
Katrina Derbyshire Unannounced Inspection 15th January 2007 10:50 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 Park Nursing & Residential Home DS0000017665.V326639.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 Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beaumont Park Nursing & Residential Home Address Shortmead Street Biggleswade Bedfordshire SG18 0AT 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) 01767 313131 01767 313181 manager@beaumontpark.healthcarehomes.co.u k Abbott Healthcare Limited - Parent Company Mr James Sewards Care Home 38 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (38), of places Physical disability (5), Terminally ill (5), Terminally ill over 65 years of age (5) Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home can accommodate a maximum of 38 service users of either sex. No one falling into the category of PD (40-65 years) may be admitted to the home when there are already 5 persons in this category. No one with a diagnosis of dementia may be admitted to the home when there are already 20 persons in this category. No one with a diagnosis of terminal illness may be admitted to the home when there are already 5 persons in this category. 3rd November 2005 Date of last inspection Brief Description of the Service: Beaumont Park Home is a large detached property close to the town centre of Biggleswade, a Mid-Bedfordshire village that is within easy access of the A1 motorway. Residents are accommodated in single and double bedrooms on the ground and first floor. There is a lift and staircases connecting the two levels and a small platform lift where there are steps. The home is registered for 38 residents, however one bedroom has been converted into an office so the maximum residents accommodated is 37. The home is situated off the main road and has parking at the front, for staff and visitors. There is a well laid out garden to the rear with a pond and seating areas. The fees for this home vary from £555.00 per week, to £700.00 per week, depending on the funding source. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit took place on 15th January 2007. The Registered manager Mr. James Seward was present throughout the inspection. During the inspection communal areas and private rooms in the home were visited and the inspector spent time with many of the residents’ in the sitting areas of the home and a dining room. The care of three residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents and relatives were also received and their feedback has been used alongside information from the home through a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit alongside their views. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
Health and safety is managed well, safety checks are carried out by the home and they arrange for regular servicing of equipment in the home. They keep records of all these tests, so that they know if they have to take any action to make things safer. This means that the residents benefit from the protection provided by fire procedures being followed correctly, gas and electrical equipment being serviced and maintained and environmental health requirements being met. The home continues to be good at providing activities for the residents. They have a plan of activities so residents can attend a programme designed to meet their different needs. Staff at the home make sure that future events are displayed in reception. On the day of this inspection entertainers visited the home, providing music and an opportunity for the residents to sing-a-long. Residents at the home also think that the food is of a good standard and they feel that they have a sufficient amount. A choice of meals is available and menus are displayed in the home so residents can see what is on offer. Many residents gave favourable comments about the food at the home; one resident said, “ l enjoyed my dinner very much”.
Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request.
Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of pre admission assessment at this home is good ensuring the staff have sufficient information to know if they will be able to meet the individual needs of the residents. EVIDENCE: Resident individual care records contained documentation to show that an assessment had been undertaken prior to their admission to the home. Information examined showed that the resident’s physical, social and emotional needs had been looked at. In addition written evidence was also seen from commissioning authorities that had been used alongside the homes assessment information to ascertain if the home would be able to meet the residents needs.
Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 9 Residents through discussion confirmed that some had been visited prior to their admission and recall being asked to provide information about them. The manager at the home also stated that prospective residents and their families were welcome to visit the home at anytime before they made a decision to move into the home. Intermediate care is not provided. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems for the administration of medication in this home are good so residents receive all prescribed medication to maintain a good level of well being. EVIDENCE: Medication taken by residents were detailed within the individual care records, these gave guidance to staff on all prescription medication that should be given. In addition individual medication administration sheets were maintained and these were noted to match all other records. Medication was kept in a locked storage area and was seen to be secure. The receipt, recording, current storage and handling of medication are appropriately carried out, and the home utilise a sealed dispensing system for the administration of medication. Controlled Drugs are administered by two appropriately trained staff and recorded in a Controlled Drugs Register. Staff training records submitted to the
Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 11 Commission for Social Care Inspection showed that staff responsible for administering medicines had received appropriate up dates in their training. Care plans were examined within the individual records of resident’s; a plan of care was in place for the assessed needs of the residents. Written records and observation at this visit indicated that personal care is carried out appropriately. Observation of the interaction between residents and staff on showed staff speaking to residents in a supportive and encouraging manner. Appropriate equipment was in place for the treatment and prevention of pressure ulcers, and risk assessments alongside nutritional screening is in place, and reviewed regularly. Records showed that residents had access to medical services if required, appropriate aids were available and advice is sought from Healthcare specialists in the care of residents. There was evidence of nutritional screening prior to or after admission on each file, if a resident need a diabetic/specialist diet this is provided. All residents are registered with a General Practitioner and access to dental, chiropody and community health services had been accessed on behalf of the residents by the home. Observation of the personal support to residents by staff to be sensitive and respectful. It was noted that all staff knocked on resident’s doors before entering and used only a preferred form of address. The majority of resident comment cards received by the Commission for Social Care Inspection indicated that residents believed their privacy was respected and Relative/Visitor comment cards all indicated that they could meet their family member in private. However one resident was seen to have a bruise on her leg. An entry within the daily reporting notes showed that the resident had sustained this during a transfer by staff using a hoist, however no accident form had been completed. This was discussed with the manager on the day of this inspection. All accidents must be reported in the appropriate way and in doing so when he undertakes his monthly audits of accidents in the home action can be taken to prevent further accidents of this nature. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities and recreational opportunities available to the residents are of a good standard so resident’s social needs are met. EVIDENCE: Resident’s interests are recorded in their personal files. Activities are advertised on a notice board in the home. Resident comment cards sent to the Commission for Social Care Inspection stated that they believed the home provided suitable activities. Local places to visit include local pubs, churches, libraries and shops. Residents said that the home has an open visiting policy. Residents are able to choose whom they see and do not see and are able to receive visitors in private. On relative spoken with said, “ this is the best place around, l can’t thank the staff enough they support me and mum so well”. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 13 Residents are supported and encouraged to maintain and develop appropriate control over their own lives. Their financial affairs are managed by them for as long as they are able and wish to do so. Many had personal possessions that they were encouraged to bring with them at the time of their admission to the home. Menus are in place and detail that there are options available from the lunchtime menu. Through discussions with residents and staff it was confirmed that the practice of offering choices did take place. Snacks and beverages are available at all times and offered regularly to residents. Special therapeutic, religious or cultural diets are provided when required or requested. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place for residents to complain are good so residents can feel confident that their concerns will be listened to and acted upon. EVIDENCE: As assessed previously the home had a complaints procedure that was displayed in the hallway. This clearly indicated the complaints procedure including time frames for response, and the Commission for Social Care Inspection contact details. Residents were aware of the process if they wished to make a complaint. Many relatives and all residents spoken to at this visit said that they had a good relationship with the manager who visited them daily and checked that everything was satisfactory. Examination of records showed that complaints that had been received by the home had been looked into and responded to by the management in the home. There was a policy for the Protection of Vulnerable Adults (POVA) available in the home, however this requires updating as it indicates that the management in the home should commence investigation if a suspicion of abuse is raised. This policy must reflect the guidance as detailed within the local guidance for the Protection of Vulnerable Adults, which the home did have a copy of. All
Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 15 staff new into care had a three-day induction programme where POVA was a key theme. Other staff had attended a half-day training where they learnt about the various types of abuse and how to record and report any suspicions. In view of the managers understanding that an investigation should not take place and that the home did hold a copy of the local guidance the judgement within this section remains a good. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 16 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of cleanliness in this home is of a very good standard and provides a pleasant environment for the residents to live in. EVIDENCE: The Residents are accommodated in single and double bedrooms on the ground and first floor. There is a lift and staircases connecting the two levels and a small platform lift where there are steps. The furnishings, fittings and décor in these areas are of an acceptable standard. All residents who were seen commented that the environment was pleasant and felt that the home catered well for their needs in this area. The rear garden area provides spaces
Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 17 to sit out in the warmer months. Individual rooms contained personal items of the resident to assist in creating a homely atmosphere. All areas visited were noted to clean, tidy and free of odours. Staff were observed to wear suitable protective clothing when carrying out certain activities. Cleaning schedules were in place and clinical waste was disposed of in an appropriate manner and clinical waste contracts are in place. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems in place for the recruitment of staff are not sufficient to protect residents and places them at risk. EVIDENCE: Staff files were examined and at this visit contained application forms, evidence of identification and Criminal Records Bureau checks. However the most recently employed staff members had actually commenced their employment prior to the home receiving their second written reference for their induction at the home, this information was only secured by the home after their induction period. Through discussion the manager confirmed that he believed this to be sufficient. This places the residents at risk and a requirement has been made relating to this. Staff training records submitted by the home to the Commission for Social Care Inspection were also examined and showed that staff had attended a variety of courses and workshops including health and safety, food hygiene and management of medication. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 19 Staffing rotas submitted by the home showed that the number and skill mix of staff were sufficient to meet the needs of the residents. Residents and staff felt that there were enough staff to care for the residents, it was reported that at times residents would need to wait for assistance if help was being offered to another resident but that this would normally only be for a few minutes. Staff through discussion demonstrated that they were aware of the needs of the residents as recorded within their care records and were able to describe the individual. It was observed that the interaction between the staff and residents was positive and showed that supportive relationships between them had been established. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager continues to show effective leadership skills that ensure residents and staff feel confident in his approach. EVIDENCE: The management of monies held on behalf of some residents continues to show that a robust system is in place that provides a clear audit trail. Balances seen were correct and receipts of all expenditure are maintained and available for inspection. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 21 The Home Manager has many years experience, which is directly relevant to the role of manager in the home. All staff spoken with stated that they felt the home to be run very well for the befit of the residents and felt that they had an excellent level of support and encouragement from the manager of the home. Residents spoken with on this visit described the manager as a “lovely person” and “so very kind”. The home has a system for gaining the views of residents and relatives and in addition undertake a quality review in areas such as medication, maintenance and staff training. The manager confirmed that they had now sought those views and were in the process of looking at the feedback to see what changes and actions that would need to be taken. The homes Health and Safety policy was noted to contain all required information. Staff confirmed that they had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments had been undertaken and were seen on the residents care files that were tracked on this inspection. All major equipment is serviced regularly and the home maintains documentation to support this and when safety checks such as recording water temperatures have been undertaken. Staff training records show that staff have undertaken fire, manual handling, food hygiene and first aid training Risk assessments had been undertaken and were seen on the residents care files that were tracked on this inspection. Records of the testing of water temperatures, emergency lighting and fire equipment are maintained. Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 (4) & 13(5) 13(6) Requirement All accidents must be reported to ensure action can be taken to reduce the risk of further accidents taking place. The homes policy on the Protection of vulnerable adults must reflect the guidance as detailed in the local policy to ensure all suspected incidences of abuse are investigated in an appropriate way. The home must not commence the employment of staff prior to securing two references and the relevant CRB check to protect the residents. Timescale for action 28/02/07 2. OP18 28/02/07 3. OP29 12(1)(a) & 19 15/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 24 Beaumont Park Nursing & Residential Home DS0000017665.V326639.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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
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