CARE HOMES FOR OLDER PEOPLE
Beaumont Park Nursing & Residential Home Shortmead Street Biggleswade Bedfordshire SG18 0AT Lead Inspector
Sally Snelson Unannounced Inspection 1:30 3 November 2005
rd 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.V257605.R01.S.doc Version 5.0 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.V257605.R01.S.doc Version 5.0 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 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.V257605.R01.S.doc Version 5.0 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. 13th June 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. Service users are accommodated in single and double bedrooms on the ground and first floor. There are a lift and staircases connecting the two levels and a small platform lift where there are steps. The home is registered for 38 service users, however one bedroom has been converted into an office so the maximum service users accommodated is 37. At the time of the inspection the registration allowed for three named service users under the age of 65 years with conditions, similar to those service users already at the home, to be accommodated. The home is situated off the main road and has ample parking at the front, for staff and visitors. There is a well laid out garden to the rear with a pond and seating areas. Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection of Beaumont Park was unannounced and took place on 3rd November 2005. The registered manager, James Sewards, was present throughout. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views. This was the second inspection of the year so the inspector reviewed the progress that was being made towards meeting the one requirement made at the last inspection. The six core standards not inspected at the last inspection were also assessed. Therefore this inspection was a short inspection and the report should be read alongside the last report, dated 13th June 2005. The inspector would like to thank the staff and the service users who participated in the inspection. What the service does well:
As stated previously the staff team work hard to provide ‘homely’ accommodation and care for all of the service users. The home is clean and tidy throughout and decorated appropriately. Staff have built up good relationships with the service users. Throughout the inspection it was noted that staff ‘chatted’ with service users and visitors as they went about their work. One service user said “ the attention the staff give to my husband when he comes to visit me makes his day” The home provides a varied programme of activities. The inspection was between Halloween and Guy Fawkes Day and it was clear that both dates were being celebrated. The conservatory had been decorated with colourfully drawn and painted fireworks. A Guy Fawkes that had been made and dressed by the service users sat in the corner of the room. The home has good links with the local community. On the day of the inspection a group of service users had gone to the church hall across the road for a lunch club followed by entertainment. This was particularly appreciated by those service users who had lived in the village for a number of year’s as it was an opportunity to meet friends and acquaintances. A service user told the inspector that she often liked to go to bed about 11.30 at night and this was not a problem. She said “ I like it here, it is not at all
Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 6 regimented, I can chose when I do things”. She had personalised her bedroom with items and furniture and a number of artefacts from home. The service users shared Beaumont Park with a cat and a caged bird. 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 DS0000017665.V257605.R01.S.doc Version 5.0 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.V257605.R01.S.doc Version 5.0 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 the following standard(s): 3,4,6 Good pre-admission assessments ensured that service users had their care needs met at Beaumont Park. EVIDENCE: The manager confirmed that pre-admission assessments were important to ensure the correct balance for the home. He stated that the home invariable had a waiting list and it was important to assess all the needs of a service user when a bed became available. Staff were aware that it was upsetting to a service user and their family if, even in the best interest of the service user, a move had to be made because the home was not suitable. The manager discussed the way he and the staff were sensitively supporting the family and friends of a service user whose mental health had deteriorated and alternative, more suitable accommodation was being sought. The majority of the service users accommodated had chosen Beaumont Park, or their family had chosen it on their behalf, because they lived in or around the village of Biggleswade and had connections with the home. Beaumont Park did not offer intermediate care.
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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 the following standard(s): 7,9,10,11 Care plans had been sensitively written and updated which ensured that staff had documentation to support the care they were providing to the service users. EVIDENCE: Care plans were not looked at in detail, however those sampled had been well written and updated at least monthly or when circumstances changed. The last inspection had identified a delay in producing care plans for a recently admitted service use; this was not the situation at this inspection. The inspector did not see any evidence that care plans had been agreed by the service user or their representative. However a family spoken to knew the type of things that were documented about their mother. They said that they had had conversations with the manager and staff about her care and her wishes. Medication records were sampled. It was noted that medication was checked and signed into the home at the point of delivery. The nurses had signed the medication charts as the medication was given and used appropriate codes if the medication was not given or was refused by the service user. The nurse
Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 10 confirmed that they had a good out-of-hours service from their supplying pharmacist. Separate medication trolleys and charts were in place for the separate floors of the home. The drug charts sampled did not reveal any service users who were taking controlled drugs or were self medicating. Service users spoken to said they were treated with respect, and their wishes taken into account regarding activities, meals, and furnishings in their rooms. It was noted that all service users were smartly dressed and appeared to be wearing their own clothes. Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 14 The home was run in such a way that service users had the opportunity to make personal choices and decisions and maintain a level of autonomy according to their wishes and capabilities. EVIDENCE: Service users talked of being given choices about when they got up and went to bed and if they wished to join in an activity. The majority of the service users chose to sit in the conservatory, which was off the dining room and where most of the activities took place. There was a lounge where those service users who did not enjoy communal activities could spend their time. Service users confirmed that they had the opportunity to meet their visitors in one of the communal rooms in their own bedroom. Service users were given the choice to eat in their rooms or sit in the dining room. There was a range of menu choices available and service users said they enjoyed the food and could always request an alternative. Visitors spoken to said they are always offered the opportunity to eat with the service users or have a cup of tea and always felt welcome in the home. There was information available if a service user needed to contact an independent advocate.
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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 the following standard(s): 16,18 A robust complaints procedure ensured that service users and visitors were aware of the procedure for complaining. Staffs understanding of the Protection of Vulnerable Adults (POVA) procedures safeguarded the service users. EVIDENCE: 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. Service users and visitors spoken to were aware of the process if they wished to make a complaint. Service users said that they had a good relationship with the manager who visited them daily and checked that everything was satisfactory. The manager confirmed that there had been no official complaints made in the last year and he also outlined how verbal concerns were addressed. There was a policy for the Protection of Vulnerable Adults (POVA) available in the home. All 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. Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 23 Service users who occupied a double room were aware that they were sharing a room and the implications. However, as they had not met first, to discuss their feelings about sharing with each other, this could not be described as a ‘positive choice’ to share. EVIDENCE: None of these standards were inspected in detail at this inspection. However it was noted that the home was clean and tidy throughout and free from any offensive odours. The manager had introduced a letter that was sent to any service user who chose to share a bedroom. While this did not fully meet the requirement made at the last inspection it was clear from the documentation who was sharing a bedroom, and that before admission both parties were aware of the situation. Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The home’s ability to retain, recruit and train competent nurses and care staff was good, which resulted in service users needs being met in a satisfactory manner. EVIDENCE: The company and the manager had a positive attitude to training and learning. New staff had a robust induction programme that was tailored to take into account their previous experiences and could last up to three whole days. They followed a specified programme which was ‘signed off’ before they began to work unsupervised. Care staff were undertaking NVQ training at various levels, although it did not appear that that had reached the 50 quota hoped for. Qualified staff reported that they identified training that enabled them to keep themselves updated, as required by the NMC, their professional body. A number of the qualified staff had identified particular areas of care that they were interested in and took lead on these subjects. For example a nurse was the nutrition lead and would liaise regularly with dieticians the cook and representatives from food supplement companies. She would attend appropriate courses and training on this subject and fed back to the rest of the staff. Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 There were a variety of systems in place to ensure that service users, visitors and staff had the opportunity to give their views on the running of the home. The manager demonstrated effective leadership skills that ensured service users and staff were able to feel confident in his approach. EVIDENCE: The manager had a particular interest in audit and had developed several quality assurance systems that were completed by service users and visitors to the home. The manager confirmed that the audits were used to improve best practise and any shortfalls were investigated. For example the last audit suggested that sometimes call bells were not answered promptly, although everyone suggested they were answered. The reason for this was investigated.
Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 16 Service users and staff said they had meetings and felt this gave them an opportunity to voice any concerns. The home did not have power of attorney for any of the service users money. Service users were advised to hold only small amounts of money and they could if they wished ask the home to hold these small amounts on their behalf. Money held was not checked at this inspection, as the administrator was not on duty. The manager confirmed that if a service user needed money that was being held for them this could be made available at any time. Since the take-over of the home an independent company had done the Regulation 26 visits. The manager stated that these unannounced visits had been beneficial. No problems were identified at an inspection of the home carried out by Bedfordshire and Luton fire and rescue service on the 26.10.05. Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 17 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X 3 X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action 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 OP7 OP20 OP23 Good Practice Recommendations There should be documented evidence that the care plans have been agreed and discussed with the service users. The dining room allows sufficient space for service users and staff to move around. A service users decision to share a bedroom is a positive choice. Beaumont Park Nursing & Residential Home DS0000017665.V257605.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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