CARE HOMES FOR OLDER PEOPLE
Beauvale Court Wellington Place Eastwood Nottingham NG16 3GD Lead Inspector
Richard Ramsden Unannounced 13 July 2005 10:00 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. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Beauvale Court Address Wellington Place Eastwood Nottingham NG16 3GD 01773 768183 01773 913143 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) Nottinghamshire County Council Mrs Angela Christine McNally Care home 38 Category(ies) of DE(E) Dementia - over 65, x 10 registration, with number OP Old age, x 38 of places Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: NONE Date of last inspection 7 March 2005 Brief Description of the Service: Beauvale Court is owned and run by Nottinghamshire County Council Social Services and is a purpose-built care home for up to 44 older people. Beauvale Court was built in the 1980s and is situated within 150 yards of the town centre of Eastwood, which has a good range of services and facilities. The accommodation is on two floors with a shaft lift assisting independent access. All of the bedrooms are for single occupancy and are fitted with wash hand basins, there are no ensuite facilities. The communal space at Beauvale Court compensates for the fact that some of the bedrooms are small. There is a well maintained enclosed rear garden which is accessible to all residents. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over one day and lasted for approximately 5 1/2 hours. It included the inspection of care and of other records, a discussion with three of the management staff, one care staff, three residents and two visitors to the home. A partial tour of the building was also completed. What the service does well:
The majority of staff have worked at Beauvale Court for a considerable length of time, providing consistency and experience. They have completed a considerable amount of training, which is updated, on a regular basis. The residents spoken with during the inspection said that staff are always friendly helpful and respectful. The observed interaction between staff and residents was of a very good standard. Residents said that they appreciate the freedom they have to make decisions about how they wish to spend their time. One person said that she regularly walks to a luncheon club and attends church every Sunday. The residents and visitors spoken with during the inspection said that the food at the home is very good and that an alternative will be provided if they do not want the food suggested on the menu. One person said that the home is like a five-star hotel the laundry cleaning and food cannot be faulted. The premises are purpose built, well equipped and maintained to a good standard. The home was appropriately clean and there were no offensive odours at the time of this inspection. The gardens are well maintained and the rear garden is fully enclosed to provide a safe environment for residents. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 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.
Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 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 Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 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) 3,6. Senior staff ensure that no residents are admitted, to the home, until a full assessment has been obtained and they are confident that the home can provide an appropriate service. The home does not provide Intermediate Care. EVIDENCE: The records of three residents were assessed as part of this inspection. An Extended Social Work Assessment had been obtained for each resident prior to his or her admission to the home. The senior staff stated that residents would never be admitted without a social work assessment. The home does not offer Intermediate Care but people do attend for regular respite care. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 9 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) 7,8,9,10 Care plans do not contain sufficient information and are not reviewed frequently enough to ensure that staff are always aware of what assistance and support each resident requires. Resident’s health care needs are being fully met, they are treated with respect and their right to privacy is upheld. Appropriate risk assessments are not been completed with residents who administer their own medication. This is potentially putting them and other residents at risk. EVIDENCE: The care plans viewed as part of this inspection did not contain enough detailed information to ensure that staff are always aware what assistance and support each resident requires. Two of the care plans did not contain any information about people’s mobility, even though one person’s assessment showed that they relied on a wheelchair to assist their mobility and needed assistance from staff to complete transfers safely. Another assessment clearly stated that a resident was diabetic but this was not mentioned on the care plan, which stated that she could eat a normal diet. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 10 The resident had signed only one of the care plans, assessed during the inspection. None of the care plans had been reviewed on a monthly basis. The resident’s records show that appropriate referrals had been made to health care professionals including chiropodist’s optician’s dentist’s district nurses and doctors. One person had been admitted to the home with a pressure sore, which was being treated by the district nurse. It was recommended that an appropriate tissue viability risk assessment be completed with each resident so that people who are at risk of developing pressure sores can be referred for preventative treatment. The homes medication systems were checked and were well maintained. All of the homes medication is stored in the main office. This room was very warm on the day of inspection. Senior staff were advised that they must record of the temperature in the office each day. Medication must not be stored in temperatures above 25°C as this can cause deterioration and reduce the effectiveness of the medication. Several residents administer their own medication; their records show they had signed forms, to say that they are willing to accept responsibility for the administration of their medication. The Inspector informed the senior staff that while it is considered good practice to encourage people to administer their own medication, a full risk assessment must be completed with each person and regularly reviewed to ensure that they are safe to do so. The residents spoken with during the inspection stated that staff are always friendly and respectful and that they ensure that their privacy and dignity is maintained at all times. The observed interaction between residents and staff was of a very good standard. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 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 standard(s) 13 Residents are encouraged to main contact with family/friends and the local community as they wish. EVIDENCE: The homes policy on visitors is included in the literature provided to prospective residents. Two visitors to the home confirmed that they are always made to feel very welcome. All of the resident spoken with stated that they can receive visitors at any time and that they can see them in their bedrooms, or the visitors lounge, if they wish to see them in private. One of the resident spoken with during the inspection said that she is very pleased with the home as she has the freedom to come and go as she pleases. She walks to a luncheon club each week and attends the local church every Sunday. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 12 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) 16 Residents and their representatives were confident that any complaints would be dealt with appropriately. The records of complaints did not contain sufficient information to ensure that they had been investigated and resolved appropriately. EVIDENCE: Each resident is given a copy of the homes complaints procedure and an additional copy is displayed in the main reception area. This procedure needs to be updated to ensure the prospective complainants are aware that the Commission for Social Care Inspection has replaced the National Care Standards Commission. The home had received very few complaints, however when the records were viewed several of the complaints had not been dated and one complaint did not contain the details of any investigation or remedial action taken. It was therefore not possible to fully assess the effectiveness of the complaints procedure. All of the residents and both of the visitors spoken with during the inspection said that the senior staff are very approachable and that they were confident that if they had any complaints they would be dealt with promptly and appropriately. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 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 standard(s) 19,25,26. The premises are well decorated and comfortably furnished and at the time of inspection the home was clean and there were no offensive odours. The radiators in the communal areas including the bathrooms and toilets were unguarded and could potentially be putting vulnerable residents at risks of burning themselves. The window restrictors in the first floor bedrooms would not stop residents falling through the open windows. There were no window restrictors in the ground floor bedrooms, which means that people could gain access to the home through these windows. EVIDENCE: The location and layout of the home is suitable for the current residents. The home is only situated a few hundred yards from all the facilities in Eastwood town centre. The residents spoken with during the inspection so that they are very satisfied with their bedrooms and that the home is always clean and tidy. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 14 The communal areas are well decorated, comfortably furnished and have good natural and artificial lighting. There is a separate lounge that people can use if they wish to smoke. There is an enclosed well-maintained and easily accessible garden at the rear of the home. The inspector was informed that new garden furniture has recently been purchased. Many of the residents were sitting in the garden at the time of the inspection. The radiators in the communal areas are unguarded. The inspector stated that these would need to be risk assessed to ensure that residents are not at risk of burning themselves; senior staff stated that radiator covers are to be provided for all of the unguarded radiators. There are window restrictors fitted to the first floor bedroom windows, however these allow the windows to be open approximately 12 inches. This is unsatisfactory as vulnerable residents could still fall through this gap. It was also noted that there are no window restrictors fitted to the ground floor bedroom windows and many of the windows were open, when there were no residents in the rooms. This is potentially a security risk as people could gain access to the premises through these windows. The laundry was clean and well equipped with industrial style washing machines and tumble dryers. There were copies of the homes infection control policies and COSH data sheets, however these policies had not been updated and 2002. Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 15 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) 29,30. The staff group are very experienced and have received a considerable amount of training. The staff recruitment policies and practices are robust enough to ensure the safety of the residents. EVIDENCE: The records of the most recently recruited members of staff were assessed during this inspection. CRB checks were available as were job descriptions, written references and terms and conditions of employment. Only one member of care staff has been recruited in the last year. Her training records were checked and she had completed a TOPPS induction-training course. Records show that eight members of staff have completed the NVQ level 2 and that several more are currently completing the course. Three people have completed the NVQ level 3 and one person has completed the NVQ level 4 in Care Management. Staff have completed a considerable amount of additional training since the last inspection, including dementia training and fire training. (This is good practice). Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 16 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) none None of the standards in this section are assessed as part of this inspection. EVIDENCE: None Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x 2 3 STAFFING Standard No Score 27 x 28 x 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x x x Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 18 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 7 Regulation 15 Requirement It is required that the service user plans give detailed information on how individual residents health and welfare are to be met. The plans must be reviewed on a monthly basis in consultation with the resident and where appropriate their representatives. It is required that a risk assessment is completed with each resident who wishes to administer their own medication. The risk assessments must be reviewed regularly It is required that staff record each day, the temperature in the room in which the medication is stored. The room temperature must not exceed 25 C. It is required that the records of complaints are dated and contain details of the investigation and any remedial action, if any taken. It is required that residents are not at risk of burning themselves on unguarded radiators. It is required that window restrictors are fitted to all windows to ensure the safety of Timescale for action 1st August 2005 2. 9 13 1st August 2005 3. 9 13 1st August 2005 4. 16 17(2) 1st August 2005. 5. 6. 25 25 13(4) 13(4) 14th September 2005 14th August 2005
Page 19 Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 the residents and the security of the building. The window should not open more than 6 inches. 7. 8. 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. Refer to Standard 7 Good Practice Recommendations It is recommended that the homes staff complete a basic tissue viability risk assessment with each resident, so that those residents who are at risk of developing pressure sores can be referred for preventative treatment Beauvale Court C53 C03 S58980 Beauvale Court V237882 130705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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