CARE HOMES FOR OLDER PEOPLE
Beech Court Nursing Home 37 Newland Street Eynsham Oxfordshire OX29 4LB Lead Inspector
Chris Sidwell Unannounced Inspection 2nd November 2007 11:00 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 Beech Court Nursing Home DS0000027140.V349718.R02.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. Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beech Court Nursing Home Address 37 Newland Street Eynsham Oxfordshire OX29 4LB 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) 01865 883611 beechcourt@talk21.com Dr Brian Cheung Glynis Lynette Dunbar Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. On admission persons should be aged 60 years and over. Admission of two named residents under the age of 60. Date of last inspection 22nd May 2007 Brief Description of the Service: Beech Court is a large listed building of architectural and historical note. It is situated in Eynsham, a village five miles west of Oxford and is close to shops, Post Office and 3 churches. Beech Court is home to 26 older people who are frail and require nursing care 24 hours a day. The home has 19 residents at the present time. The home offers convalescence, holiday breaks, long, and short stay care. The accommodation is provided in single and shared rooms on 2 floors and there is a passenger lift to provide access to all areas. The communal rooms are spacious and large picture windows afford a good view of the delightful garden. There are spacious, well kept grounds on both sides of the house, to which the service users have access. The fees range from £564 - £898 per month. Additional costs are incurred for chiropody, hairdressing and personal items. Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was conducted over the course of three days and included an unannounced, seven-hour visit to the home. Information received about the home since the last inspection was taken into account in the planning of the visit. Questionnaires were distributed to service users, relatives, visiting professionals and staff prior to the visit. Eleven residents or their families, three social or healthcare professionals and nine members of staff returned the questionnaires. Residents and families were also spoken to on the days of the unannounced visit. Discussions took place with the proprietor, manager, nursing and care staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. What the service does well:
The assessment process works well and helps potential residents decide whether the home can meet their needs. The manager visits potential residents before they move to the home to give them information about the home and to assess their needs. Potential residents can visit the home or stay for a trial period before moving permanently. Resident’s cultural and religious needs are also discussed. Residents can bring personal items with them when they move to the home and some had chosen to do so, making their rooms personal and cosy. Families and friends are made welcome. Resident’s diverse personal, healthcare and medication needs are met. The local general practitioner visits the home regularly and arrangements have been made with the local pharmacist for the provision of medication There are complaints, whistle blowing and safeguarding policies in place, which are responsive to residents and their families concerns. The manager has keeps records of complaints and draws up action plans to address any concerns expressed by residents or families. The home is a comfortable and safe place for residents. It is an elegant building although some rooms are small and there are no ensuite facilities. The equipment in the home is serviced and maintained regularly. There are attractive, mature gardens. There are sufficient, well qualified staff to meet the needs of residents whilst the home is not fully occupied. Staff are well trained and caring towards residents. All carers have achieved the National Vocational Qualifications in
Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 6 Care at level 2 or above and registered nurses attend local updating courses. This is to be commended. What has improved since the last inspection? What they could do better:
The management of medication must be improved by ensuring that medication administration records are completed in full when medication is administered and that they are also completed, as well as the controlled drug register, when controlled drugs are administered. It is also recommended that nursing staff who administer medication update their skills on a regular basis. Catheter bags should be worn discretely out of sight to protect residents’ privacy and dignity. The arrangements in the lounge should be reviewed to ensure that all those residents who wish to watch television are able to see and hear it. The menus must be reviewed to give residents more of an input into the choice of main meal. The menus must contain sufficient detail to give residents an explicit choice and to ensure that the record of the food provided to residents is in sufficient detail to determine whether the diet is satisfactory and nutritionally adequate to meet their needs. The advice of a dietician should be taken as to how best to balance the timing of meals across the day.
Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 7 All staff should have safeguarding training to ensure they know the steps they should take should they have a concern about vulnerable residents. The infection control policies and procedures should be improved if residents are to be protected from the risk of acquired infection. Foot controlled pedal bins must be used for all clinical waste. Residents should not share hoist slings. Alcohol hand rub should be available to staff. The proprietor and registered manager are advised to review the employment practices in line with guidance issued by The Commission for Social Care Inspection in June 2006, entitled ‘Safe and Sound- checking the suitability of new care staff in regulated services’. All staff must have two references on file one of which is from the previous employer and where appropriate copies of their work permit status. It is recommended that the registered manager be present at interviews of prospective nursing and care staff. Interview records should be kept. All staff should have a statement of their terms and conditions. Although staffing levels are sufficient to meet the needs of nineteen residents, they should be monitored carefully as new residents move to the home to ensure that there are sufficient to meet residents’ needs when the home is full. The home’s health and safety policies and procedures should be reviewed in accordance with guidance from the Health and Safety Executive entitled Health and Safety in Care Homes. All staff should have annual updates to their moving and handling training. Advice from the Environmental Health Officer should be taken as to the level of training that staff who handle food should have. 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. Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The assessment process works well and helps potential residents decide whether the home can meet their needs. EVIDENCE: The care of four residents was followed through. Their care files showed that the manager had visited them, prior to their move to the home, and had undertaken an assessment of their needs. There were also copies of the social services care manager’s assessment on file where relevant. All the residents and their family members who returned the questionnaires said that they had received enough information about the home prior to moving in. One resident said that she had visited three homes with vacancies before deciding that Beech Court was ‘the most suitable’. The home does not offer intermediate care. The manager said that respite care could be arranged if a vacant room was available. Beech Court Nursing Home DS0000027140.V349718.R02.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 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Residents’ care needs are identified clearly and reviewed regularly to ensure that they are met. Medication management has improved although this should be further improved to ensure that residents’ medication needs are met reliably. There is a need to ensure that residents’ privacy and dignity is protected. EVIDENCE: The care of four residents was followed through. Residents’ care needs have been reviewed and there was evidence that monthly reviews take place on a regular basis. There was some evidence that both residents and their families have been involved in planning their care. Ten of the residents or their families who returned the questionnaires said that they ‘usually or always’ received the care that they needed. One said ‘sometimes’. The risk of residents acquiring pressure damage due to immobility is assessed and appropriate equipment is made available. The home has recognised that they have a need for more height adjustable beds and has bought two this
Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 11 year. Specialist airflow mattresses are available from the local health services. Three of the residents whose files were examined had been assessed as at high risk of developing pressure damage and had been provided with the appropriate air mattress. None had developed pressure damage. Continence assessments are undertaken by the nursing staff and the Primary Care Trust (PCT) provides appropriate aids. Nutritional risk assessments had been undertaken. Residents are weighed regularly and those residents whose care was followed through had maintained their weight on moving to the home. Most but not all residents had drinks within reach in the day room. Residents register with the local general practitioner who visits the home weekly. He returned the questionnaire and said that the home communicated clearly with him and that ‘the staff ask for advice and medical review appropriately’. There was also evidence that residents are seen by an optician regularly, although one family member commented that she had had to remind the staff about this. There was evidence that falls assessments are undertaken and the advice of the local Primary Care Trust specialist falls prevention team is taken where necessary. Nursing staff have received additional training in fall prevention. Residents have access to additional physiotherapy. A chiropodist visits the home regularly. There are medication management policies and procedures in place. No residents manage their own medication at present. The home has completed the changeover to a dossette form of medication provision, provided by the local pharmacist. He has audited medication management at the home and recommended that staff undertake updating training. The storage facilities have improved. The drugs refrigerator has been defrosted and a new thermometer has been purchased to ensure that it runs at the correct temperatures to prevent deterioration of medication. The manager said that the temperature of the refrigerator would be recorded regularly. Medication with an expiry date is labelled with the date on which it was opened. Records are kept of medication entering and leaving the home. In general the medication administration records were accurately completed, although there were a couple of gaps with no initials to record that a medication had been administered. There were also three gaps on the medication administration chart relating to controlled drugs although these had been signed for correctly in the controlled drug administration record book. Controlled drugs were stored satisfactorily and two people signed all entries to the controlled drug register. A contract is held for the disposal of unused medication. The manager said that medication was not administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make to the decision, the doctor and family would be informed and a way forward agreed.
Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 12 The staff were observed to be respectful towards residents. A number of residents, who require catheters, wear leg bags during the day. These were clearly on view in the lounge on the day on the unannounced visit. This is not dignified and the care staff should ensure that catheters and leg bags are hidden by clothing or blankets in public areas of the home to protect resident’s dignity. The staff said that all care was given in residents’ rooms or the bathrooms. The general practitioner also confirmed that he saw residents in their rooms. Residents were wearing their own clothes and most were ironed and appeared to be in a good state of repair. There are portable screens in shared rooms. The manager stated that there are telephone points in residents’ rooms, which are connected to the home’s telephone system for the use of residents. Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 13 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 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There is an activities programme for residents, to bring interest and diversion to the day. Families and friends are welcomed to the home to enable residents to remain in touch with their families and friends. The menus must be reviewed to show the choices available. Menus must also be more explicit to ensure that they are balanced, meet residents’ nutritional needs and that an accurate record of the food offered to residents is kept. EVIDENCE: The manager has developed the activities programme. A volunteer activities co-ordinator helps her with this. Gentle chair exercises to music are held weekly. Bingo, painting and a variety of musical events are offered. A school choir and an Oxford University playgroup are coming as part of the planned Christmas celebrations. Of the residents who returned the questionnaires three said that activities were sometimes available and two that they were usually available. One commented that there were no ‘outside trips, films or talks’. There were no activities planned on the day of the unannounced visit. One family member said that the television had been replaced, although not with a new one, and that residents who were sat at the back of the lounge could not see it. On the day of the unannounced visit one gentleman had been moved near to the television and he said that he could see and hear it. Two
Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 14 residents who were sitting further away said that they could neither see nor hear the television. This needs to be addressed and the lounge and dining areas rethought to make it easier for residents who want to watch the television to do so and for the television to be part of planned activities during the day and not just on in the background. The family members who returned the questionnaires and those spoken to on the day of the visit said that they were able to visit at any time and could see their family member in private. Residents can bring personal items with them when they move to the home and some had chosen to do so, making their rooms personal and cosy. There is a rotating menu. This does not show that there is a choice of main meal although the chef said that he knew most residents’ likes and dislikes. The menu is not detailed in that it does not show the vegetables available and makes reference to ‘two vegetables of the day’ and ‘fish of the day’. On the Friday of the unannounced visit the main meal of the day was fish fingers, baked beans, frozen peas and chips, followed by cheesecake. Omelettes were available for three residents who did not like fish fingers. Supper consisted of tomato soup and sandwiches. There was no evidence that fresh fruit or fresh vegetables are available on the day of the unannounced visit. The manager said that hot drinks were not served later in the evening unless a resident asked for one specifically. Four of the five residents who answered the relevant question on the questionnaire said that they ‘usually’ liked the food and one said ‘always’. One commented that high tea was ‘rather dreary just soup and sandwiches, I have been used to something cooked and more variety’. Six residents sat at a large round table at lunchtime and the rest ate at small tables in front of their armchairs. Staff were observed to be assisting those who needed help discretely. Liquidised food was available for those with swallowing difficulties. A requirement was made at the last inspection that a choice of meals must be made available to residents. This has been partially met in that an alternative is available if residents do not like the main meal but this is not shown on the menus. This should be addressed and clear menus with sufficient detail should be provided to give residents an explicit choice and to ensure that the record of the food provided to residents is in sufficient detail to determine whether the diet is satisfactory and nutritionally adequate to meet residents’ needs. There is also a long break between supper, which was being served at 16:45 on the day of the visit and breakfast the following day. The advice of a dietician should be taken as to how best to balance the timing of meals across the day. Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 15 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 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There are complaints, whistle blowing and safeguarding policies in place, which are responsive to residents and their families concerns. All staff should have safeguarding training to ensure that they are know what constitutes a safeguarding issue and the steps they should take to protect residents. EVIDENCE: There are complaints, whistle blowing and safeguarding policies and procedures in place. A complaints record is kept. There has been one complaint. This was clearly described and an action plan had been developed to address the concerns. All the residents and family members who returned the questionnaires said that they knew how to make a complaint and one said that the manager had responded to her concerns promptly. The home was not able to locate a copy of the local multi-agency strategy for safeguarding vulnerable people although the manager knew that the local social services are the lead agency and who to refer any concerns to. She is registered to undertake safeguarding training in January 2008. The carers have had safeguarding training as a module of their National Vocational Qualifications in Care courses. Not all qualified nurses have had this training. All staff should have safeguarding training with annual updates. The Commission for Social Care Inspection has not received any complaints since the last inspection and has not been notified of any safeguarding allegations made to the local authority social care teams.
Beech Court Nursing Home DS0000027140.V349718.R02.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, 24 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home provides a comfortable and homely place for residents to live in. The infection control policies and procedures should be improved if residents are to be fully protected from the risk of acquired infection. EVIDENCE: The home is a listed building and is not purpose built. As such it is attractive and homely but lacks some personalised facilities such as ensuite toilets or showers. The grounds are attractive and there are outdoor sitting areas. The home employs a handyman for one day per week who tends the garden and undertakes minor repairs. There was evidence to show that services and equipment are maintained and serviced regularly. Most people who returned the questionnaires said that the building was usually fresh and clean. One respondent however commented that the internal décor was dull and felt that the home would improve with brighter rooms and better lighting. Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 17 Residents are encouraged to bring furniture, ornaments and pictures to personalise their rooms and many had chosen to do so. The standard of bed linen has improved and new sheets and bed covers have been bought to replace worn and frayed linen. A review of the nurse call bell system has been undertaken and the manager said that all but five rooms now had a functioning call bell system. She has ensured that all residents who could use a call bell have one. There are call points just outside each resident’s room door, if staff need help in an emergency The proprietor said he was considering replacing the call bell system as spare call bells and spare parts for the existing system are not available. Two new height adjustable, profiling beds, with integrated, optional bed rails, have been bought, bringing the total number of height adjustable beds to ten. The manager has undertaken risk assessments of the remaining beds and bed rails to ensure that residents are not at risk of entrapment due to poorly fitting bedrails. These should be reviewed on a regular basis. It is recommended that all residents requiring nursing care should have height adjustable beds and a plan to provide these over a period of time should be developed. The home’s infection control policies have not been fully updated in line with guidance issued by the Department of Health (DoH) in June 2006, although there have been some improvements since the last inspection. The bedpan washers were both working on the day of the unannounced visit and the manager said that commode inserts were no longer soaked in the bath. Residents still share hoist slings, which does not comply with the latest DoH guidance. All waste bins which are used for clinical waste must also have lids and be foot operated. There are paper towels and liquid soap in residents’ rooms although the towel dispensers are not fixed to the walls and are difficult to use with wet hands. There was no evidence on the day of the unannounced visit that alcohol hand rub is available in the home. The home’s infection control practices should be revised in line with the guidance from the Department of Health. Beech Court Nursing Home DS0000027140.V349718.R02.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 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There are sufficient, well qualified staff to meet the needs of residents whilst the home is not fully occupied. Staff are well trained and caring towards residents. Recruitment procedures should be reviewed to reflect best practice and to be sure that residents are protected from unsuitable staff. EVIDENCE: The proprietor manages the staff rota and recruits all staff. The registered managers stated that she would alert the proprietor if she felt that the staffing levels were insufficient to meet resident’s needs. The intention is to have four care staff including one registered nurse on duty in the mornings, three in the afternoon and four between 5pm and 8pm. There is one registered nurse and one carer on duty at night. A cook is on duty between 8 am and 2pm. There is a housekeeper on duty for three or four hours six days per week. The care staff do the laundry. Eight care staff returned the questionnaires and all said that they felt that there were ‘usually’ or ‘always’ enough staff to meet residents’ care needs. The staff also said that they all ‘pulled together’ if there was sickness or staff absence. It is a stable staff group and there have been no staff appointed since the last inspection. The home was not running at full occupancy at the time of the inspection and had 19 residents. The staffing levels must be monitored carefully to ensure that there are sufficient staff to meet the needs of residents should full occupancy (26 residents) be achieved. Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 19 All care staff hold the National Vocational Qualifications in Care at Level 2 or above and the home renewed the Investor in People Award in 2007. This is to be commended. Registered nursing staff have undertaken short courses run by the local Primary Care Trust (PCT) to update their knowledge on a variety of topics, including mental healthcare, managing challenging behaviour, wound management, continence promotion and nutritional assessment. The standard of training within the home is good and the staff who returned the questionnaires said that they were supported to undertake training to give them the skills and knowledge that they needed to care for residents. The recruitment records of two members of staff were examined. Both had completed application forms and Criminal Records Bureau disclosures had been sought before the employee started work. One had two references including one from their last employer. The other did not have any references on file. She had only worked one shift. Copies of passports, birth and marriage certificates were on file. The files seen did not hold a copy of the employees work permit status. The proprietor interviews all employees himself. The registered manager does not interview them. Interview records are not kept. This is not good practice. The registered manager should be involved in all interviews of prospective nursing and care staff and interview records should be kept. The proprietor stated that staff do not have contracts of employment with statements of terms and conditions and this was confirmed by the two carers on duty. The proprietor and registered manager are advised to review the employment practices in line with guidance issued by The Commission for Social Care Inspection in June 2006, entitled ‘Safe and Sound- checking the suitability of new care staff in regulated services’. The guidance is available on the Commission for Social Care Inspection’s web site www.csci.org.uk. All staff must have two references on file one of which is from the previous employer and copies of their work permit status if appropriate. The registered manager should be present at interviews of prospective care and nursing staff and interview records should be kept. All staff should have a statement of their terms and conditions. A copy of these should be kept on file. Beech Court Nursing Home DS0000027140.V349718.R02.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 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home is adequately managed and resident’s views are taken into account. There is a need to develop the quality assurance programme further and to review health and safety procedures to ensure that safe working practices are in place to protect residents and staff from risk arising from their care. EVIDENCE: There is an experienced manager in post who is a registered nurse and holds the National Vocational Qualifications in Management and Care at Level 4. She has updated her skills and knowledge this year by attending additional update courses run by the local Primary Care Trust. She has a job description although she said that she did not have a contract nor terms and conditions of employment. She is in day-to-day control of the care aspects of the home Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 21 although the provider who lives on the premises plays an active part in the running of the home. The home keeps records of expenditure made on behalf of residents and receipts are given. There are facilities for the safe keeping of residents valuables should they wish to keep them in the home. There is a quality assurance system in place. The proprietor and manager have undertaken a survey of residents and their family’s views about the care offered in the home. The information from the survey has been analysed and a development plan agreed. The manager has also undertaken a review of some procedures. The local pharmacist undertakes an audit of medication management on a quarterly basis. It is recommended that the quality assurance programme be further developed to include regular environmental, care plan, staff recruitment and infection control audits. Advice about undertaking a self-assessment of infection control measures is available on the Department of Health website www.dh.gov.uk. There are health and safety policies and procedures in place although the home does not hold regular meetings and it was unclear who the responsible person is, the manager or proprietor, with regard to health and safety measures. The proprietor and manager should undertake a health and safety audit of the home to ensure that residents and staff are not exposed to risk arising from their care or work. Advice and an appropriate template for a Care Home health and safety audit can be found in the book Health and Safety in Care Homes published by the Health and Safety Executive and available from their website www.hse.gov.uk. There is a need to ensure that staff have appropriate training in safe working practices. Advice should be sought from the Environmental Health Officer as to the level of training that carers who handle food should have. Staff must also have annual updates to their moving and handling training to ensure that neither they nor residents are at risk, when helping residents who cannot move unaided. The use of bedrails in the home has been reviewed and risk assessments undertaken for individual rails and beds to ensure that they are compatible and that there is no risk of entrapment. Footplates were available for wheelchairs to ensure that residents are not at risk of injury when being moved. Beech Court Nursing Home DS0000027140.V349718.R02.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 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Beech Court Nursing Home DS0000027140.V349718.R02.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 OP9 Regulation 13 (2) Requirement The management of medication must be improved by ensuring that: - the medication administration records are completed in full when medication is administered - the medication administration record is also completed, as well as the controlled drug register, when controlled drugs are administered. - the temperatures of the drug refrigerator must be recorded regularly to ensure that it running at the correct temperature. Catheter bags must be applied discretely and hidden from view to protect residents’ dignity. Residents must be offered a choice of main meal. The menus must be revised to show the choice and must be in sufficient detail to determine whether the diet is satisfactory and meets residents’ nutritional needs. The advice of a dietician should be taken as to how best to balance the timing of meals across the day.
DS0000027140.V349718.R02.S.doc Timescale for action 31/03/08 2 3 OP10 OP15 12(4)a 16 (2) (i) and paragraph 13 of schedule 4 31/03/08 31/03/08 Beech Court Nursing Home Version 5.2 Page 24 4 OP18 13(6) 5 OP29 19 and schedules 2 and 4 6 OP38 13(5) 7 OP38 13(3) All staff must have safeguarding training to ensure that they are fully aware as to what constitutes a safeguarding issue and the steps they should take to protect residents from harm. Two references must be sought for all staff before they commence work. The recruitment files must contain the documents specified in Regulation 19 and Schedules 2 and 4 of the Care Homes Regulations 2001. Copies of staff members work permit status must be on file. All staff must have annual updates to their moving and handling training, to ensure that residents and staff are not at risk. The advice of the Environmental Health officer should be taken as to the level of food hygiene training that all staff who handle food should undertake. A copy of that advice should be sent to the Commission for Social Care Inspection. 31/03/08 31/03/08 31/03/08 31/03/08 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 OP26 Good Practice Recommendations The infection control policies and procedures should be updated in line with guidance issued by the Department of Health in June 2006 and available from them on their website www.dh.gov.uk. Residents should not share hoist slings, to reduce the risk of cross infection. The registered manager should be present at interviews of prospective care and nursing staff and interview records
DS0000027140.V349718.R02.S.doc Version 5.2 Page 25 2 OP29 Beech Court Nursing Home 2 3 4 OP29 OP33 OP38 should be kept. All staff, including the manager, should have a statement of their terms and conditions. The quality assurance programme should be further developed to include regular environmental, care plan, staff recruitment and infection control audits. The proprietor and manager should undertake a health and safety audit of the home to ensure that residents and staff are not exposed to risk arising from their care or work. Advice and an appropriate template for a Care Home health and safety audit can be found in the book Health and Safety in Care Homes published by the Health and Safety Executive and available from their website www.hse.gov.uk. Beech Court Nursing Home DS0000027140.V349718.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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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