Inspection on 22/05/07 for Beech Court Nursing Home

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beech Court Nursing Home 09/09/09

Beech Court Nursing Home 22/10/08

Beech Court Nursing Home 02/11/07

Beech Court Nursing Home 09/05/06

Beech Court Nursing Home 04/11/05

Beech Court Nursing Home 14/07/05

Beech Court Nursing Home 22/03/05

Beech Court Nursing Home 26/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beech Court Nursing Home 37 Newland Street Eynsham Oxfordshire OX29 4LB Lead Inspector Andy McGuckin & Chris Sidwell Unannounced Inspection 22nd May 2007 08:30 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.V336071.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.V336071.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.V336071.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 9th May 2006 Brief Description of the Service: Beech Court is a large listed building of architectural and historical note. It is situated in the village of 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 22 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. Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced “Key Inspection”. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s proprietor and manager, and any information that the CSCI has received about the service since the last inspection. Prior to the inspection questionnaires were sent to the manager for distribution to residents, their families and healthcare professionals. Seven were returned. Fees range from £608 to £850 per week. Additional costs include hairdressing, chiropody and personal items. What the service does well: What has improved since the last inspection? The detail in the pre admission documentation has improved. Medication management has improved since the last inspection and the home now uses a pharmacy dispensed dosette system. Cleanliness has improved and the routine maintenance of small items of clinical equipment and electrical equipment has improved. Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 6 What they could do better: There is a need to improve the standard of care planning and to ensure that an accurate up to date record is kept of residents’ needs and the steps to be taken to meet them. The home must ensure that residents are encouraged to move position regularly. Where this is felt not to be in the residents best interests this should be recorded on the care plan. Whilst the management of medication has improved since the last inspection there is a need to ensure that all records are accurately maintained, refrigerated storage is improved, a protocol is developed to guide carers as to their responsibilities when checking controlled drugs and that medication is kept secure at all times. The home should ensure that residents’ interests are recorded and assist residents to enjoy opportunities for stimulation through activity, in line with their wishes and choices. The provision of meals should be reviewed to ensure that a choice of main course is offered, adequate arrangements to cover the chef are in place and that mealtimes become a more sociable occasion for residents. The complaints procedures should be improved to ensure that accurate records are kept, that action is taken in response to residents and their families concerns. Call bells should be available in all residents’ bedrooms. Residents in the lounge should also have a means of contacting a member of staff. A programme to replace old divan beds and provide height adjustable beds for residents requiring nursing care should be introduced, if necessary over a period of time. 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.doh.gov.uk. Residents should not share hoist slings and if the net pants used to secure continence pads are not to be treated as disposable they must be clearly labelled with residents’ names and used for them only. The staffing levels should be monitored carefully to ensure that frail residents are supervised adequately, have a choice as to when they get up and go to bed and that their needs during the day are met in a timely way. The quality assurance monitoring systems in the home should be developed to include a consistent self-monitoring and an internal audit at least annually. The quality assurance systems should include regular consultation with residents and their families. Action plans should be drawn up to improve the service in line with their ideas and comments. Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 7 Footplates should always be used on wheelchairs when moving residents to protect them from injury. The use of bed rails should be reviewed in line with guidance issued by the Medicine and Healthcare products Regulatory Agency to ensure that they are used safely and reduce any risk to residents of entrapment. 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.V336071.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.V336071.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 home provides prospective service users with sufficient information upon which to make an informed choice about the home. EVIDENCE: The home provides prospective service users with sufficient information upon which to make an informed choice about the home. Many residents have visited the home prior to moving in either by having short stays or by having visited friends and relatives. The care of four residents was followed through in detail. The manager had visited them and had assessed their needs before they moved to the home. The assessment documentation was comprehensive and had been completed in full. The home does not offer intermediate care. Beech Court Nursing Home DS0000027140.V336071.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 poor quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Care planning is poor and the care plans do not contain sufficient information to ensure that residents’ needs are identified nor do they describe the steps that should be taken to meet them. In general residents’ medication needs were met but there is a need to ensure that medication is kept securely at all times to ensure that residents and other are not put at risk. EVIDENCE: All residents had a care plan, although the level of detail that they contained was variable. The care plans did not have a photograph of the resident. They had not been updated regularly and did not in all cases hold the most current information about residents. In one record the overall care needs sheet had been last updated in August 2004 although some areas had been updated in July 2006. There was evidence elsewhere in the file that the dietician had seen the resident and that her care had been changed but this was not reflected in the care plan. In one care plan a resident’s needs had been identified but a care plan had not been developed to meet them. One had developed pressure damage for which there was no clear care plan although it was described in the daily evaluation notes. Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 11 The manager stated that a ‘named nurse’ system was not in place, although each resident had a named carer, and the responsibility for maintaining accurate care plans for all residents was not clear. The permanent staff spoken to were, in general, aware of residents’ needs and how to address them, despite these not being well documented. There is a need to improve the standard of care planning and to ensure that an accurate up to date record is kept of residents’ needs and the steps to be taken to meet them. There was evidence in the files that residents had seen the doctor when necessary and one resident spoken to confirmed this. Residents had had nutritional assessments although detailed care plans as to what actions should be taken if a resident was at risk nutritionally were not seen. Residents were weighed regularly. Fall risk assessments are undertaken and a standard care plan is put in the file although this is not tailored to the individual needs. Two residents had pressure damage some of which had developed in hospital. They had appropriate pressure relieving mattresses, which are supplied by the local primary care health services. Residents however sit in the lounge for long periods and although some go back to bed, for a rest, after lunch there is a need to ensure that residents are helped to change their position frequently. There are policies and procedures covering administration of medication although these are not dated and it was unclear when they had been last updated. On arrival at the home the keys of the medication cupboard were in the cupboard, which was unattended. The home is introducing a pharmacy dispensing system, which has improved the administration of medication since the last inspection. This has only been in place for the last two months. The medication administration charts were by and large completed accurately although there were some gaps. The home do not record the medication received or destroyed on the medication administration records but in separate books. The nurses spoken to said that medication was never administered covertly. The controlled drugs register was checked and found to be correct. A carer acts as the second person to check controlled drugs. There is a need to ensure that a clear protocol is agreed as to what the carer’s role is when checking controlled drugs. The drug fridge was dirty on the outside and needed defrosting. There were papers on the top obliterating the air-vents. The refrigerator temperature is recorded regularly. Medication within the refrigerator is not labelled as to its date of opening. One family member, who visits regularly, said that she was concerned that medication is left on resident’s tables and that they are not always helped to take their medication. This was not observed on the day of the unannounced visit to the home. Whilst the management of medication has improved since the last inspection there is a need to ensure that all records are accurately maintained, refrigerated storage is improved, a protocol is developed to guide carers as to Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 12 their responsibilities when checking controlled drugs and medication is kept secure at all times. Staff should also ensure that residents are helped to take their medication when necessary. The carers were observed to be speaking to residents respectfully. Personal care is given in residents’ rooms. Beech Court Nursing Home DS0000027140.V336071.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 poor quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Feedback from users of the service stated that there was a lack of activities for residents. The provision of meals should be reviewed to ensure that residents are able to exercise a choice as to what they eat and to ensure that their nutritional needs are met. EVIDENCE: There was little evidence that residents had any planned activity or opportunity for maintaining their social, cultural or recreational activities. A questionnaire returned from a regular visitor states ‘As far as I am aware his physical health needs are well met. There doesn’t appear to be much emphasis on meeting psychological or emotional needs’. Other relatives stated ‘they should have extra time / staff to care for the emotional and spiritual needs of the people instead of just their physical needs’, ‘they don’t do much, no social events or anything apart from the Baptist church going in once a week. Other homes have activities every day, drawing games etc and the carers don’t seem to have time to sit and talk to the residents’. Relatives and friends are made welcome to the home and staff said that they would help a resident back to their room if they wished to see their relative in private. The staff also said that residents are encouraged to have as much choice and control over their lives as they are willing or able. Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 14 The chef was not on duty on the day of the unannounced visit and one of the carers was standing in. The lunch comprised casserole, broad beans, carrots and potatoes. Many residents had left the meat which, when tasted by the inspector, was found to be tough and clearly difficult to chew. There is a fourweek rotating menu, although the manager was unclear what the menu for the day should have been. There is no choice of main meal although the manager and carer said that an alternative would be offered if they knew residents did not like what was on offer. Most residents ate their meal in their armchairs at small tables. Mealtimes were not seen to be a sociable occasion and most residents did not sit at a dining table. The provision of meals should be reviewed to ensure that a choice of main course is offered, adequate arrangements to cover the chef are in place and that mealtimes become a more sociable occasion for residents. Beech Court Nursing Home DS0000027140.V336071.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, 17 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. The complaints procedures are not sufficiently robust to give residents and their families’ confidence that action will be taken in response to their concerns. Safeguarding policies and procedures are in place to protect residents from abuse. EVIDENCE: The inspector was shown a book, which was presented as the complaints book. Recordings of incidents were also recorded. Where a complaint had been made the information regarding the complaint only was recorded. There was no recording of who had made the complaint, what date it had been made, who was dealing with it, what form did the investigation take and what was the outcome. Whether the complainant was satisfied with the outcome was not recorded and any further action was not identified. The inspector was satisfied that the legal rights of residents are being protected and that residents are being protected from abuse. The training records showed that most staff had had Safeguarding training although this should be updated on annual basis. The Commission for Social Care Inspection has not received any complaints and has not been notified of any allegations of abuse. Beech Court Nursing Home DS0000027140.V336071.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. Whilst the environment is homely there is a need to ensure that the furniture and fittings in residents’ rooms are suitable for their use and are kept in a good state of repair. There is a need to improve the control of infection practices if residents are to be protected from cross infection. EVIDENCE: The home is situated in a listed building and is not purpose built. As such it is homely but lacks some personalised facilities such as en-suite toilets and bathrooms. The grounds are tidy and attractive and provide shady sitting areas. The home employs a maintenance person one day per week. His tasks mainly involve the garden and some minor repair work. The home was relatively well maintained and documentation to evidence this was found to be satisfactory. Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 17 The manager said that residents were encouraged to bring in their own furniture to personalise their rooms and some had chosen to do so. There are eight height adjustable beds. Other beds are of a divan type and not suitable for the provision of nursing care. A programme to replace these beds, with height adjustable beds, should be agreed and implemented, if necessary over a period of time. Bed rails were available although not all care plans had risk assessments relating to these. It was not clear whether the bed rails were specific to the type of bed. This should be checked to ensure residents are not at risk of entrapment. The use of bed rails should be reviewed inline with guidance issued by the Medicine and Healthcare Products Regulatory Agency and available on their website www.mrha.gov.uk The standard of bed linen has improved since the last inspection although one room seen had frayed sheets. Rooms were carpeted although some bedside mats were dirty. Seven of the rooms seen did not have call bells although the wall box was in place. The bedside cabinets had locked drawers. There are screen for use in shared rooms. There were commodes in most rooms. There are infection control policies and procedures which require updating in line with guidance issued by the Department of Health in June 2006 and available from them on their website www.doh.gov.uk. There are paper rolls in all rooms for the use of carers and liquid soap. The bathrooms, sluices and clinical areas should have pedal operated bins for the disposal of clinical waste. Residents should not share hoist slings. There is a red bag system for dealing with soiled linen and washing machines had a sluice wash cycle. Some residents require elastic pants to secure continence aids. These are not individually labelled and it was not clear whether they are disposed of or rewashed and used again. Residents should have their own individual elastic pants if they are to be reused to prevent cross infection. On the day of the visit the commode pans were soaking in the bath. The manager said that the bedpan washers worked although the commode pans were sometime stained and this was why they were being soaked. It is not good practice to soak these in a bath that residents will subsequently use to bathe in. Beech Court Nursing Home DS0000027140.V336071.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. The staff recruitment process is thorough and staff have access to training to give them the skills they need to care for frail elderly people. The staffing levels are not always sufficient to ensure that frail residents are supervised and that their needs are met in a timely way. EVIDENCE: On the day of the unannounced visit, there was one registered nurse, two carers and one bank carer on duty in the morning, one registered nurse and two carers in the afternoon and one registered nurse and three carers in the evening. One had agreed to stay on duty for a little longer after lunch as there was clearly pressure to help those who wished to go to bed and those who wished to go to the toilet. Feedback from questionnaires included the following: “ Staff are welcoming to visitors and are easy to talk to and will help and advise if needed “ “ The staff are mainly great but they have no time for anything but physical care- some do try but its minimal “ “ Staff are cheerful and friendly in a demanding and stressful role “ ” Staff do seem to be exceedingly busy, could do with extra staff “ Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 19 One lady called for some time before a carer had time to go to her. Residents in the lounge were observed to be left unattended for long periods during the morning whilst the carers were helping others get up. There was no call bell in the lounge. When asked what she would do if she needed help one lady said ‘there is nothing you can do, you just have to wait until someone comes’. One visitor spoken to said that she feels residents have to go to bed early because of staffing levels in the evening. A member of staff said that they usually started putting residents to bed at 18.30 although if they wished to stay up felt that they could. Given the layout of the home and the high dependency of many residents the inspectors were of the opinion that the home would benefit from more staff on shift especially at busy periods during the day. The staffing levels should be monitored carefully to ensure that frail residents are supervised adequately, have a choice as to when they get up and go to bed and that their needs during the day are met in a timely way. The inspector viewed six staff recruitment files and found that all documentation relating to the employment of staff was satisfactory. Evidence was found at inspection that staff are supported, supervised on a regular basis and are given training to undertake care roles. Fifty per cent of care staff hold the National Vocational Qualification in Care at Level 2. Beech Court Nursing Home DS0000027140.V336071.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 poor quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home’s quality assurance systems are not robust and do not ensure that care is delivered in a timely way and is responsive to residents wishes. Health and safety procedures should be strengthened to protect residents from potential harm. EVIDENCE: The home manager has been in post since 1998. She is registered with the Commission for Social Care Inspection. The proprietor has overall responsibility for the home in conjunction with the registered manager. The inspectors were informed that the manager does not have input into the recruitment of staff as the proprietor does this. As the registered manager is responsible for the staff group she must have a role in the recruitment and retention of staff. The training and recorded supervision and appraisal of staff is good. However the proprietor and manager must ensure that the concerns identified regarding the Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 21 staff’s ability to meet residents’ needs effectively and in a timely and safe manner are met. The manager and proprietor said that the home undertakes an annual quality assurance questionnaire although the results had not yet been collated this year. This should be completed an action plan drawn up and the outcomes shared with residents and their families. This was a recommendation following the previous inspection undertaken in May 2006. There are no regular resident or family meetings. The manager said that she did not undertake any regular audit of procedures in the home for instance medication procedures or care plan audits. The quality assurance monitoring systems in the home should be developed to include a consistent self-monitoring and an internal audit at least annually. The quality assurance systems should include regular consultation with residents and their families. Action plans should be drawn up to improve the service in line with their ideas and comments. The home keeps appropriate records of expenditure made on behalf of residents and receipt are given. There are facilities for the safe keeping of residents’ valuables should they wish to keep them in the home. On the day of the inspection the inspectors rang the door- bell and walked into the lounge through the open door. The inspectors were not challenged for some time. During the wait the inspectors noticed that the medication cabinet had been left unattended and with the keys in the door. This could have led to a serious breach of health and safety and put the residents at risk. There are wheelchairs, which are used to transfer a resident from their rooms to the lounge. Although these appeared to have footplates they were not always attached and one member of staff was observed transferring a resident in a wheelchair without a footplate. This is poor practice and may put residents at risk of injury. The maintenance schedules showed that regular maintenance of services and equipment is undertaken. There is a part time handyman in post who attends to minor repairs and maintains the gardens. Beech Court Nursing Home DS0000027140.V336071.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 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 3 18 2 2 X X X X 2 X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Beech Court Nursing Home DS0000027140.V336071.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 OP7 Regulation 15 Requirement Residents must have an accurate care plan, which describes their care needs and how these are to be met. The care plan must be reviewed regularly and updated when necessary. The home must ensure that residents are encouraged to move position regularly. Where this is felt not to be in the residents best interests this should be recorded on the care plan. The management of medication must be improved by ensuring that: - the keys of the medication cupboard are not be left in the cupboard whilst the cupboard is unattended. - the opening date of medicines, which expire within a time limit following opening are recorded. - the medication refrigerator is be cleaned and de frosted regularly - a protocol is developed to guide carers who act as a second person to check controlled medication. DS0000027140.V336071.R02.S.doc Timescale for action 30/08/07 2 OP8 12(1)(a) 30/07/07 3 OP9 13 (2) 30/07/07 Beech Court Nursing Home Version 5.2 Page 24 4 OP15 16 (2) (i) 5 OP16 22 6 OP24 16(2)c 7 OP26 13(3) Residents must be offered a 30/07/07 choice of main meal. Meals must be cooked thoroughly and tested prior to be given to residents. The complaints procedures 30/08/07 should be improved to ensure that accurate records are kept, that action is taken in response to residents and their families concerns. The home must review its bed 30/08/07 stock and forward to the commission a timed plan of upgrading. The plan is to include the upgrading of bedding. The infection control policies and 30/09/07 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.doh.gov.uk. Residents should not share hoist slings, to reduce the risk of cross infection. If the net pants used to secure continence pads are not to be treated as disposable they must be clearly labelled with residents’ names and used for them only, to reduce the risk of cross infection. The home must re-assess and update residents care plans to inform them of the need to adjust the current staffing levels and ensure that there are sufficient staff on duty to meet residents’ needs in a safe and timely manner. The home’s quality assurance monitoring systems must be developed to include consistent self-monitoring and an internal audit at least annually. Residents and families should be consulted regularly. DS0000027140.V336071.R02.S.doc 8 OP27 18(1)a 30/08/07 9 OP33 24(1) 30/09/07 Beech Court Nursing Home Version 5.2 Page 25 10 OP38 13 (4)(a) 11 OP38 13(4)(c) The use of bed rails should be reviewed in line with guidance issued by the Medicine and Healthcare products Regulatory Agency Wheelchair footplates must be used when moving residents. 30/08/07 30/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The home should ensure that residents’ interests are recorded and assist residents to enjoy opportunities for stimulation through activity, in line with their wishes and choices The home should make greater effort to enable residents who are able to sit at the table in order to make mealtimes a more sociable occasion. Pedal bins should be available for the disposal of clinical waste Commode pans should not be soaked in a bath that is used for residents to bathe in. All staff should have annual updates of safeguarding training. 2 3 4 5 OP15 OP13 OP13 OP18 Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 © 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 Beech Court Nursing Home DS0000027140.V336071.R02.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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