Inspection on 04/09/07 for Beechcare Care Centre

This inspection was carried out on 4th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beechcare Care Centre 02/09/08

Beechcare Care Centre 05/02/07

Beechcare Care Centre 02/05/06

Beechcare Care Centre 21/11/05

Beechcare Care Centre 13/04/05

Beechcare Care Centre 07/09/04

Beechcare Care Centre 01/06/04

Beechcare Care Centre 20/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

Thorndene

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Beechcare Care Centre Darenth Road South Darenth Dartford Kent DA2 7QT Lead Inspector Elizabeth Baker Key Unannounced Inspection 4th September 2007 10:00 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 Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechcare Care Centre Address Darenth Road South Darenth Dartford Kent DA2 7QT 01322 628000 01322 628001 beechcare@fshc.co.uk www.fshc.co.uk Four Seasons Beechcare Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Karen Elizabeth Kempson Care Home 74 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) Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (26) of places Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2007 Brief Description of the Service: Beechcare Care Home, incorporating the Peter Gidney Unit, is a purpose built single storey facility. In May 2005 Four Seasons Healthcare Limited acquired the home. The home is situated within a five-acre site of well-maintained grounds in a rural area. Public transport is limited. The main A2/M25 junction is easily accessible by car from the home. Dartford town centre is approximately two miles to the north and is served by a regular train service to and from London, the Medway Towns and Kent Coast. There are ample car parking facilities. Bedroom accommodation comprises 58 single and eight double rooms. All bedrooms have ensuite WCs and wash hand basins. A number of ensuite rooms also have a shower. Day space consists of three lounges, a large reception room and two separate dining rooms. A large gym is currently sited on the Peter Gidney Unit. All bedrooms used by residents Users are connected to the nurse call system. The home has one mini bus for residents’ use. Current activities include bingo, newspaper readings, poetry reading, card games, manicures and skittles. At the time of the visit, fees ranged from £543.49 to £1010.36 per week, excluding the registered nurse contribution. Additional charges are made for hairdressing, newspapers, toiletries, private physiotherapy and chiropody. A copy of the latest inspection report is kept at the main reception. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key unannounced visit to the home for the inspection period 2007/08. Link Inspector Elizabeth Baker carried out the visit. The visit was carried out over two days on the 4 and 5 September 2007 and in total lasted about 15 hours. As well as touring each unit and the laundry, the visit consisted of talking with some residents and staff. Five residents, two relatives/advocates and four members of staff were interviewed in private. Feedback of the visit was provided to the Regional Director and Clinical Services Director and one of the two acting home managers. The visit was also used to assess the Provider’s compliance to the Improvement Plan issued by the Commission following the visit to the home on the 5 February 2007. At the time of compiling this report, in support of the visit, the Commission received survey forms and comment cards about the service from 8 residents, 10 relatives/visitors/advocates, one care manager and three healthcare professionals. Some of the information gathered from these sources has been incorporated into the report. The visit took place prior to the statutory return date of the requisite Annual Quality Assurance Assessment (AQAA). At the time of the visit, 60 residents requiring nursing care were residing at the home. Although the Commission has not received any direct formal complaints about the service since the last visit, the Commission was made aware of a concern made direct to the home by a healthcare professional. What the service does well: Relatives are welcome at the home at any time and are involved in the care of their relatives. The design of the home promotes independence for all residents. The provider’s representatives were receptive to advice given and demonstrated an eagerness to continue to strive to improve the home and its services further for the benefit of its current and future residents. Comments from respondents included “[The home] is good at dealing with quite complex disabilities. They are good at doing the preliminary conversations with the resident, family, friends and care managers to ensure that they can tailor the service to meet the need. They will also look further a field to ensure that an interest can be maintained”; “As a [relative] of a resident with special needs I find staff very competent when caring for them” and “The nursing staff seem very attentive to my [relative’s] needs”. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Some care staff must gain a better understanding of person centred care and not give the impression they are too rushed for time or indeed disinterested in the residents. The home must ensure that all areas used by residents are kept at temperatures to meet the individual needs of current and future residents, including the communal bathrooms on the Beechcare unit. The home should review its current staffing levels and cover so that residents are not left or inconvenienced during busy periods and annual leave. Activities and menus must continue to be reviewed with input from residents and or their advocates, to enable them a say in the range and quality of services being provided. Care staff should continue to improve their care record keeping skills to reflect the holistic needs and wishes of residents. The care home must make available on site appropriate pressure relief/preventative equipment to meet the assessed needs of the current and future residents. Facilities for residents to use when requiring assistance must be reviewed to see that appropriate equipment is left easily accessible for their use. Residents must be moved in the way described on their corresponding risk assessment, to maximise their safety. All matters constituting adult protection must be reported in accordance with the County’s Adult Protection Procedures, to maximise residents’ protection. Additional comment card responses included “More help with outside activities, ie shopping, pub, seaside, garden centres”; “I think more staff would be helpful, sometimes staff are too busy to attend”; “[it would better] if new overseas staff were more knowledgeable of the roles of other health professionals in the PCT”; “Need more carers at bedtime as some residents are left waiting and carers do not have time with the residents to talk, as they are always on the go”; “Staff do not always have the right skills and experience to look at residents properly, the [permanent] staff are very good but some of the agency nursing staff are not as good or friendly”; “More outings for residents and one to one time with residents”; Staff do listen and act on what I say, but it would be preferable not to have to ask for things to be done in the first place. Very concerned recently as my [relative] was left in their room for a considerable number of hours without being moved or given a drink. There never seems to be enough staff”; My [relative] asked the nursing staff a question once and got a blank look and they didn’t even know the name of the Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 7 manager”; “We would like more help with feeding, particularly breakfast and lunch. Responses to raised concerns can be very slow and often we have to ask several times” and “Continual calls from residents and bells ringing that take a long time to be responded to”. 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. Beechcare Care Centre DS0000026147.V348455.R01.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 Beechcare Care Centre DS0000026147.V348455.R01.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): 1, 3 and 6. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents move into the home knowing their needs can be met. EVIDENCE: The home’s brochure, service user guide and statement of purpose are currently under review to reflect the environmental changes currently taking place. The provider will be issuing new documents shortly. Standard 1 will be assessed at the next visit. Generally the home manager visits prospective residents in their current place of occupation to determine whether the home is suitable to meet their individual assessed needs. Information is also obtained from other health and or social authorities as part of the pre admission process. If admission is appropriate, the information gathered from these sources forms the basis of the residents resultant care plan. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 10 Because not all prospective residents are able to visit the home prior to a decision of their admission being made, some come in initially on a respite or trial basis. Indeed during a conversation with a particular resident this was their experience, leading them to decide to stay at the home on a permanent basis. The home is not registered for intermediate care. Standard 6 is not applicable. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Residents who use the service experience adequate quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. The health and personal care needs of residents are usually met with evidence of multi-disciplinary working taking place when required. EVIDENCE: Since the last visit there has been an overall improvement in the standard of care record keeping. The care records of six residents were inspected for case tracking purposes. Care records contained dependency assessments, care plans and a variety of supporting clinical and other risk assessments, including tissue viability, nutrition, pain, falls, oral hygiene and moving and handling. Registered nurses and key workers maintain their respective daily records. However the content of the actual care record information varied between Beechcare and Peter Gidney. While one unit provided more care plan detail the other unit provided a more holistic picture of residents’ quality of day experiences. Some practitioners use meaningless phrases to describe the care they have delivered to residents, such as “safety maintained”. This is contrary to their professional body’s guidelines to record keeping. One resident described two particular needs, which were not reflected in their respective care plan, but which impacted on their daily routine. Staff were unaware of Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 12 this. Moving and handling assessments contain details of how residents are to be moved. Disappointingly one transfer was carried out contrary to the care records instructions, placing the resident at risk. Standard 38 refers. As is expected of homes providing nursing care, Beechare has a range of pressure relief and preventative equipment. Indeed some was seen in use. On an assessed needs basis there are occasions when specialist equipment is made available to specific residents from the local primary care trust. In one particular case where the treatment was effective, the trust gave notice of removing the equipment and instructed the home to substitute the equipment with “like for like” provision. This did not happen resulting in the resident acquiring a grade III pressure sore. For the resident’s safety the trust reinstated the appropriate equipment for the resident. The wound is now healing. The home has since acquired more pressure relief equipment. However during this visit it was identified that another resident has been supplied with a static pressure relief mattress because their air pressure mattress has broken down. The resident and senior staff member were both of the opinion that arrangements for the repair of the equipment would be made by the maintenance man. The maintenance man is on annual leave. A visit to another of the provider’s care homes identified that there are occasions when pressure relief equipment is borrowed from homes within the group, including Beechcare. As primary care trusts no longer automatically provide specialist equipment, it is essential each care home have sufficient equipment easily identifiable on site. Each unit has a clinical room in which medicines, nursing aids and sundries are stored. The rooms vary in size, resulting in the one on Peter Gidney Unit being cramped. To get round this the drugs trolley on that unit is stored in a separate cupboard. The decorative state of the Beechcare clinical room does not allow for effective cleaning, as plaster boards, which have been installed on some walls have not yet been painted. It was also noted on this visit that the type of the lock on the Beechcare unit is not the type expected to maximise security. Residents and an advocate were complimentary about the laundry service. Indeed one respondent added, “First class laundry service – nothing gets lost. Clothes nicely folded and put away properly”. Residents spoken with indicated their dignity is maintained when care staff assist them with their personal hygiene needs. However a survey respondent commented that a particular hoist is embarrassing for them to use. Care staff were seen knocking on bedroom doors. Sadly they did not always wait for an answer before walking in. Care plans now contain a component about death and dying and there was clear evidence that staff are striving to obtain this information. However the records seen contained no spiritual or cultural information. Care records also contain forms relating to resuscitation. However in one case the form had Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 13 been started inferring the resident may not wish to be resuscitated, whereas the corresponding care plan clearly stated they did. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 14 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. Residents who use the service experience adequate quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. Although staff are caring and well meaning, their actions do not always demonstrate this is the case, resulting in some residents feeling left out and bored. EVIDENCE: The home’s routines are flexible enabling residents to choose how to spend their day. A weekly activities programme is usually put up in certain places around the home. However some residents said the notices are too high for them to read. This was also the case for menus. The provider is aware of this and intends to introduce new practices once the redecoration of the home is complete. Since the last visit one of the two activities co-ordinators has left. The home has a mini bus to take residents on trips out. Unfortunately the activity co-ordinator is unable to drive this so trips have been curtailed. It is anticipated the new activities co-ordinator will be starting shortly and residents are hopeful that she will be able to drive the mini bus. Some staff where observed interacting, assisting, communicating and responding to residents in a calm, interested and reassuring manner. However some poor practices were seen including assistance with meals and not responding appropriately to requests for assistance. Other residents were seen left without much or any meaningful interaction for long periods. Whilst acknowledging there is only Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 15 one activities co-ordinator at the current time, all staff have a duty to interact positively with residents. Indeed comments from residents about how they are spending their days included “I feel I am under arrest here – curtailed in doing things I want to do”; “Bored out of my head”; “Spend my days just like this – boring”; “Nothing to do for me all day other than watch TV”; “Fed up sitting here doing nothing” and “Not enough goes on here to keep me occupied!” As part of the refurbishment programme, a large flat screen TV has been provided in the main Peter Gidney Unit. This is much appreciated by those residents who use this room. The gym is currently being re-arranged so that it can be used for the dual purpose of providing physiotherapy treatment and or as a small theatre where DVDs and other entertainment will be shown from the very large screen, which has just been installed. Some residents like to continue with their religious observance, as this has been very important to them throughout their lives. Indeed a number of residents receive Holy Communion on a weekly basis from a layperson of their church. And a monthly religious service is arranged at the home for any resident to attend, if that is their wish. Comments about the home’s menus and quality of food varied. These included “Food is good”; “Food quite nice”; “Meals are alright at times, although I still get served things I don’t like”; “Meals are up and down”; “Food is terrible”; “Meals are passable”; “Haven’t noticed an improvement in the meals”. Where residents have a particular like or dislike this is not always appropriately recorded and they continue to be presented with meals they do not like. The provider has introduced a new form to obtain details of likes and dislikes. Not all care records inspected contained these forms. Those that did have them were not always totally reflective of the current situation. Some residents require special diets and or assistance with their meals. Sadly on this visit one resident was seen receiving assistance from a carer in a non-attentive manner. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 16 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. Residents who use the service experience adequate quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. Not all complainants can be assured their concerns are taken seriously and acted upon. EVIDENCE: Although the Commission has not received any direct complaints about the service since the last visit, the Commission was copied into one made directly to the home manager. The provider has investigated this under its own complaints procedure. However the findings of the investigation may have constituted adult protection (AP). The matter had not been referred under the county’s multi agency’s AP procedures. The provider’s policies and procedures contain guidance on what constitutes adult abuse. The matter referred to in this instance is included in the guidance. The matter has now been appropriately reported to the county’s local AP contact who indicated they are satisfied with how the matter is currently being dealt with. It is recorded that the home has reported other concerns under the County’s AP procedures in a timely manner. The home maintains a complaints record book. However a review of this identified that not all matters of concern or complaint had been recorded. The training matrix indicates some staff have received protection of vulnerable adults training since the last visit. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 17 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, 21, 22, 23, 24, 25 and 26. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. The current refurbishment work has made the home a nicer place for residents to live in. EVIDENCE: Since the last visit the provider has commenced on a refurbishment and upgrade programme of both units. So far bedrooms on the Peter Gidney unit (PGU) have been refurbished, dining rooms and lounges on both units have been refurbished and a separate designated smoking lounge has been provided on the Beecchare unit. Work to upgrade the home continues, including the proposed re-vamping the satellite kitchen on the Peter Gidney Unit and making good bedroom doors on the Beechcare unit. As stated previously the gym has been re-arranged and redecorated so that it can now be used for the dual purpose of treatment and entertainment. The dining room tables in the PGU are height adjustable making it easier for residents who use wheelchairs. Sadly this design was not extended to the dining room on the Beechcare unit, even though residents requiring wheelchairs also reside in this unit. Indeed one resident commented that the home changed in the dining room tables on Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 18 Beechcare without consultation and the new ones are more difficult for eating when in a wheelchair. The local council carried out a food hygiene inspection at the home on the 23 August 2007. A couple of points were made. The acting manager said this has been complied with. Because of this a reinspection of the kitchen was not undertaken. The home sits within extensive grounds, which are generally kept in good order. Indeed residents and their advocates were seen walking around or sitting out enjoying the good weather. A number of en suite rooms on Beechcare are being upgraded. A resident mentioned this was the reason why they were not having their regular showers at the moment. There are a number of communal bathrooms on this unit. However the resident mentioned that they feel the cold and had declined using these facilities. These bathrooms are not heated via fixed radiators but are dependent on the use of electrical bar heaters. To bring the bathrooms up to an acceptable temperature there is a need for the heaters to be turned on sometime prior to the room being used. There are no wall thermometers in these rooms to monitor the situation. The onsite laundry is suitably equipped to do the home’s washing as well as residents’ personal clothes. Bed linen is supplied to residents as part of the normal contractual conditions. However the standard of linen seen on some residents’ beds was poor in that it was thin and in one case torn. This could compromise residents’ skin integrity. Rooms used by residents are connected to the nurse call system. However not all residents were in a position to safely activate the alarm when they required help. This included a bedfast resident on the Peter Gidney unit and two residents sitting in a Beechcare unit lounge. This resulted in visitors seeking assistance on behalf of the residents. Indeed during a conversation with an advocate it transpired it is not uncommon for visitors to assist other residents in seeking staff support. The home has a range of lifting and moving aids so staff can safely transfer residents. Since the last visit the home has acquired more slings so they are used by fewer residents. It is the home’s intention to acquire more. Having individual slings helps minimising cross infection hazards. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 19 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. Residents who use the service experience adequate quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. The visibility and availability of staff give residents and advocates the impression the home is understaffed. EVIDENCE: In addition to care staff, staff are employed for cooking, activities, housekeeping, laundry, administration and maintenance. Staffing levels generally followed the minimum levels set by the original regulatory authority in 2001. Dependency assessments are used, which should assist the home in determining whether staffing levels reflect the assessed needs of the current residents. Despite this some residents were seen calling for assistance without appropriate acknowledgment from staff within their vicinity. Indeed comments about staffing from respondents, residents and advocates included “the reason staff give [about their availability] is that they are too busy due to staff shortages; “They are always doing somebody else”; “Insufficient staff particularly around coffee and tea times and handovers. Somebody may visit and tell residents they’ll have to wait until handover is finished” and “On the rare occasions I have been put on the toilet the staff have left me there to go for their tea break”. Although the home employs a maintenance man, there is no planned cover for his leave. Although it was reported on this visit that some additional cover had been provided from another home, the off duty roster provided in support of this visit, did not include this information. A respondent commented, “when a Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 20 light bulb goes and [maintenance man] is not on duty, nobody else can do it and we have to wait until he gets back”. Staff files inspected demonstrated procedures had been followed for the recruitment and appointment of staff. This includes attending interviews, completing application forms, obtaining full employment histories and relevant references and clearance. In support of this visit the home provided a copy of the up to date training matrix. This indicated that since the last visit some staff have received training covering various topics such as moving and handling, protection of vulnerable adults, fire awareness, fire warden training and first aid. Customer care training is provided. Despite this a comment card respondent added an additional comment “It is not pleasant to hear care staff bickering amongst themselves, usually about what they will and will not do”. After the initial induction programme, new unregistered care staff are required to undertake in-depth induction training. The intention is that unregistered care staff then progress to undertake and complete NVQ level II training in care. However this is not proving the case. To date the percentage of unregistered care staff now trained to NVQ level II or equipment is 16 , which is far below the 50 percent now expected. During an interview with a carer there appeared to be some confusion about the funding for NVQ training, which may be one of the reasons why take up is not as good as the provider would like. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 21 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, 34, 35, 37 and 38. Residents who use the service experience adequate quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. The interim management arrangements together with regional support, has not impacted on the welfare or well being of residents. EVIDENCE: The registered manager is a registered nurse and since the last visit has successfully completed a Registered Managers Award course. Because of her absence, two other home managers are running this home on a temporary basis, with regional support. A peripatetic manager was expected to take as of the 28 August 2007. However this has now been revised to 10 September 2007. The provider is committed to improving the service and resources and systems are in place to assess the quality and performance of the home. This includes annual surveys, facilitating meetings and regular internal and external audits. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 22 Indeed the provider undertook a financial audit last week. A bedrail audit coincided with this visit. The home is currently responsible for maintaining personal monies on behalf of some residents. Appropriate records are kept. Information is now available to current and future residents informing them of some restrictions to this service, if residents wish to use it. The residents’ financial records were included in the recent financial audit. Since the last visit two members of staff have undertaken fire warden training, four others have completed first aid training and many have attended moving and handling training. Sadly as mentioned previously, this did not prevent a resident being moved inappropriately. Following the refurbishment works on the Peter Gidney unit, storage arrangements for residents’ care records have changed on the Peter Gidney unit. While the arrangement increases residents’ confidentiality, the current situation prevents all care staff having easy access to the care records when required. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 23 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 2 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 2 2 2 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 X 2 2 Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4 and 5 Requirement The home’s brochure must accurately reflect the current registration of the service. Timescale 30/08/07 not met. The home’s brochures are to be reviewed following the completion of the refurbishment works. Care plans must reflect all the care needs, preferences and wishes of residents. The home must ensure it has appropriate and sufficient pressure relieve/preventative equipment on site to meet the assessed needs of current and potential residents The range of activities and facilities must reflect the preferences of all residents. The selection of meals must reflect the preferences of all residents. All adult abuse allegations must be referred in accordance with the County’s Adult Protection procedures Residents must be easily able to DS0000026147.V348455.R01.S.doc Timescale for action 31/01/08 2 3 OP7 OP8 15 16(1)(2) (c) 15/10/07 15/10/07 4 5 6 OP12 OP15 OP18 16 16 13(6) 30/11/07 30/11/07 15/09/07 7 OP22 23(2) 30/11/07 Page 25 Beechcare Care Centre Version 5.2 8 OP25 23(2)(p) 9 10 OP27 OP38 18(1)(a) (b) 13(5) access call alarms when assistance is required All rooms used by residents, including communal bathrooms on the Beechcare unit, must be appropriately heated to meet the needs of the individual residents. Staffing levels and cover must be reviewed to reflect the needs of the current residents Residents must be moved in accordance with their respective moving and handling assessments 15/10/07 30/09/07 15/09/07 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 2 Refer to Standard OP8 Good Practice Recommendations Daily records should contain a meaningful picture of the residents quality of day experiences; Meaningless phrases should not be used The lock to the clinical room situated on the Beechcare unit should be BS level 5 type; Clinical rooms must be maintained in a good order to promote effective cleaning All staff should interact with residents in a positive and meaningful way A record of all types of complaints must be kept to demonstrate the home takes all kinds of complaints, niggles and adverse comments seriously Dining furniture in both units should reflect the needs and preferences of the residents residing on the units. All bed linen used by residents must be of a quality which does not compromise their skin integrity Residents requiring hoist assistance should be provided with individual slings to minimise cross infections. 50 of unqualified care staff must trained to NVQ level II care. OP9 3 4 5 6 7 8 OP10 OP16 OP20 OP24 OP26 OP28 Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 26 9 10 OP37 OP38 All residents’ care records must be easily available to care staff at all times. The fire safety logbook must evidence fire safety checks are being carried out as required, by fire safety specialists. Not inspected this visit. Beechcare Care Centre DS0000026147.V348455.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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