Inspection on 05/02/07 for Beechcare Care Centre

This inspection was carried out on 5th February 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 04/09/07

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 Unannounced Inspection 5th February 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.V322827.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.V322827.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.V322827.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7 August 2006 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 Service Users are connected to the nurse call system. The home has one mini bus for residents’ use. Available activities include bingo, quizzes, local theatre and shopping centre trips. At the time of the visit, fees ranged from £407.12 to £1135.98 per week, exclusive of hairdressing, newspapers, toiletries and chiropody charges. A copy of the latest inspection is kept at the main reception. Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key unannounced visit to the home for the inspection period 2006/07. A random unannounced visit was made to the home on the 10 October 2006. The inspection carried out on the 5 February 2007 was undertaken by Lead Inspector Elizabeth Baker and Regulatory Inspector Justine Williams (Registered General Nurse). As well as touring the home, the visit consisted of talking with some residents and staff and inspecting some records for case tracking purposes. Five residents, one visitor and one member of staff were interviewed in private. A number of other residents and staff were also spoken with. Feedback was provided to the home manager at the conclusion of the visit. At the time of compiling this report, in support of the visit, the Commission received comment cards about the service from two residents, four relatives/visitors and three health care professionals. At the Commission’s request the home manager completed and returned a pre-inspection questionnaire. Some of the information gained from these sources has been incorporated into the report. At the time of the visit, 61 residents were residing at the home. Since the last visit the Commission has received one anonymous complaint about the home. This is being dealt with under the County’s Adult Protection procedures. What the service does well: The former regional manager carried out a thorough and lengthy reinvestigation into a complaint, to the complainant’s satisfaction. Residents were complimentary of staff and stated “nursing staff are brilliant, keep a good eye on you and carers are good as well” and “staff are really nice”. A newly appointed healthcare assistant spoke enthusiastically about her role and her desire to commence NVQ training in care. The design of the home enables residents with a physical disability, as well as self-propelling residents, to move freely around the home and grounds. Visitors are able to have meals with their relatives/friends, subject to a small charge. The home maintains personal monies on behalf of residents if requested. To ensure residents are kept informed of account balances, statements are provided to residents after a transaction is made on their behalf. As well as the conventional nurse call buzzers, touch call pads are available. This helps to ensure that most residents are able to request assistance when there is a need. Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current brochures may inadvertently mislead potential residents to the Peter Gidney Unit due to descriptions and pictures not being totally reflective of the actual situation. Not all of the information gathered at the initial pre admission stage is adequately recorded, potentially placing some residents at risk of their complete needs not being met. EVIDENCE: Beechcare Care Home incorporates a separate facility known as the Peter Gidney unit. The home is currently registered for and inspected against National Minimum Standards for Older People. The Peter Gidney Unit was originally commissioned in 1997 to operate as separate spinal injury unit. Indeed the majority of residents admitted to the Peter Gidney unit at that time were residents with spinal injuries requiring intensive rehabilitation prior to returning to their own homes for independent living. However this is no longer the case. Indeed the majority of residents now admitted onto this unit are permanent, below pensionable age, with chronic medical and or physical conditions such as strokes, MS, Parkinson’s and epilepsy. The ages of the last Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 9 three residents admitted into the unit are 54, 61 and 64. The unit’s current brochure contains pictures and text, which does not now wholly reflect the service. In order that the home is appropriately registered and inspected the provider is required to contact the Commission so discussions can take place to determine the correct registration of the home, with particular regard to the Peter Gidney Unit. Prospective residents and or their advocates are provided with an information pack, which contains various documents including the home’s statement of purpose, service user guide and colour brochure. However one newly admitted resident said they had not been provided with any information prior to moving in. And a comment card received from a resident indicated they had not received enough information about the home before moving in. Where possible, the home manager endeavours to visit and assess prospective residents in their current environment prior to a decision of admission being made. A number of assessments relating to recently admitted residents identified they were incomplete of all the information. As admission assessments are used to inform care plans this could result in some important aspects of care, including social needs and preferences, not being identified and consequently met. The home is not registered for intermediate care. Standard 6 is not applicable. Beechcare Care Centre DS0000026147.V322827.R01.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, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care records are still not wholly reflective of residents’ complete needs, preferences and wishes, potentially placing them at risk. Improvements in medicine storage facilities would reduce potential risks to residents. EVIDENCE: The maintenance of care records varied between the two units. Although an improvement was noted on both units, some records were still deficient of important information. The care records tracked contained care plans and associated clinical risk assessments. These included nutrition, continence, skin integrity, oral hygiene and moving and handling. However some of the forms where blank, incomplete and unsigned. There was limited social information and in one case the form was blank. Skin integrity assessments, when completed, contained details of the preventative/relief equipment provided. Not all care plans evidenced they had been composed with input from the resident and or their advocate. And a comment card received from a Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 11 relative/visitor indicated they are not kept informed of important matters affecting their relative/friend’s care. Death and dying information, including spiritual and cultural preferences, is still lacking. As the majority of residents admitted to the home live there for the rest of their lives, this is an important aspect of care and needs to be addressed. Progress sheets are maintained on a daily basis. Those reviewed on Beechcare provided a picture of the resident’s quality of day as well as their physical/medical condition. However those on Peter Gidney only covered the physical/medical condition. The home has a limited range of its own pressure relieving/preventative equipment for residents who have or who are at risk of developing pressure sores. A comment card respondent from a health care professional included the additional comment, “by taking more responsibility for providing pressure relieving/reducing equipment, the service could be improved”. During the visit a resident said they felt the cold and had been unhappy because the heating in their bedroom had been broken for a few days. The resident’s care plan did not contain any information about the resident’s body temperature preferences and needs, even though these are well known to care staff. Neither could the lack of heating be identified in the respective care records. The resident had just completed a course of antibiotics because of a chesty cough. It is of a serious concern that although care staff were aware of the resident’s medical condition they failed to report the matter to the home manager. This situation placed the resident at risk. The home has a number of residents who like to smoke. Information about the risks and preventative action was seen incorporated into individual general risk assessments and in a number of cases incorporated into the accompanying care plan. However the information is still not comprehensive. For example where supervision is stated as being required, the actual level is not recorded. Residents spoke well of the laundry service and commented that items taken for washing one day are usually returned the next. However one resident was seen dressed in a creased jumper with their name label exposed on the outside of their socks. This situation does not protect the dignity of residents. The topic of laundering of residents’ clothes was included in the last residents’ meeting notes in that it is stated “sometimes their clothes come back ruined or shrunk and they often get the wrong clothes back”. A number of medication administration record charts were inspected and found to be in order. Each unit has a clinical room in which medicines, nursing aids and sundries are kept. The size of the room on Peter Gidney is limited, resulting in the drugs trolley having to be kept separately in a small storeroom. The room is not monitored for temperature control purposes. This situation may affect the efficacy of some medications. Following new regulations for the Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 12 disposal of waste medicines, new storage bins have been acquired. Each clinical room has its own. However both bins were overflowing. The provision of the bin in the Peter Gidney unit clinical room has further reduced the workable area for registered nurses when preparing and working with medicines. Beechcare Care Centre DS0000026147.V322827.R01.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although dietary needs of residents are catered for with a balanced and varied selection of food, the provision available does not meet all residents’ tastes and preferences. The availability and range of activities do not meet the choices and aspirations of all residents. EVIDENCE: A weekly programme of activities is produced and displayed on notice boards around the home. However the programme seen in the Peter Gidney dining room was out of date. A game of bingo was underway during the afternoon of the visit in the Beechare dining room. Some residents were seen sitting in two of the day rooms watching television. Other residents were in their bedrooms watching their own TVs, listening to the radio or reading. While some residents felt the choice and availability of activities was satisfactory others did not. Indeed one resident commented that it is boring. One resident mentioned they liked using computers but the home does not have one for residents’ use. Comment card responses about activities included “they have a very good activities programme here”, while another comment card respondent indicated the resident could only sometimes join in the activities at the home. Indeed the latest residents’ meeting notes includes the comment that “residents have Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 14 asked for more theatre trips and some would like to try paper Mache and some have asked for painting”. There was no indication whether these requests have been taken on board. Visitors are able to come and go as they wish. Indeed a visitor said they visit every day, and have supper and Sunday lunches at the home every week with their relative. This arrangement is very much appreciated by the visitor. Residents are supported in attending day centres, where this has been an important part of their life prior to moving into the home. Residents said they are offered daily menu choices and indicated meals are normally good. However details of residents’ likes and dislikes are not well described in their care records. Although one resident said they receive portion sizes to their liking, another resident indicated portions could be a bit large which is a bit off putting for them. A resident said that although the food is quite good they do not like most of what is offered, for example cauliflower cheese and pasta, although they do enjoy fish and roasts. Another resident indicated the food has deteriorated lately with regard to what is offered and how it is cooked. This is disappointing, as it was picked up at May 2006 visit that meals had actually improved, following a period of poor provision. Beechcare Care Centre DS0000026147.V322827.R01.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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems are in place for residents and others to make a complaint. Systems are in place for residents and others to make a complaint. Although more staff have received adult abuse training, this does not guarantee all residents are protected from all forms of abuse. EVIDENCE: The home has a complaints procedure, which is displayed in the main reception, and sets out the provider’s complaints route. A local complaints procedure has also been developed and is included in the information pack, which is provided to prospective residents and or their advocates. The procedure contains the address and telephone number of the Commission. Since the last visit the Commission has received some information alleging poor care. The informer is anonymous. The allegations are now being investigated under the County’s adult protection procedures. The Commission is also aware of another complaint made directly to the provider. These matters had not been recorded in the home’s complaints logbook. At the last key visit it was identified that not all staff have received adult protection training. Indeed the home did not have a copy of the County’s adult protection procedures. The manager now advises that the home has obtained a copy of the procedures. Following that visit a recommendation was made that all care staff receive adult protection training. The training matrix received from the manager on the 12 February 2007 indicates that eight members of staff had received such training at the time of this visit to the Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 16 home. The matrix also indicates that a further nine staff have subsequently received such training. Despite this as already stated in this report, a resident was left to sleep in an unheated bedroom, although staff had been made aware of the situation. Other issues of concern as noted in this report, do not fully protect service users from harm. Beechcare Care Centre DS0000026147.V322827.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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been no change in the décor or furnishings in the home, despite assurances from the provider that a planned refurbishment programme was to commence. Although this does not place residents at risk it does not create a pleasant and pleasing place for residents to live in. EVIDENCE: Beechcare is a purpose built care home, providing nursing care. It was originally built and equipped to a high standard in 1989. However with the passage of time, and lack of meaningful re-investment, the home is looking shabby. Despite assurances given to residents and the Commission by the former and new providers refurbishment has not taken place. Indeed comments about the internal environment received from comment card respondents as well as residents themselves included: “needs decorating to cheer it up”, “décor is scruffy” and “[the home] needs tarting up”. Walls, doors and doorframes in corridors and bedrooms are damaged by continual Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 18 contact with nursing aids and equipment. The provider’s response to the May 2006 visit included the comment that the Regional Estates Department had undertaken a review of the contact damaged and metal door coverings had been ordered. The manager said on this visit that this did not happen because of the intention to refurbish the home. Following the random visit to the home on the 7 August 2006 the provider responded that a refurbishment plan is in place and they were currently awaiting quotes for all areas of work contained within the refurbishment plan. A copy of the improvement plan was to be forwarded to the Commission when complete. Indeed the manager had reported at that visit that the works were due to commence in November 2006. As there had been no communication from the provider or home on this matter, the provider was reminded on the 30 November 2006 that the plan was still awaited. The provider responded that an initial visit had been made by their Estates Department and they were devising a full refurbishment programme, which would be forwarded to the Commission once received from them. On this visit the home manager said the programme has been postponed. The Commission had not been formally advised of this. The home’s environment had been a topic at a residents’ meeting facilitated shortly after Four Seasons acquired the home from the previous owners in May 2005. During that meeting residents and their advocates were informed by the providers that the home would be refurbished. A copy of the most recent residents’ meeting notes includes the comment “Refurbishment – Residents have asked when this will take place”. Residents are able to smoke if they so wish. However there are no separate designated smoking lounges. Smoking currently takes place in an area of the main reception room on the Beechcare Unit and in dayroom of the Peter Gidney unit. Both the areas are near to windows for ventilation purposes. However this situation may prevent other residents who wish to sit near windows to enjoy the views sharing this space because of the fumes. At a previous visit a resident said they are put off going into the day room on their unit because of the smoke, particularly because they are vulnerable to respiratory conditions. There is no mention in the home’s statement of purpose of the fact that smokers are admitted or to the fact that smokers share communal areas with non-smokers. Residents spoken with indicated they had bath or showers as often as they liked. Indeed in one case the resident said they have a shower daily, which they enjoy. The home is designed with wide corridors and handrails are fitted throughout. This enables residents to move around and through each unit independently. Some residents have been provided with touch call buzzers, as they are unable to use the conventional type. The majority of residents require assistance with moving and handling by the use of mechanical hoists. However it was identified on this visit that it has not been the home’s practice to provide residents with individual slings. To minimise cross infections, it is recommended that individual slings be provided for each resident who requires Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 19 them. Kent Health Protection Unit’s publication “Guidelines for Infection Prevention and Control in the Community” (January 2006) provides additional information on this subject. During a visit to a particular bedroom and ensuite room, the wallpaper dado was torn in places and nine tiles had been taken off the ensuite room wall, as they were about to fall off. There was no indication when they would put back. Wallpaper above the dining room serving hatch in the Peter Gidney unit has started to come away from the wall. There is evidence there has been a leak in this spot. As mentioned previously, during the visit a resident said they had been without heating in their bedroom for a number of days. The matter was recorded in the maintenance book, but because the maintenance man was on annual leave, nothing was done. The manager was unaware of the situation. With the inspectors’ intervention the radiator was replaced prior to the completion of the visit. Maintenance was a subject brought up at the residents’ meeting held on the 30 January 2007. The notes record “residents have said about no cover when [the maintenance man] is on annual leave and their light bulbs need changing and if their heating goes wrong”. The main kitchen was clean and tidy on this visit. An inspection by the environment health department of the local authority was carried out on the 8 August 2006. This resulted in a number of requirements and recommendations being made. The manager reported that all the works had been concluded. It was therefore of a concern on this visit that one of the light diffusers in the Peter Gidney unit satellite kitchen was again seen to be dirty and contained dead inspects. This matter was included in the environmental health report as well as the Commission’s previous inspection report. Although prepared food had been labelled, refrigerated limited life juices were again noted not to be dated on opening. Fresh skimmed milk with a use by date of 2/2/07 was stored in the Peter Gidney unit satellite fridge. The home’s fridge in the gym contained items well past their use by dates, for example fresh raspberries (mouldy and furry) with a display by date of 18/1/07 and a carton of yoghurt with a use by date of 26/1/07. In addition, the fridge contained a can of slimming drink and a can of lager with respective use by dates of 06/2005 and 06/2002. Nursing sundries have now been removed from a particular resident’s ensuite room. This situation allows for easier use of the facilities as well as more effective cleaning of the room. However it was again noted that separate facilities for the storing of unused wheelchairs or large hoists have still not been provided. Indeed wheelchairs and other pieces of equipment are parked in the Peter Gidney gym and a large hoist and commode chair stored in a particular bathroom on the Beechcare unit. The gym is also being used to store cupboards containing incontinence pads. The room now resembles a Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 20 large store as opposed to a gym. This is despite the room still being used as a gym three times a week by residents for physiotherapy sessions. Although no odours were noted on the Beechcare unit, odours were noted along corridors in the Peter Gidney unit. A comment card respondent remarked “I find the smell in the corridor often offensive. I would have thought that the unavoidable odours could be better controlled”. The respondent does not identify which unit the comment refers. Residents’ rooms are provided with lockable facilities. However not all residents have been provided with keys. This is by choice by some but not others. Whilst acknowledging some residents have dexterity difficulties, consideration should be given to investigating other methods, which would enable residents to secure small items of importance or value for themselves, if that is their wish. Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 21 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well staffed, although availability to residents is sometimes lacking. Scrutiny of information provided by new applicants has improved, minimising potential risks to residents. EVIDENCE: As well as care staff, staff are employed for catering, cleaning, administration, activities, maintenance and gardening. Staff rotas are maintained and demonstrate the home is staffed 24 hours a day. The staffing levels on each unit generally follow the levels required by the former regulatory authority in 1997. Despite this residents indicated that responses to the nurse call buzzers vary. Comments included “ do not have to wait long when ringing the buzzer, but has to wait to get dressed” and “sometimes I have to wait up to 10 minutes”. Survey respondents included comments such as “sometimes a little short of staff”, care usually very good but due to shortage of staff and volume of work my relative sometimes has to wait longer than they are comfortable with for toileting” and “not enough staff”. According to the returned pre inspection questionnaire form 19 of unregistered care staff are now trained to NVQ level II. Sadly this only a six percent increase since the last key unannounced visit. There is an expectation that at least 50 of unregistered care staff now have this qualification. Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 22 Following a requirement about the need to obtain full employment histories made at the random visit, the home has carried out an audit of all staff files and written to those employees where employment gaps appear. So far 50 of staff has supplied this missing but vital information. A review of staff files of two new members of staff showed requisite references had been sought and replies received. The applicants had been processed for criminal bureau record checks and subject to POVAfirst checks. Another file was inspected and this related to a member of staff transferring from another home within the organisation. This contained all the original documentation and provided incorrect information. Indeed details referred to the applicant still living in another county and details of the applicant’s maiden name. The applicant is male. It has not been the home’s practice to involve residents in the interviewing of new applicants. Introducing this enables residents to ask questions that staff perhaps would not normally think important, but which could be essential to residents. The training matrix supplied to the Commission on the 12 February 2007 in support of this visit identified that some staff have received training in subjects including POVA, basic food hygiene, fire awareness, diabetes, nail care During a conversation with a kitchen assistant who had recently changed roles, it transpired the employee had not received any training relevant to her new role. Four basic food hygiene certificates are displayed in the Peter Gidney Unit dining room. All are dated December 1999. Two of the employees are no longer employed at the home. In the laundry a first aid certificate is displayed. It names the employee as an “appointed person”. The certificate was awarded in February 2000. The employee said they had received no refresher or other first aid training since that time. Although the training matrix includes the names of three members of staff who have received first aid training in 2004 and 2005, it does not state whether the staff are “appointed persons”. A newly appointed health care assistant spoke enthusiastically about her role and aspirations for the future in the care profession. Indeed she expressed an eagerness to commence NVQ care training. New staff are required to undertake a three-day intensive induction programme. This leads into a more in-depth induction programme during which the employee works under the supervision of a mentor. Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 23 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, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A permanent manager who is trying to improve the service now runs the home. However her limited managerial experience and the lack of support from some senior staff could have a detrimental impact on residents. EVIDENCE: The new manager has now been in post for a year. The manager is a registered nurse and has almost completed the Registered Managers Award course. Residents and staff spoke openly throughout the visit. The manager said the organisation has just instigated a satisfaction survey seeking the views and opinions of residents of the services provided by Beechcare. Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 24 All care staff are now receiving supervision. However it was established that the manager herself does not receive formal supervision. The manager reported that although line management support by phone is available whenever she needs it, she does not feel this is sufficient. The home facilitates residents meetings and these are carried out on a regular basis. However there was little evidence on this visit that matters identified during these meetings bring about service improvements the residents desire. It has not been the manager’s practice to facilitate relatives meetings. The preference being that she has an open door and relatives can always approach her. Indeed a relative said how helpful the manager has been to them. However this practice does not encourage greater debate about the home’s current services and practices, which formal relatives meetings may encourage. The organisation has made available various quality assurance policies and procedures to assist home managers in auditing their services. Disappointedly these are not being properly followed at the home resulting in some poor standards being repeatedly identified during regulatory visits. For example the state of the Peter Gidney unit kitchen and contents of refrigerators. It is also apparent that the manager is not always aware of events affecting the welfare and wellbeing of residents. In particular the resident who had to endure sleeping in a cold room because their heating appliance had broken. The organisation has published and provided the home with policy and procedure manuals. These are held at both nurses’ stations. The new member of staff was aware of these and had started to familiarize herself with the contents. The home provides care for residents with complex medical needs. One of conditions is not included in the home’s policy and procedure care manual. However a copy of a relevant clinical publication, recommended by specialist respiratory nurses, is held on the Peter Gidney Unit. The manager was unaware of the existence of this guidance. Including the availability of the document into the home’s manual may assist bank or agency registered nurses in accessing the information if required. There is a notice in the Beechare unit informing the public of the availability of registration reports. It was suggested the wording be changed to inspection reports, to prevent any misunderstandings. It was also identified on this visit that it has not been the home’s practice to draw attention to the availability of inspection reports on the Peter Gidney unit. Having this information on both units may assist visitors who always go direct to the Peter Gidney unit in accessing such information. The home is responsible for maintaining personal monies on behalf of some residents. To assist in the recording of this, the organisation has published and provided appropriate documentation. However staff are not always completing Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 25 the forms as is required. This could be problematic if an investigation into misappropriation of funds was carried out. Residents monies are held appropriately. Receipts are obtained for services and items purchased or obtained on their behalf. Residents are provided with balance statements after each transaction. This is good practice as it keeps residents and or their advocates up to date. Although there has been an improvement in the maintenance of records, not all care records had been completed or signed as required. The returned pre inspection questionnaire indicated that apart from the gas installation and central heating system, which were last inspected in December 2005, the home’s equipment is generally serviced regularly as expected. However a review of the fire safety logbook indicated that monthly checks of equipment are not always being carried out. The manager was of the opinion that the checks had taken place but felt documents in support of this had not been filed. Residents observed smoking during the visit were appropriately protected and being supervised for this activity. However as stated previously, risk assessments for this activity still lack detail. The manager said she has not received any risk assessment training. To assist the home in developing its risk assessments it was suggested the manager obtain guidance from an appropriate fire safety specialist. The HSE website www.hse.gov.uk may also prove useful in this respect. Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 26 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 2 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 1 1 3 3 2 3 2 1 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 2 2 2 Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 27 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 OP19 Regulation 23 Requirement Contact damage to bedroom doors and frames must been made good. Previous timescale 30/11/04 and 30/06/05 (BetterCare ownership); and 31/03/06 (Four Seasons) not met. The Commission is informed that refurbishment work is due to commence in November 2006. Timescale 31/01/07 not met. The provision of a separate smoking room for service users has not yet been provided. Previous timescale 30/11/04 and 30/06/05 (BetterCare ownership) and 31/03/06 (Four Seasons) not met. The Commission is informed that refurbishment work is due to commence in November 2006. Timescale 31/01/07 not met. The standard of cleaning in the Peter Gidney Unit kitchenette must improve. The contents of refrigerators must be regularly checked and disposed of as necessary. Timescale for action 30/06/07 2. OP20 23 30/06/07 3. OP19 16 28/02/07 Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 28 4. OP9 13(2) 5. OP22 23 Medicine storage must be reviewed, improved and updated in accordance with guidelines from the Royal Pharmaceutical Society. (Timescale 31/08/06 not met). Storage facilities must be available for nursing aids and equipment currently stored in bathrooms (Beechcare) (Timescale 31/03/06 and 30/06/06). Commission informed refurbishment due to commence Novemebr 2006. Timescale 31/01/07 not met) An internal system of obtaining advocates views must be introduced. (Timescale 31/08/06 partially met). The home’s brochure must accurately reflect the current registration of the service. Care plans must be reflective of resident’s current’s needs, being regularly reviewed and contain evidence they have been composed with input from the residents and or advocates. The range of activities and facilities must reflect the preferences of all residents. The selection of meals must reflect the preferences of all residents. Bedrooms must be properly heated at all times. Staff employed to assist in meal preparation must be suitably trained in basic food hygiene practices. Effective inhouse monitoring and auditing systems must be introduced. Risk assessments for residents who smoke must be further enhanced to include all pertinent DS0000026147.V322827.R01.S.doc 30/06/07 30/06/07 6. OP33 24 31/07/07 7. 8. OP1 OP7 4 and 5 15 31/08/07 30/04/07 9. 10. 11. 12. OP12 OP15 OP25 OP30 16 16 23 18 30/04/07 30/04/07 28/02/07 30/04/07 13. 14. OP33 OP38 24 13 31/03/07 30/06/07 Beechcare Care Centre Version 5.2 Page 29 information. 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 OP8 Good Practice Recommendations Clinical risk assessments should be complete of all information. Daily progress sheets should provide a complete picture of the residents’ day and experiences. Residents should be appropriately dressed to maximise their dignity and self-esteem. Information in respect of resident’s wishes for death, dying and last rites must be obtained and recorded. Limited life fruit juice cartons must be dated upon opening to ensure the manufacturer’s instructions re the consumption are complied with. A record of all complaints should be kept, in a manner, which promotes effective quality assurance monitoring. The gym should not be used to store excessive nursing aids and equipment. Residents’ bedroom furniture must be kept in a good condition. Commission informed refurbishment is due to commence in November 2006. Refurbishment did not take place. Lockable facilities should be available to meet the individual needs and abilities of all residents. All areas of the home used by residents should be kept odour free. 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. Involving residents in new staff interviews would improve the current selection process. The registered manager should successfully complete her management course. Restrictive access by residents to their personal monies must be recorded. Prospective residents should be informed of such restrictions. All records relating to residents must be kept up to date. DS0000026147.V322827.R01.S.doc Version 5.2 Page 30 2 3 4 5 6 7 OP10 OP11 OP15 OP16 OP22 OP24 8 9 10 11 12 13 14 15 OP24 OP26 OP26 OP28 OP29 OP31 OP35 OP37 Beechcare Care Centre 16 17 OP38 OP38 The fire safety logbook must evidence fire safety checks are being carried out as required, by fire safety specialists. Sufficient numbers of staff must be suitably trained in first aid. Beechcare Care Centre DS0000026147.V322827.R01.S.doc Version 5.2 Page 31 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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