Inspection on 12/11/07 for Beechey House

This inspection was carried out on 12th November 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

Beechey House 29/07/08

Beechey House 27/07/07

Beechey House 23/01/07

Beechey House 14/08/06

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Beechey House 14 Beechey Road Charminster Bournemouth Dorset BH8 8LL Lead Inspector Anne Weston Key Unannounced Inspection 12th November 2007 10:45 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 Beechey House DS0000064864.V354660.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. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechey House Address 14 Beechey Road Charminster Bournemouth Dorset BH8 8LL 01202 290479 01202 290479 beecheyhouse@aol.com 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) Mr Dhanjaye Damhar Miss Nisha Devi Damhar, Mr Dhanjaye Ravi Damhar Miss Nisha Devi Damhar Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (16) Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Any residents accommodated on the second floor must not be dependent on staff to evacuate the building. The schedule of requirements must be completed within the agreed timescales. 27th July 2007 Date of last inspection Brief Description of the Service: Beechey House is a large detached property, situated in the Charminster area of Bournemouth. Beechey House is registered under Mr Dhanjaye Damhar, his daughter Miss Nisha Devi Damhar and his son Mr Dhanjaye Ravi Damhar. Miss Damhar is the registered manager responsible for the day-to-day running of the home. A maximum of 16 people can be accommodated there. The home is within walking distance of the local shopping area of Charminster, local buses are available close to the home to travel to nearby towns, including Poole and Bournemouth. The property is set back from the road and approached via a short driveway. On street parking is available for visitors. A secluded garden at the rear of the property is accessible to residents. Beechey House is registered to accommodate people over age 65 who have dementia or a mental disorder. The accommodation is arranged over three floors, with a passenger lift available to assist access between floors. There are 15 bedrooms (one shared room), all bedrooms have a wash hand basin and 12 bedrooms have ensuite toilet facilities. A lounge/dining room is available to residents and is on the ground floor. Weekly fees (reviewed at least annually) range from £492.00 to £505.00. Fees include all care and accommodation costs, including meals, laundry and activities. Additional charges are made for hairdressing, dry cleaning and chiropody. People are expected to pay for their own personal items such as private telephone, toiletries and newspapers. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk. The home hold a copy of the most recent inspection report, which is available, on request. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visits took place on 12 and 30 November 2007 and 02 January 2008. Anne Weston and Debra Jones were the inspectors who carried out the visits. Nisha Damhar (registered manager) and staff at the home helped the inspectors in their work. The main purpose of the visit was to check that the 15 residents living in the home were safe and properly cared for and to review progress in meeting requirements and recommendations made as a result of previous inspections. A tour of the premises took place and a variety of records and related documentation was examined, including care records. Time was spent observing and talking with residents in the lounge and dining area and time was spent in discussion with Nisha Damhar and staff. In order to get a feel for what it is like to live at Beechey House, one of the inspectors carried out a snap shot observation, lasting over two hours using a Short Observation Framework for Inspection (SOFI). This gave first hand experience of sitting alongside people during a regular part of the day in the lounge; gave an insight into their general state of well-being during this time and gave insight with staff interaction with residents. What the service does well: What has improved since the last inspection? Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 6 Nisha Damhar has updated the Statement of Purpose to give information that rooms on the second floor are only available for residents who are independently mobile. This is because it is important for people to know that any residents who are accommodated on the second floor must not be physically dependent on staff members to evacuate the building, for example if there was a fire in the home. The home has worked hard on developing a new system of care planning and updated care plans have been completed with two people. The home is working on updating care plans with the other thirteen people. Staff behaviour and interaction with residents had improved with staff showing increased respect and value with residents. It was good to see that staff were no longer adopting institutional care practices and had moved to a more individual approach that offered people a more personalised service with promotion of their dignity. A programme of planned staff supervision had started so that staff practice can be monitored. The home must demonstrate that senior staff who have been delegated supervision duties have the knowledge and skills to effectively supervise care staff. Management of health and safety had improved with potentially hazardous substances securely stored and with portable equipment safely maintained. What they could do better: The home must develop a nutritional procedure including nutritional screening so that people are screened for risk of malnutrition. People who are assessed as at risk of malnutrition must have a nutrition care plan which is kept under review. The home must make sure that care plans give sufficient details, with evidence of regular review about management of pressure area care, changes in general health and skin condition. Procedures for nutritional screening and management of pressure area care must be implemented so that people can be confident that their health needs will be identified and met. Record keeping of food intake must be improved to demonstrate that a snack meal is offered in the evening, and the interval between this and breakfast the following morning should be no more than 12 hours. Nisha Damhar must improve monitoring with medication systems as medication is not always being administered as prescribed. All handwritten entries on Medication Administration Record (MAR) sheets must be signed and where staff make changes these need to be countersigned by another competent member of staff to confirm their accuracy. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 7 Improvement with support and assistance in engaging people in the activities of daily life and with recreational pursuits needs to continue so that the home supports people to follow personal interests and activities to make their daily lives more interesting, stimulating and enjoyable. The home should provide information to residents and people involved with them about how to contact people, such as advocates, who would act in residents’ best interests, if needed. Improvements with refurbishment and decoration need to continue so that people are able to live in a well-maintained, hygienic and pleasant home. There must be towel facilities in all WCs so that people can dry their hands properly. Consideration should be given to incorporate current good practice relating to the environment of a dementia care setting, which may help to minimise confusion. For example colour and cues provided by décor and fittings such as paintwork and floor coverings. Nisha Damhar has to be sure that everyone working at the home has been properly recruited and has the correct training so that people are looked after by suitable staff who have the skills to do this. Shortfalls in staff training in dementia care remain outstanding since the last inspection in July 2007. Beechey House is a specialist service for people with dementia and mental disorders. As such anyone living at the home would expect the staff working there to have training appropriate to provide specialist care. The level of training in dementia care that staff have received so far has been very basic. It may be helpful for Nisha Damhar to access a mentor or another professional for support and supervision in relation to professional practice. 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. Beechey House DS0000064864.V354660.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 Beechey House DS0000064864.V354660.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): 3 Standard 6 is not applicable 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. Assessments of care needs are carried out with people before they move into Beechey House. This means a service is only offered to those people the home feel capable of supporting. EVIDENCE: The care records of four people were examined, including the records of one person who had moved into the home during the last two months. Discussion with Nisha Damhar and examination of records showed that Nisha Damhar had carried out a care needs assessment with the new person before they moved into the home. Nishar Damhar confirmed she routinely carries out a care needs assessment with people before she offers them a service. Observation of the most recently admitted person evidenced a state of general well-being. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 10 Nisha Damhar is in the process of implementing a different system for assessment and care planning. She had used the revised assessment system with the person who had most recently moved in. The assessment information was clear and concise and included assessment information on: - Physical Health - Mental Health - Behaviour - Skin care - Nutrition Beechey House DS0000064864.V354660.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 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 plans and health care practices do not always promote safe care, potentially placing people at risk. Some medication practices need improvement to ensure the safety of people is promoted. People’s right to privacy is generally respected and the support they get from staff is given in a way that maintains their dignity. EVIDENCE: The care records of four people were examined and discussion was held with Nisha Damhar about care planning. The home are working hard to develop a new care planning system so that there is accurate information about people’s needs. The revised care planning system had been used with the person who had most recently moved into the home. For the most part, this care plan showed detailed information about the person, giving good guidance to staff about how Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 12 to support the person with their particular care needs, including their specific care needs during the night time. The care plan included clear information and guidance to staff about their approach when the person displayed challenging behaviour. It was clear from the daily records that this person had specific skin care needs due to a skin condition and a pressure ulcer. There was no information in the care plan about management of skin condition. Two care plans had been implemented using the revised care planning system. Nisha Damhar said she felt confident that revision of all care plans would be completed by the end of April 2008. The care records of two other people showed that there were concerns about both people in relation to their nutrition and dietary needs. Discussion with Nisha Damhar confirmed both people were at risk of malnutrition. The home had not carried out nutritional screening with either of these people. The weight chart for one person who was consistently refusing to eat their supper showed a weight loss within the year of one stone, four pounds. The other person’s records showed they were not eating very much, their weight chart was not completed, the care records showed that the person was ‘unable to stand on the weighing scale’. This meant there was no available information about their monthly weight. There was no evidence that weight change had been monitored by any other means, for example measurement of mid upper arm circumference. Nisha Damhar was advised that a validated nutritional screening tool such as the ‘Malnutrition Universal Screening Tool’ (MUST) must be implemented and that relevant professional advice should be sought when people are assessed as at risk of malnutrition, for example a dietician. Information was given about accessing our website www.csci.org.uk for guidance on ‘The management of nutritional care for older people in care homes’. Care records included individual professional visit logs, these showed access to health professionals was promoted. People had been assessed by health professionals including GPs, Community Nurses and Community Psychiatric Nurses. The home uses Medication Administration Record (MAR) sheets printed by their pharmacy. These routinely include medicine allergies, or “none known” if applicable to protect residents. Staff record on the MAR sheets medicines received and administered. It was good to see that medication administration charts were in a folder with photographs of residents preceding them. However there was no sample signature sheet in this file so it was not possible to tell who had been administering the medication from the records. The code ‘F’ is used throughout at times when residents do not take their medication. The MAR says that when this code is used this should be defined. In no case was this done. Concerns have been raised at previous inspections about the use of codes on the MARs. One resident is prescribed ventolin to be Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 13 used when needed when they are short of breath. This was mostly coded ‘F’, not defined but clearly not given. For a recent 4-day period the resident had the ventolin 4 times a day. There was nothing in their care notes as to why this was. Where there was a choice of dose the amount administered was recorded. A number of residents are prescribed medicines to be administered ‘when required.’ This is particularly the case with paracetamol. One resident was prescribed to have one or two tablets four times a day when required. The one had been crossed out and records showed that they were getting two tablets four times a day. Other residents had the same instruction on the sheet but were not having any tablets. Care plans were not clear as to why this was the case. A care worker was able to give a clear verbal explanation as to why the first resident needed regular paracetamol for their pain. Care records for the others state they are not able to say whether they want tablets or able to communicate pain, staff are instructed to look out for general signs of pain (facial expressions and body language) but the signs for the individual are not clear in their plans. For medicines given when needed you could not tell from the records how many should be on the premises. Some bottles, tablets and boxes were marked with the date they were brought into use, some were not. Carry forward balances are not noted on the MARs. As at previous inspections a number of gaps were seen on the MARs. In some cases, through checking the balances of the medication, it was clear that the medicines had been administered, in other cases it was not so clear e.g. if the medicine was in liquid form. In one case it was clear that the resident had not had their medicine as prescribed. Again it was the case that where staff had made handwritten changes to MARs these had not been countersigned by another competent member of staff to confirm their accuracy. Again examples were seen where handwritten entries on the charts had not been signed at all. Medicines in use were being stored and transported securely. Those not in use were being inappropriately stored with food products. There is a separate fridge for medication, which does not lock. No medicines were being stored in the fridge at this visit. Observation showed that staff adopted a respectful, pleasant and kind manner and that staff worked well together. One person had a zimmer frame that they kept forgetting to use. Staff were vigilant to this and reminded the person kindly each time they forgot their zimmer frame, went to get the frame, asking the person to sit and wait while they did this to ensure their safety. When staff assisted another person to move from their wheelchair to the dining room chair encouragement was given for the person to do most of this move on their own. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 14 Staff explained to the person how they were to move and staff were on hand to reassure and keep the dining chair safely in place. When staff assisted people with drinks they sat at their level and talked with them. Staff were good at adjusting clothes to promote dignity – always saying what they were doing. When people came into the lounge they were offered choices about where to sit. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People would benefit from continued development with the activities programme so that the home offers more support for people to follow personal interests and activities. Open visiting arrangements are in place, people are able to maintain contact with visitors. People are generally encouraged to make choices about their life style, information is not available to let people know about other organisations who would act in residents’ best interests, if needed. A varied diet is provided, more detail is needed with food records so nutritional intake can be properly assessed. EVIDENCE: On the first day of the inspection (unannounced) people were having their hair done by the hairdresser in the lounge. Observation showed that people enjoyed having their hair done, they thanked the hairdresser and complimented each other. On the second day of the inspection (announced) people were sitting at tables in the morning in the dining area doing puzzles. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 16 During the afternoon a film was put on in the lounge for anyone interested in watching. One of the care plans that had been developed under the new system showed good information about the person’s hobbies and included information on religious and spiritual needs. Discussion was held with Nisha Damhar about some of the information that was too generalised. For example the care plan gave information about keeping links in the community that the person had when they came into the home. There was no detail about what these community links were, or how they were going to be maintained. Support with individual recreational activities is under development so that people have improved quality of life through increased opportunity to participate in daily life in accordance with their needs, preferences and capacities. Observation and contact with people and visiting relatives confirmed that people maintained contact with friends, family and representatives. Visiting is open and flexible and visitors are welcomed into the home. Talking with residents and observation confirmed that people living at Beechey House are given opportunities to exercise choice and control over their lives. Residents that walk independently are able to move freely about the home. Residents, and people involved with residents, are not informed how to contact people, such as advocates, who would act in residents’ best interests. Duties of care staff include cooking and serving of all meals as there is no designated cook. People were observed having their lunch in the dining area and care staff assisted people with their meal, as needed. Care staff tried to give people choices, in one instance a person asked for a banana for their pudding but there was no banana or other fresh fruit for them to have. This was discussed with Nisha Damhar who said that a delivery of fresh fruit was expected the day after this incident. Concerns were also discussed with Nisha Damhar about how people may need additional food between the evening meal at 5:00 pm and breakfast the next day at 8:00am. Nisha Damhar confirmed that people were offered a snack and a drink around 7:00pm in the evening. No record was routinely made if people had a snack at this time so it was not possible to accurately identify details in respect of nutrition. Concerns about adequate nutrition with people who have specific nutritional needs have been reported on, and addressed under health care needs in Standard 8. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have access to a complaints procedure and procedures for responding to suspicion or evidence of abuse promote protection for people. EVIDENCE: The home has an accessible complaints procedure. Nisha Damhar confirmed there had been no written complaints since the last inspection. Beechey House has both adult protection and whistle blowing policies in place. Examination of four staff files showed that staff received training in Safeguarding Adults both through induction training and through refresher training. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 18 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 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. Aspects of environmental design and routine maintenance must be given attention to ensure residents live in a safe, hygienic and well-maintained environment. The home is generally clean. EVIDENCE: Beechey House, a care home for older people with dementia or mental disorder still does not have many environmental features to distinguish it from a care home for older people. There is a secure key pad system in use to exit the building to ensure the safety of residents. Inspection of the premises demonstrated that the home had floor pressure mats which alerted staff to residents getting out of bed, this promoted safety of residents, particularly at night. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 19 Some improvements have been made with the environment. Exposed pipes have been covered so that people are prevented from scalding or harming themselves and the discoloured carpet has been replaced. The home needs to continue to work on refurbishment and decoration so that people are able to live in a well-maintained and pleasant home. For example a number of toilet bowls were black at the bottom, paintwork was worn and chipped and one headboard that was checked was loose. We advised Miss Damhar that she must check all headboards to make sure they were securely fitted and safe. Inspection of the premises demonstrated the home was generally clean. The home employs a part-time cleaner in the mornings Monday to Friday and has a laundry room with washing and drying facilities. Commodes are cleaned and sterilised with a sterilising solution. In the downstairs communal toilet, the bowl was black at the bottom, the toilet roll holder had come of the wall and had not been fixed and there was no towel facility for people to dry their hands. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 20 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. Whilst improvements have been sustained with the numbers of staff on duty shortfalls in recruitment practice and staff training are still leaving people at risk of not being properly safeguarded. EVIDENCE: There are nine permanent care staff working at Beechey House. Staff rotas show that during the day there are three care staff on duty in the morning and three care staff on duty in the afternoon. During the night (8.00pm to 8.00am) there are two waking care workers on duty. In addition a part time domestic worker is employed. Care staff carry out cooking and laundry duties. Recruitment records for the two most recently appointed staff members were examined. One of the staff records showed recruitment procedures included completion of an application form, health check, obtaining a POVA First check and obtaining one reference. There was no evidence of a second reference or a Criminal Records Bureau (CRB) disclosure. The other staff records showed completion of an application form, health check, obtaining a POVA First check and obtaining two references. There was no evidence of a CRB disclosure. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 21 Training records showed that staff progressed through an induction linked to the Skills for Care Common Induction Standards. Training records showed that staff had attended training in mental health, health and safety, medication and Protection of Vulnerable Adults in the last year. Records for one staff member showed their refresher training in manual handling was over due as they had not received updated manual handling training since May 2006. Training in mental health and dementia remained at a basic level giving staff only basic knowledge about mental health and dementia, for example instruction for staff to say ‘good morning’ instead of ‘hello’ to assist to orientate people who have dementia. Discussion with the three staff members on duty showed that one staff member was knowledgeable and informed about dementia care and that the other two staff members had limited knowledge and understanding about dementia care and still had a lot to learn. One staff member has obtained National Vocational Qualification (NVQ) level 3. Two staff members have obtained NVQ2/3 or equivalence and two staff members are working towards their NVQ level 2. There was evidence of confirmation on one staff file that a health training certificate obtained overseas had equivalence to a standard between NVQ2 and NVQ3. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 22 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 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is working hard to make sure the home operates as a safe service. Implementation of the improvement agenda needs to continue to fully demonstrate that Beechey House is being managed with sufficient care, competence and skill. EVIDENCE: Nisha Damhar has gained the Registered Managers Award and is intending to commence the National Vocational Qualification (NVQ) Level 4 in Care. In respect of dementia care training Nisha Dahmar has completed a 12-week long distance course. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 23 Prior to this inspection the home completed an Annual Quality Assurance Assessment (AQAA), which they submitted to the Commission. This identifies how the home have taken into account the views of residents and their supporters in the running of the home and sets out their plans for improvement over the next twelve months. The home is also in the process of introducing their own quality assurance system. Some questionnaires have been distributed about the service to residents and relatives. Nisha Damhar again confirmed that Beechey House have very little involvement with residents’ financial transactions. Residents either have a relative or representative to assist in the management of their financial affairs. Beechey House invoice relatives or representatives for any money spent by residents. Discussion with Nisha Damhar and staff showed that one member of senior care staff had been allocated one day a week (when the home were not short staffed) to work on developing care plans and carry out staff supervision. This meant there has been some progress with staff supervision. There was no evidence to show that the senior staff member had received any supervision and mentoring to enable them to effectively carry out these delegated management tasks. The home was visited by the Dorset Fire and Rescue service on 13 July 2007. At the time of the visit a satisfactory standard of fire safety was evident in the areas they audited. The hot water was tested and found to be at a safe and comfortable temperature. Portable appliances had been tested to make sure they are in safe working order. Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 24 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 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 Timescale for action Unless it is impracticable to carry 30/04/08 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Evidence of progress with compliance. Previous timescale of 30/09/07 not fully met. 29/02/08 The home must develop a nutritional procedure including nutritional screening so that people are screened for their risk of malnutrition. People who are assessed as at risk of malnutrition must have a nutrition care plan which is kept under review. The home must make sure that care plans give sufficient details, with evidence of regular review about management of pressure area care, changes in general health and skin condition. Procedures for nutritional DS0000064864.V354660.R01.S.doc Version 5.2 Page 26 Requirement 2. OP8 15(2)(b) 17(1)(a) Schedule 3 (3)(m) & (n) 17(2) Schedule 4 (13) Beechey House 3. OP9 13 screening and management of pressure area care must be implemented so that people can be confident that their health needs will be identified and met. The registered person shall make 29/02/08 suitable arrangements for the recording, handling, safekeeping and safe administration of medicines received in the care home including: Competent members of staff signing and countersigning all handwritten entries on MAR sheets to confirm their accuracy. Making secure any refrigerated medicines. Recording the administration or reason for non-administration of all medicines. Previous timescale of 30/09/07 not met. Records must demonstrate that a snack meal is offered in the evening, and the interval between this and breakfast the following morning should be no more than 12 hours. Improvements with refurbishment and decoration need to continue so that people are able to live in a wellmaintained, hygienic and pleasant home. This includes deep cleaning of toilet bowls to remove the black stains and decorating so that the paintwork is in a reasonable condition. Towel facilities must be introduced for use in the WCs. Previous timescales of 30/09/06 and 30/09/07 not met. 4. OP15 16(2)(i) 31/01/08 5. OP19 23 31/03/08 6. OP26 13 31/01/08 Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 27 7. OP29 19(1) 8. OP30 18 Miss Damhar must operate a thorough recruitment procedure in accordance with Schedule 2 to ensure the protection of residents; including obtaining confirmation of pre employment checks of agency staff. Previous timescales of 31/03/07 and 30/09/07 not met. Miss Damhar must ensure that all care staff have training in mental health and dementia care to a level suitable for the specialist service provided. All care staff must have up to date training in manual handling. Staff must receive regular formal supervision. Evidence of progress with compliance. Previous timescale of 30/09/07 not fully met. 31/01/08 31/03/08 9. OP36 18(2) 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Arrangements should be made to extend the activities programme to provide residents with opportunities for occupation, including daily living activities that provide stimulation and socialisation. This recommendation is carried forward from the last inspection. Residents and people involved with residents should be given information about opportunities to choose an external representative or advocate. Residents wishing to choose an external representative or advocate should be DS0000064864.V354660.R01.S.doc Version 5.2 Page 28 2. OP14 Beechey House 3. OP19 supported in doing so. This recommendation has been carried forward from previous inspections. Consideration should be given to incorporate current good practice relating to the environment of a dementia care setting, which may help to minimise confusion. For example colour and cues provided by décor and fittings such as paintwork and floor coverings. This recommendation has been carried forward from previous inspections. Nisha Damhar should complete her National Vocational Qualification Level 4 in Care. This recommendation has been carried forward from previous inspections. 4. OP31 Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Beechey House DS0000064864.V354660.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!