Inspection on 23/01/07 for Beechey House

This inspection was carried out on 23rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 12/11/07

Beechey House 27/07/07

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 Unannounced Inspection 23rd January 2007 10:10 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.V328430.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.V328430.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.V328430.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. 4th December 2006 Date of last inspection Brief Description of the Service: Beechey House is a large detached property, situated in the Charminster area of Bournemouth. The home had a change of ownership in November 2005. Beechey House is now 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. Under the new owners the registration has increased from accommodating a maximum of 14 people to accommodating a maximum of 16 people. Three additional single bedrooms have been registered on the second floor, a shower room has also been installed on the second floor. 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 on the ground floor. Weekly fees (reviewed at least annually) range from £461.00 to £480.00. 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.V328430.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place in the day time over two days on the 23rd January 2007 and the 2nd February 2007 with Anne Weston as the Lead Inspector and Debra Jones as the second Inspector. The first day was unannounced and the second day was announced, 16 hours was spent planning and carrying out the inspection. Miss Damhar, the Registered Manager was away on holiday on the first day of the unannounced inspection but was present for the second day announced inspection. Christine Main, the Pharmacy Inspector also visited to inspect the medication systems. The purpose of this year’s second annual key inspection was to review the 9 requirements and 7 recommendations that had been previously made; to review all key National Minimum Standards and to check that the 16 people who were living at Beechey House were safe and properly cared for. A random inspection visit was carried out on the 4th December 2006 when immediate requirements were made in relation to shortfalls in staffing levels and recruitment practices so particular attention was given to staffing and recruitment practices. No new staff had been employed since the random visit in December 2006. The premises were inspected, including the communal areas and a sample of bedrooms. A range of records and related documentation were examined. Discussion was held with Mr Dhanjaye Damhar, Miss Nisha Damhar and four care staff. All 16 residents were either spoken with or observed and discussion was held with two relatives who were visiting. Some residents were observed and spoken with in a group and one resident was spoken with in the privacy of their individual room. Observation included two hours closely observing residents’ daily life in the lounge and dining room on the first day of the inspection. What the service does well: Residents had an assessment of their care needs carried out before they moved into Beechey House. This meant their care needs were identified. Regular contact and communication was maintained with GP’s and Community Nurses. The home uses monitored dosage system blister packs with Medicine Administration Record (MAR) charts printed by the pharmacy and medicines were stored safely during administration. Residents and relatives said that staff were kind and worked hard. Staff were observed to be interacting with residents in a friendly and caring manner. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 6 The care staff promoted a relaxed and friendly approach. Visiting times were unrestricted, visitors said they were always made to feel welcome and were routinely offered refreshments. A balanced and varied diet was provided. People felt confident about raising any complaints or concerns, relatives said that Miss Damhar properly addressed their concerns. The home was clean. Fire safety checks and staff fire training were up to date. What has improved since the last inspection? What they could do better: Care plans need revision to be more concise and accurate as they did not always provide staff with the necessary information to ensure residents’ needs were met. Not all moving and handling practices were being carried out in accordance with care plans or in a safe manner. Not all care staff were up to date with their moving and handling training, this must be put right as a matter of priority. There must be improved access to relevant health care professionals in the circumstances where a specific monitoring of a health care need has been identified. The medication policy, storage of refrigerated and reserve medication, the recording of allergies and administration of some medicines need improving. Systems for monitoring medication records and audit trails should be introduced to improve recording. All staff (including agency staff) must receive training in how to deliver personcentred dementia care so that they show respect and value by including residents in all interactions of daily life including delivery of personal care. Some care staff who have been working in the home since the beginning of 2005 had not received any training in dementia care. Promotion of independence was limited, the home must review their working policies and move from some institutional care practices to a more individual approach. Drinks were always available at set times but hot and cold drinks should also be offered outside of these set times. Inaccuracies in the detail of some food records means that it is not possible to be sure that residents are having a diet that meets their individual nutritional needs and supports their right to make choices. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 7 The activities were not sufficient to meet the range of stimulation that residents needed. Arrangements must be made to ensure residents have the opportunity to participate in a range of activities, including daily living activities, that provide stimulation and socialisation. During the key inspection in August 2006 it was identified that not all care staff had received training in protecting residents from abuse. No progress had been made with adult protection training. It is important that all care staff receive training in the protection of vulnerable adults so they do not commit unintentional abuse. Adult protection training must be urgently arranged for those care staff who have not received the training. Following the inspection Miss Damhar has confirmed that all staff have received adult protection training. Improvements are needed with the building and facilities to ensure residents live in a safe and well-maintained environment. Consideration should be given to incorporate current good practice related 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. Two of the requirements in relation to a lock on the laundry room door and infection control measures set as a condition of registration with a three month timescale remained outstanding. The importance of meeting the outstanding requirements had been brought to Miss Damhar’s attention during the key inspection carried out in August 2006, these were again brought to her attention. Policy and procedures for the cleaning of commode pans must be updated to ensure the right decontamination methods are used. It is important that all members of staff have a clear understanding of their responsibilities to prevent the spread of infection, and are familiar with any infection prevention and control policies and procedures that are in place. Following the first day of inspection enforcement action was taken to improve staffing levels urgently as it was evident that there were not sufficient numbers of care staff on duty at peak times of activity during the day; during the afternoon and through the night to effectively meet the individual assessed needs of all 16 residents. This was quickly put right with the addition of one staff member in the afternoon and an additional staff member on waking night duty. During the previous random inspection in December 2006 there was evidence to show that recruitment procedures were poor. As Beechey House have not recruited any new staff since then it was not possible to evidence that recruitment practices have improved. The requirement about operating a thorough recruitment procedure to ensure the protection of residents is therefore carried forward. Miss Damhar did not always ensure the health and safety of residents and staff. On the first day of inspection some hot water was at excessively high temperatures placing residents and staff at risk of scalding. The bed rails Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 8 fitted to a resident’s bed were not safe as they had not been securely fitted. Both these matters had been put right by the second day of the inspection. Potentially hazardous denture cleaning tablets are readily available around the home. Not all care staff were up to date with their food hygiene training although care staff prepare meals as part of their duties as Beechey House does not employ designated catering staff. Food hygiene training must be put right as a matter of priority. Miss Damhar had not made any progress with formal staff supervision and had not followed up on some outstanding training issues identified by the previous owners. A formal quality assurance system remains outstanding for implementation so that the home can evaluate the quality of their service. Miss Damhar has not been informing the Commission, as required by regulation, about important events that affect the quality of life experienced by people who live at Beechey House although she had previously been reminded about the importance of keeping the Commission informed of any significant events. She was again reminded about the importance of telling the Commission about matters that require notification. The Commission continue to have serious concerns that Beechey House is not being managed with sufficient care, competence and skill. This means that the home is not operating as a safe service. The shortfalls in staff training and record keeping are a matter of persisting serious concern. Consideration will be given to taking further enforcement action if training standards and record keeping continue to be poor. 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.V328430.R01.S.doc Version 5.2 Page 9 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.V328430.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have an assessment of their care needs carried out before they move into Beechey House. This means their care needs are identified. EVIDENCE: The care records of the resident who had most recently moved into the home were examined. A social services assessment had been received by the home before the person moved in and the person had also had a pre-admission assessment carried out by the home before they moved in. It was not clear on this pre-admission assessment carried out by the home where the information had been obtained from, for example a relative, the prospective resident or hospital staff. Assessments should be further improved by clearly recording the source of the assessment information. Beechey House DS0000064864.V328430.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information in care plans did not effectively provide staff with the information they needed to meet the needs of residents. Not all health care needs were fully met. Arrangements for the recording, handling, safekeeping and administration of some medicines need improving to safeguard residents. Care practices did not always promote residents rights of respect and dignity. EVIDENCE: The care records of eight residents were examined. These showed that seven residents needed the assistance of two members of care staff to assist them with their care needs. Care records were complex and were divided into separate sections with recorded information about assessment of care needs and separate care plan recording. The information from the care assessments did not always cross reference with the information given on the care plan. Some important information had not been transferred across onto the night care plans so some individual care needs were not being properly met at night. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 12 This meant that it was not always easily apparent to tell what staff were supposed to be doing in order to meet individual care needs. There was no evidence of residents or relatives being involved in drawing up the care plans. One GP contacted during the course of the inspection said that the manager maintained good communication about residents’ health needs. Records showed that residents have access to health care professionals, for example GP’s and Community Nurses. Some residents have medical conditions that need close individual monitoring and care, for example diabetes. Whilst this is mentioned in care plans those seen were not specific enough to the individual to properly outline the care they needed. For example one care plan recorded about the need to have feet checked daily but did not say what for and it was not clear from the daily records of personal care if daily checking of feet was being carried out. The same care plan referred to the need for regular eye tests but did not say how often and did not say whether this was for reading glasses rather than diabetes. Another care plan for a resident with diabetes said that bloods were to be regularly checked by the Community Nurse but there was no recording of any blood checks since July 2006. The medication policy had improved but does not include procedures for new resident’s medication, Controlled Drugs, when the doctor changes medication, household medicines and providing medicines needed when a resident is away from the home. The home uses MAR charts printed by the pharmacy but some did not include medicine allergies, or “none known”, if applicable to protect residents. Staff recorded medicines received, administered and returned for disposal and most audit trails for tablets checked agreed with the records, indicating that they were given as prescribed. Some tablets, which had been removed from the monitored dose blister pack, were recorded as “refused” rather than “refused and disposed of”. For some medicines the dose given was not recorded. There were no records of administration of some topical creams or food supplements or reason for this. There was no information on the MAR chart or in the care plan to indicate when medicines prescribed, “when required” should be given and care plans were not updated with changes to medication. Staff said they were not aware of the purpose of medicines they were administering or where they could find information to refer to. Mr Damhar said that carers, who give medicines, have done a medication course and that they are looking at providing further training that would give staff more awareness of what medicines were for. Medicines in use were stored and transported securely. Storage for reserve medication had not been improved as recommended following the previous inspection. The medicines fridge was not locked and the maximum and Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 13 minimum temperature was not monitored. There was an overstock of some medicines. The manager said that she had not implemented an “in house” system for monitoring medication records and audit trails to ensure that medicines are given as prescribed. Residents and relatives said that staff were kind and worked hard. Staff were observed to be interacting with residents in a friendly and caring manner. Observation showed that staff had not received training in using personcentred care as a value base as not all care was delivered which promoted quality of life through valuing people as individuals. Examples of this lack of training were staff sometimes treating residents as if they were an object. This happened when staff straightened the clothes of residents or put their bibs on at meal times, they sometimes did these tasks without even speaking to the residents to explain what they were doing. One member of care staff was cleaning a table where a resident was sitting and did not speak to the resident when they were carrying out this cleaning task. Another staff member was observed helping a resident to drink a cup of tea and eat a biscuit. Although the staff member was kind, warm and gentle in her approach, she did not speak to the resident throughout the time she was assisting the resident to eat and drink. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities were not sufficient to meet the range of stimulation that residents needed. Open visiting arrangements were in place, residents were able to maintain contact with family and other visitors. Residents have limited opportunity to exercise choice and control over their lives and arrangements were not in place to access advocacy services. A balanced and varied diet was provided with specialist diets catered for, improvements need to be made with availability of hot and cold drinks. EVIDENCE: An activities programme has been developed and implemented. This needs further development so that the individual needs of socialisation and stimulation for all residents are met. On the first day of the inspection the home asked the activities organiser to come into the home because an inspection was taking place so she could explain about the activities. The activities organiser came, as requested, although it has not been her intention to visit the home that day as she was unwell due to a flu virus (she placed a Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 15 protective mask on her face to minimise passing on the flu virus). The activities organiser confirmed she visits the home once a week to carry out activity sessions. She explained that currently there were only two residents that were able to engage in these organised activities, the recordings of activity sessions were examined which confirmed this. In addition to the once weekly activity sessions a music session is held fortnightly. During the first day of inspection some residents were observed sat at the dining tables with various activity pastimes readily available for use. Most residents did not have the capacity to engage in these activities without assistance and there were no additional staff on duty to assist residents with one to one socialisation and stimulation. The lack of staff engagement with residents for socialisation and stimulation has also been observed by some social workers during their visits to the home when carrying out reviews with residents. The television was constantly on regardless of whether any residents were watching the programme. Contact with residents and visiting relatives confirmed that residents maintained contact with friends, family and other visitors. Relatives said that visiting was open and flexible and that they were always made to feel welcome into the home. One relative said “They look after X really well – very happy for X to be here”. Contact with residents and observation confirmed that residents were given some opportunities to exercise choice and control over their lives. Those residents that walked independently were able to move freely about the home and were guided in the right direction if they became confused about where they were going. However, opportunities for choice and independence were not consistently promoted. For example when one resident said to a care worker at 11.20am that they wanted to go to bed, the care worker replied that it was too early to go to bed and that it was nearly lunchtime (lunch was not served until two hours later). The resident was then asked “would you like a sweet-chocolate?” to which the resident replied “No, I want to go and lay down”. The resident was not helped to go and lay down on their bed and then fell asleep in their armchair, snoring occasionally until woken up for lunch. The care practices in relation to ‘toileting’ indicated that institutional care practices were allowed to happen. During the afternoon staff said they had to toilet everyone at 4.00pm. Meals were served close together, residents did not finish their lunch and leave the dining tables until about 1.45pm and were sitting at the dining tables for tea again at 4.50pm. Residents and people involved with residents were not informed how to contact people, such as advocates, who would act in residents’ best interests. Duties of care staff include preparation and cooking of all meals as there is not a designated member of catering staff. Residents were observed eating their lunch in the dining room. All residents had the same meal of fish pie and accompanying vegetables of swede and sprouts. Swiss roll and custard was served for pudding, one resident had fresh fruit for pudding. One resident said Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 16 how much they enjoyed their lunch. During the inspection drinks were available at the planned times of mid morning, lunch time, mid afternoon and tea time. No drinks were available or offered between these times. On the first day of the inspection residents were observed through lunch time. There were four residents who needed assistance to eat their meals, three of these residents sat at tables in the dining area and one remained in their arm chair in the lounge. One care worker was allocated to the kitchen to serve and bring out the main meal and pudding and two care workers helped the three residents with their meals at the dining tables. The lunch was served at 13.20. One care worker started helping a resident with their meal but they did not appear very hungry so this care worker then went and helped a second resident with their meal. She stayed with this second resident until they had finished their meal and then returned to help the first resident again at 13.45. This was 25 minutes later when the food was cold. The other care worker stayed with the third resident at the dining table all the time to properly help them with their meal. The fourth resident in the lounge did not have their meal brought out until after the people at the dining table had finished needing assistance. It is not acceptable for a resident to have to eat a cold meal and arrangements must be made for residents to have assistance with their meals before their food gets cold. Examination of food records confirmed a balanced and varied diet was provided. The food records did not always accurately reflect what food had been eaten. The food records showed that one resident had eaten all their meal but observation had shown that this resident had left all their sprouts. The resident was not asked if they disliked this vegetable or if the sprouts had been left untouched because they were not hungry. Beechey House DS0000064864.V328430.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those residents who had capacity, their relatives and representatives felt able to voice concerns over anything they were not happy with. Management responded to these concerns. Residents are not fully protected by the procedures for responding to suspicion or evidence of abuse as not all care staff had received training in the prevention of abuse. EVIDENCE: The home has a complaints policy. Miss Damhar confirmed there had been no written complaints since the last inspection. Relatives who were spoken with felt confident about raising any complaints or concerns with Miss Damhar and said that any concerns were always properly addressed. The home has an Adult Protection policy in place including a whistleblowing policy. An Adult Protection investigation was being carried out during the inspection process due to poor care practices arising from low staffing levels. The outcome was an increase in staffing numbers in the afternoon (increase of one staff member from two to three staff on duty) and during the night (increase from one waking member of staff and one sleep-in member of staff to two waking night staff). At the time of the inspection there was no evidence to show progress had been made with adult protection training for staff. Records showed that some care staff had still not received adult protection Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 18 training to enable them to identify different forms of abuse and know how to deal with any suspicion or allegation of abuse. Following the inspection visits Miss Damhar said that all staff had received adult protection training on 19 January 2007. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements are needed within the home to ensure residents live in a safe and well-maintained environment. The home is clean, improvements are needed with some aspects of infection control to ensure hygiene standards are maintained. EVIDENCE: Beechey House, a care home for older people with dementia or mental disorder 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. Improvements need to be made with the décor and furnishings as it was Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 20 evident that some aspects of the premises were not well maintained. In some rooms there was a patch of concrete on the wall where the previous call system had been removed and filled in but had not been covered over or redecorated. In one room there was a hole in the wall, about the size of a fist with crumbly rubble exposed. Not all rooms occupied by residents who were independently mobile and who got up during the night had a bedside light. Some rooms were in need of redecorating, in one room the wall paper was coming off the wall in the ensuite. Some rooms did not have lampshades, in one room the door was not closing to latch (the door was again checked on the second day of inspection, maintenance work had been carried out and the door was closing properly). In another room one set of drawer fronts were hanging off. In two rooms there were obvious holes in the bedding and in one of these rooms there was a ragged towel on a chair, the curtains were hanging off the rail (the curtains had been put right by second day of inspection) and the carpet was discoloured in a large patch where there had been an accident with bleach falling from the table. Mr Damhar was advised that the carpet needed changing. On the second day of the inspection Miss Damhar told us that care staff have been sorting through the linen and throwing out unacceptably worn towels and bed linen. Inspection of the premises demonstrated the home was generally clean. Contact with residents, relatives and staff confirmed the home was routinely clean. A part-time cleaner is employed. There is a laundry room with an industrial washing machine and tumble dryer. The schedule of requirements set as a condition of registration included: 1 A suitable lock to be fitted to the laundry door to prevent access by vulnerable residents. A suitable lock had not been fitted on the laundry door. 2 Liquid soap and paper towels must be introduced for staff to use in the laundry and WC’s to aid infection control and help prevent any possible cross-contamination. Liquid soap and paper towels were not available for use in the laundry room. Paper towels were not available in either of the ground floor WC’s that are regularly used by residents and staff. The importance of meeting these two requirements was discussed with Miss Damhar during the last inspection in August 2006, she still has not complied with the conditions of registration, five months later but stated it was her intention to do so. Availability of paper towels in the WC’s needs particular consideration due to the special needs of one resident. It was therefore suggested that paper towels could be stored in a secure place known to care staff. Discussion was held with Miss Damhar about the cleaning of commode pans. The home do not have a pan washer-disinfector. Care staff use the wash hand basins in residents’ bedrooms to clean commode pans and then use disinfectant to maintain hygiene. This does not meet the decontamination standards as recommended by the Department of Health Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 21 Infection Control Guidance for Care Homes (June 2006). This states items which are contaminated with bodily fluids are to be thoroughly cleaned to remove physical soil and then wiped with a freshly prepared solution of a chlorine-releasing agent with a concentration of 1000 p.p.m. available chlorine. Disinfectants should not be used routinely as cleaning agents for chemical disinfection. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 22 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 poor. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of staff were not always available to meet resident’s individual care needs but this was put right during the inspection process. The staff rota was not accurately maintained, this meant the rota did not show the names of the agency staff currently working in the home. Practices in relation to recruitment needed improvement (no new staff recruited since last inspection) as residents were placed at risk through lack of protection. Not all care staff were properly trained, this meant residents were at risk from unsafe care practices. EVIDENCE: There are a total of ten care staff. On the first day of inspection the staff rota showed that during the day there were three care staff on duty in the morning and two care staff on duty in the afternoon. During the night (8.00pm to 8.00am) there was one waking care worker and one sleep-in care worker on duty. It was evident through examination of records and close observation that there were not sufficient numbers of care staff on duty at peak times of activity during the day; during the afternoon and through the night to effectively meet the individual assessed needs of all 16 residents. Following enforcement action this was quickly put right with an increase in staffing levels in the afternoon and during the night. On the second day of inspection the Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 23 staff rota was again examined, this did not show the names of the afternoon agency staff and did not properly show that there were two waking night staff on duty. Miss Damhar was advised that the staff rota must accurately reflect the staffing arrangements and show all the names of the staff on duty. Discussion was held with Miss Damhar about the current use of agency staff. She was not aware of what training had been received by the agency staff currently working in the home and did not know if any of the agency staff had received dementia care training. She was advised that she was responsible for finding out this information. Miss Damhar employs a number of staff from overseas, some with a nursing qualification. She states that four members of staff have a nursing qualification equivalent to a National Vocational Qualification (NVQ) Level 3. Two of these four members of staff are currently studying for their NVQ3. Miss Damhar said that a further staff member was nominated to start NVQ training in April 2007. This means that currently four out of ten members of care staff are trained to the equivalent of NVQ Level 2 or above. The home have not recruited any new members of staff since the last inspection when two new staff members had been allowed to start work in the home before all required pre-employment checks had been completed. The files of the two staff members were re-examined and there was evidence to show that the required pre-employment checks had been retrospectively completed. The home had held training in infection control (December 2006), health and safety (June 2006), manual handling (May 2006), fire safety (December 2006), medication (January 2006) and food hygiene (April 2006). Training records of three care staff were examined. Not all staff members had attended the required training. Two staff members had not attended manual handling training since May and June 2005. Two staff members who had started work in the home during the first three months of 2005 had not received any training in dementia care. Miss Damhar had not arranged any training in dementia care since she took over in November 2005. She confirmed that dementia care training for care staff has been arranged for March 2007. She said that Beechey House planned to use an identified trainer to deliver the dementia care training and also to deliver a one day refresher induction training for all staff. Not all care staff had attended the food hygiene training although care staff prepare meals as part of their duties as the home does not employ designated catering staff. Guidance on funding streams for training may be accessed from www.picbdp.co.uk and www.traintogain.gov.uk. Guidance for employers on training may be also accessed from www.lsc.gov.uk/bdp/employer/eggt_intro.htm. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 24 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management responsibilities are not being fully discharged, this means Beechey House is not operating as a safe service. The home does not have fully developed formal quality assurance systems to show that Beechey House is run in the best interests of residents. The home does not accept responsibility with residents’ financial affairs. Staff have not received formal supervision with Miss Damhar, this means staff are not appropriately supervised. Working practices do not always ensure that the health, safety and welfare of residents and staff are promoted and protected. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Commission have serious concerns that Beechey House is not being managed with sufficient care, competence and skill. This means that the home is not operating as a safe service. Miss Damhar has gained the Registered Managers Award and is intending to commence the National Vocational Qualification (NVQ) Level 4 in Care in April 2007. It may be helpful for Miss Damhar to access a mentor or another professional for support and supervision in relation to professional practice. A useful internet site with information regarding management support is www.managementhelp.org/. Miss Damhar said that she had sent some questionnaires out to relatives. A formal quality assurance system was not in place. Staff have not received formal supervision since Miss Damhar took over as manager in November 2005. Some supervision records that had been completed by the previous owners showed that some members of staff needed further training in their oral and written communication. Miss Damhar had not followed up on these outstanding training issues. Miss Damhar confirmed that Beechey House have very little involvement with residents’ financial transactions. She said 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. Examination of fire records showed that regular checks are maintained on fire facilities and staff had received fire training. On the first day of inspection the hot water in the ground floor toilet regularly used by residents throughout the day was excessively hot at 60°C. This meant that residents and staff were at risk of scalding themselves from the hot water. This was put right by the second day of inspection when the hot water on the ground floor and first floor was tested and was at safe and comfortable temperatures. Moving and handling practices were not being carried out in accordance with care plans or in a safe manner. Two residents in the lounge were observed being assisted by two members of care staff with a transfer from their armchair into a wheelchair. The care plans for both these residents stated that the resident’s should use a zimmer frame to ensure a safe transfer. A zimmer frame was not used with either of the resident’s although zimmer frames were readily available for use. One of these resident’s was then moved in a wheelchair without any footplates, this meant their toes brushed along the floor. The bed rails fitted to one resident’s bed were not safe as they were not securely fitted (put right by the second day of inspection), a risk assessment in relation to bed rails had not been properly completed. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 26 Discussion was held with Miss Damhar about the potential risks with the tubes of denture cleaning tablets which were left out for easy access in many of the residents’ rooms. Denture cleaning tablets were observed in a number of residents rooms around the home. Due to the danger to residents they pose, for instance, should anyone mistakenly eat one, these should not be so readily available in the home. The risk is greater to residents given that most residents are confused and it was recorded that some residents went in and out of other residents’ rooms taking things. Miss Damhar was advised to carry out risk assessment procedures in relation to the tubes of denture cleaning tablets to show how risks to residents were minimised as far as possible. Regulation 37 Notifications were not always submitted to inform the Commission of deaths, illness and other events. The Commission had not been informed about the death of one resident; a resident having a fractured ankle and that the lift had not been in working order. A Regulation 37 Notification about the out of order lift was retrospectively received on the 17th January 2007 and was back in working order on the first day of inspection on the 23rd January 2007. Miss Damhar was not aware of her duty of reporting of serious injuries (for example a resident sustaining a fractured ankle) under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995. Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 1 Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 28 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 31/03/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. (Care plans must be revised so that they are more concise and accurate and give clear information about what action staff need to take in order to meet residents’ care needs, including night care needs). The registered person shall make 31/03/07 arrangements for service users to receive where necessary, treatment, advice and other services from any health care professional. (The need for regular health checks such as eye and hearing tests and blood monitoring should be clearly documented to show how often they should happen, if they have taken place DS0000064864.V328430.R01.S.doc Version 5.2 Page 29 Requirement 2 OP8 13(1)(b) Beechey House 3 OP9 13 and when they are next due). The registered person shall make 31/03/07 suitable arrangements for the recording, handling, safekeeping and safe administration of medicines received in the care home including: a) Updating the medicines policy. b) Recording details of any medicine sensitivity or ‘none known’ on or with the MAR chart to protect residents. c) Including the purpose of, and directions for, ‘when required’ medicines on the MAR chart and / or in the care plan so that staff know why and when they can be given. d) Monitoring the maximum temperature of the medicines cupboard to ensure that it does not exceed the recommended 25°C. Previous timescale of 31/12/06 not met. Storage for refrigerated medicines must be secure to protect residents and storage arrangements for reserve medicines, including food supplements must be improved so that they are stored off the floor. The administration or reason for non-administration of all medicines, including creams etc must be recorded. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service usersDS0000064864.V328430.R01.S.doc 4 OP10 18(1) (c ) 31/03/07 Beechey House Version 5.2 Page 30 5 OP12 16(2)(n) 6 OP14 12 7 OP15 16(2)(i) & 17(2) ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. (All staff must receive training in how to deliver person-centred dementia care so that they show respect and value by including residents in all interactions of daily life, including giving personal care). The registered person shall 31/03/07 having regard to the size of the care home and the number and needs of service users provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. (Arrangements must be made to ensure residents have the opportunity to participate in a range of activities, including daily living activities, that provide stimulation and socialisation). The registered person shall so 01/03/07 far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare and so far as practicable ascertain and take into account their wishes and feelings. (Residents must be supported in their individual choices (for example expressing a choice to lie on their bed for a rest in the day time) and be assisted to use the toilet when they wish and not be fitted into the home’s toileting routine). The registered person shall 02/02/07 having regard to the size of the DS0000064864.V328430.R01.S.doc Version 5.2 Page 31 Beechey House Schedule 4 care home and the number and needs of service users provide, in adequate quantities drinks properly prepared and available at such time as may reasonably be required by service users. (Hot and cold drinks must be available at all times and regularly offered). The registered person shall maintain in the care home records of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. (Food records must be accurately maintained so that dietary intake and choices are properly evidenced). The registered persons must 31/03/07 ensure that residents are protected from possible abuse. All staff must receive Adult Protection training to ensure a proper response to any suspicion or allegation of abuse. Previous timescales of 30/06/06 and 31/12/06 not met. The registered person shall 31/03/07 having regard to the number and needs of the service users ensure that all parts of the care home are kept clean and reasonable decorated and such support, equipment and facilities, as may be required are provided. (The walls where the old call system has been removed must be repaired to good order; redecorating must take place DS0000064864.V328430.R01.S.doc Version 5.2 Page 32 8 OP18 13(6) 9 OP19 23(2) Beechey House where the wallpaper is coming off the walls; all bedding and towels must be checked, those that are unacceptably worn must be replaced and all furniture must be in a reasonable state of repair eg drawers properly fixed). All residents must have an accessible bedside light in their room unless a reason for the absence of a bedside light is documented. Previous timescale of 31/12/06 not met. A suitable lock must be fitted to the laundry door to prevent access by vulnerable residents. Liquid soap and paper towels must be introduced for staff to use in the laundry and WC’s to aid infection control and help prevent any possible crosscontamination. Previous timescales of 30/09/06 and 31/12/06 not met. The registered person shall after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. (Cleaning of commode pans must meet the decontamination standards as recommended by the Department of Health Infection Control Guidance for Care Homes (June 2006)). The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service usersensure that at all times suitably DS0000064864.V328430.R01.S.doc 10 OP26 13(4) (a) & (c) & 16 (2) (j) 01/03/07 11 OP27 17(2) Schedule 4 (7) & 18(1)(a) 01/03/07 Beechey House Version 5.2 Page 33 qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (You must immediately ensure that there are sufficient numbers of staff on duty at peak times of activity during the day; during the afternoon and through the night to effectively meet the individual assessed needs of all 16 residents. There must be at least a minimum of three care staff in the afternoon and two waking night staff). This requirement was immediately met. (Miss Damhar must ensure that the agency staff used by the home have had the right training, including training in dementia care). The registered person shall maintain a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked. (The staff rota must show the names of the agency staff and also show that there are two waking night staff on duty). Miss Damhar must operate a 31/03/07 thorough recruitment procedure in accordance with Schedule 2 to ensure the protection of residents. The home have not recruited any new staff since the previous inspection. The requirement is therefore carried forward with a revised timescale. The registered person shall, 31/03/07 having regard to the size of the care home, the statement of DS0000064864.V328430.R01.S.doc Version 5.2 Page 34 12 OP29 19(1) 13 OP30 18(1) Beechey House 14 OP31 10(3) 15 OP33 24 16 OP36 18(2) 17 OP38 12 (1)(a) & 13(4) (a) & (c) & 13(5) & 37 purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (All staff must be up to date with their basic training, including manual handling and food hygiene and all staff must receive training in dementia care). Previous timescale of 31/12/06 not met. The registered manager shall undertake from time to time such training as is appropriate to ensure that she has the experience and skills necessary for managing the care home. A formal quality assurance system must be implemented to evaluate the quality of the services provided at Beechey House. Staff must receive regular formal supervision. Previous timescale of 30/06/06 not met. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (You must immediately ensure that all hot water is at a safe temperature close to 43°C so that residents and staff are not placed at risk of scalding themselves due to excessively hot water temperatures). DS0000064864.V328430.R01.S.doc 30/06/07 31/03/07 01/03/07 01/03/07 Beechey House Version 5.2 Page 35 This requirement was immediately met. (You must ensure that all bed rails are securely fitted and that a risk assessment is properly completed for the use of all bed rails. All relevant health care professionals should be included in the risk assessment process). The registered person shall make suitable arrangements to provide a safe system for moving and handling service users. (You must ensure that care staff assist residents to safely transfer from their armchair into a wheelchair in accordance with their individual care plans). Notifications must be submitted, without delay, to inform the Commission of death, illness and other events. Previous timescale of 01/09/06 not met. 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 OP9 Good Practice Recommendations The home should follow guidance from the Royal Pharmaceutical Society including: Having written confirmation (e.g. copy of prescription, hospital discharge summary or fax of amended dose). Monitoring and recording the maximum and minimum temperature (normal range 2-8°(C) of the refrigerator used to store medicines daily when in use. This recommendation has been carried forward from the previous inspection. There should be an in house system for monitoring DS0000064864.V328430.R01.S.doc Version 5.2 Page 36 2 OP9 Beechey House 3 OP14 4 OP19 medication records and the audit trail to ensure that medicines are given as prescribed and accurately recorded. This recommendation has been carried forward from the previous 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 supported in doing so. This recommendation has been carried forward from the previous inspection. Consideration should be given to incorporate current good practice related 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. All bedrooms should have lampshades so that rooms are furnished in a comfortable and homely way. The evidence obtained by the home that overseas nursing qualifications are the equivalent of National Vocational Qualification Level 3 (as stated in the Statement of Purpose) should be submitted to the Commission. This recommendation has been carried forward from the previous inspection. Miss Damhar should complete her National Vocational Qualification Level 4 in Care. This recommendation has been carried forward from the previous inspection. The home should ensure there is a system in place for effective maintenance of wheelchairs, including replacing wheelchair footplates. The home should ensure there is a system in place for effective maintenance of bed rails so that regular safety checks are carried out on all bed rails. Miss Damhar should ensure that all serious accidents are reported under the RIDDOR Regulations 1995. 5 OP28 6 OP31 7 OP38 Beechey House DS0000064864.V328430.R01.S.doc Version 5.2 Page 37 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.V328430.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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