Inspection on 27/07/07 for Beechey House

This inspection was carried out on 27th July 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 12/11/07

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 Debra Jones Key Unannounced Inspection 27th July 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechey House DS0000064864.V347069.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.V347069.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.V347069.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. 23rd January 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.V347069.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 on 26 and 30 July 2007. Debra Jones and Chris Gould were the inspectors who carried out the visit. 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 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. The inspectors were made to feel welcome in the home throughout the visit. 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. 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 2 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 insight into staff interaction with residents. The results of the observation are included throughout the report and were fed back to the manager at the end of the inspection. Following the last inspection the manager sent an improvement plan to the Commission outlining how they were going to address the requirements and recommendations made at the last visit. Prior to the inspection the home submitted to the Commission their annual quality assurance assessment (AQAA). This gave information about the service and the home’s assessment of their own performance. Both of these documents were helpful in the planning of this inspection visit. The home also sent out comment cards on behalf of the Commission. Two were returned, one by a care manager and one by a health professional. The following comment was made. ‘The care service meets the residents’ individual needs very well. The residents seem very relaxed and well cared for. ‘ The last inspection report contained 17 requirements and 7 recommendations. This inspection has resulted in 10 requirements and 8 recommendations being made. The management of the home has demonstrated through their recent success in complying with the majority of the previous requirements that there is capacity for the service to further improve. However despite this improvement the remaining requirements are of sufficient severity for the Commission to remain concerned about the overall standard and safety of this service. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection the home has worked with local care managers to improve their care plans. The medication policy has been updated and now includes procedures for handling controlled drugs, when the doctor changes medication, household medicines and providing medicines needed when a resident is away from the home. Medication Administration Record (MAR) sheets now routinely include medicine allergies, or “none known” if applicable, to protect residents. Concerns had been raised at the last inspection about the use of codes on the MARs. Codes appeared to be being used correctly at this visit. Where there is a choice of dose the amount administered is now being recorded. A minimum and maximum thermometer has been purchased for the areas where medication is stored. The home has started keeping records of the administration of topical creams. Ms Dahmar has introduced a system for auditing medication and medication charts to ensure that medicines are given as prescribed and records are kept of this. The activities programme has been expanded and now more is available to the residents at the home to enjoy. More detailed food records are being kept showing what residents eat during the day. More staff have had training in adult protection and the home is routinely checking prospective employees against the Protection of Vulnerable Adults list (held by the Department of Health) to further protect residents in their care. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 7 There have been some improvements made to the environment. Bedding and furniture has been checked and repaired / replaced as necessary. An audit has taken place in respect of bedside lamps. Bedrooms are being refurbished when they become vacant. A lock has been fitted to the laundry door. Liquid soap, paper towel, disposable glove and apron dispensers have been purchased and fitted in parts of the home. There are now suitable numbers of staff working at the home during the day and over night. Some staff training has taken place, including dementia care, moving and handling training. Skills for Care induction training has been introduced (the industry standard.) Staff preparing food for residents have all had basic food hygiene training. The home completed an Annual Quality Assurance Assessment prior to this visit and submitted it to the Commission. This outlines what the home is doing well, improvements they have made and plans for the future. What they could do better: It is recommended that the home take care to ensure that their care plans are up to date / cross reference with assessments to make sure that the staff know what the current needs of residents are in order that they can meet them. Continence assessments should be carried out in order to best meet the needs of residents and promote their continence. It would be good if the home further updated their medication policy with information about what to do with the medication of new residents. Ms Dahmar needs to monitor the medication administration as a number of gaps were seen on the Medication Administration Record (MAR) sheets making it unclear as to whether the medicines had been administered or not. All handwritten entries on 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. There must be the facility to lock all medicines away safely and to keep them at the correct temperature, including when they are stored in a fridge. More emphasis needs to be put on delivering person-centred dementia care so that residents are always shown respect and their privacy and dignity is never compromised. It would be good if there was more available to residents, in respect of occupation and stimulation generally, to make their daily lives more interesting and enjoyable. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 8 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 are needed with the building, facilities and infection control to ensure residents live in a safe and well-maintained environment. 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. Rosters must be properly kept showing who is working at the home, including agency staff, to evidence that the home has suitable numbers of staff, who are suitably experienced / trained to look after the residents, on duty at all times. The manager has to be sure that everyone working at the home has been properly recruited and has the correct training so that residents are looked after by suitable people who have the skills to do this. 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. Improvements need to be made to the home management to make sure that the care, contentment and safety of residents is central to the way the home is run. Examples of poor moving and handling were again seen, where bed rails are in place there is not a suitable risk assessment, potentially hazardous denture cleaning tablets remain readily available around the home, and portable appliances have not been tested for safety. Miss Damhar had not made any progress with formal staff supervision. In addition to the requirements and recommendations made in this report the following good practice suggestions are made that the home is urged to act upon. The home is encouraged to:• Identify on their pre admission assessments where they get the information from e.g. from the prospective resident, their relatives, health or social care professionals etc. • Consider spacing the time between lunch and evening meals out to make the day longer for residents or to routinely give snacks out in the evening to decrease the time between the evening meal, currently served at 5pm, and breakfast. • Compile an overview of staff training, showing what each member of staff has had training in and when, and also showing when refresher training is due. It may be helpful for Miss Damhar to access a mentor or another professional for support and supervision in relation to professional practice. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 9 A useful internet site with information regarding management support is www.managementhelp.org/. Also the home is asked to update their statement of purpose adding that any residents accommodated on the second floor must not be dependent on staff to evacuate the building, and to submit the updated version to the Commission. 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.V347069.R01.S.doc Version 5.2 Page 10 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.V347069.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A pre admission procedure is in place, and assessments are routinely undertaken, to ensure that only residents whose needs can be met by the home are offered places there. EVIDENCE: The rating of this outcome group is carried forward from the last inspection as no new residents have moved into the home since that time. At the visit in January 2007 a new residents’ file was reviewed. This demonstrated that the home had appropriately obtained a social services assessment before the person moved in. In addition the home had carried out a pre-admission assessment in order to confirm the individual’s needs and ensure that the home was able to meet them. It had not been clear on this assessment where the information had been obtained from, for example if it had been from a relative, the prospective resident or hospital staff. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. Arrangements for the recording, handling, safekeeping and administration of some medicines have improved but need further work to fully safeguard residents. The principles of respect, dignity and privacy are not always put into practice. EVIDENCE: The care records of residents were reviewed. Care records remain complex and are divided into separate sections i.e. assessments of care needs and separate care plans. Since the last inspection, through the adult protection investigation, local care managers have spent time in the home reviewing residents and looking and advising the home about their care planning documentation. An assistant care manager, who had visited the home for the first time recently, commented on the homes excellent care plans on a survey form to the Commission. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 13 Inspectors drew to Ms Dahmar’s attention, at this and at the last inspection visit in January 2007, examples of where information from the care assessments was not cross referencing with the information given on the care plan. This resulted in it not being easily apparent for staff to know what they were supposed to be doing in order to meet the current care needs of individuals. For example one resident was on medication for their diabetes yet their assessment said that their diabetes was diet controlled. The home has not undertaken continence assessments for residents to find out what their individual needs are and how best to meet them to promote continence. There was still no evidence of residents or relatives being involved in drawing up the care plans. Records showed that residents have access to health care professionals, for example GPs and community nurses. A community staff nurse, who returned a survey form to the Commission prior to the inspection visit, said that the home always sought advice and acted upon it to manage and improve individuals’ health care needs and usually met their health care needs. The medication policy has been updated and now includes procedures for handling controlled drugs, when the doctor changes medication, household medicines and providing medicines needed when a resident is away from the home. What to do with the medication for new residents is yet to be added. The home uses Medication Administration Record (MAR) sheets printed by their pharmacy. These now routinely include medicine allergies, or “none known” if applicable to protect residents. Staff record on the MAR sheets medicines received and administered. Concerns had been raised at the last inspection about the use of codes on the MARs i.e. “refused” and “refused and disposed of”. Codes appeared to be being used correctly at this visit. Where there was a choice of dose the amount administered had been recorded. It was good to see that the home is now keeping records of the administration of topical creams. Since the last inspection Ms Dahmar has introduced an “in house” system for auditing medication and medication charts to ensure that medicines are given as prescribed. This is carried out by night staff. Records are kept of the audits. However a number of gaps were seen on the sheets so it was not clear if the medicines had been administered or not. These were to be investigated by Ms Dahmar. Where staff had made handwritten changes to MAR sheets these had not been countersigned by another competent member of staff to confirm their accuracy. In some cases handwritten entries on the charts had not been signed at all. Medicines in use were being stored and transported securely. There is a separate fridge for medication which does not lock. However no medicines were being stored in the fridge at this visit. A minimum and Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 14 maximum thermometer has been purchased for the areas where medication is stored. The home monitors the temperature of the fridge. On the day of inspection the fridge was unsuitably cold. The community staff nurse, who returned a survey form to the Commission prior to the inspection visit, said that in her opinion the home always respected individuals’ privacy and dignity and usually supported individuals to live the life they choose. During the inspection visit staff were observed to be mostly interacting with residents in a friendly and caring manner and were kind, warm and gentle in their approach. However not all care was delivered in a manner which promoted quality of life through valuing people as individuals. At times staff explained what they were doing, for example when they were putting on slings and hoisting people in order to go to the toilet but at other times were staff seen treating residents as if they were objects. This happened when staff straightened the clothes of residents without even speaking to them to explain what they were doing, or took their temperature and did not feed back what they found. Another member of staff spoke sharply to a resident who was sat with her elbows on the dining table, telling her to sit up straight. This had been after the staff had moved the resident there after being taken to the toilet about an hour before lunch was served. During the course of the morning a District Nurse came to the home. One of the residents she was visiting was in the lounge. He was someone who needs to be hoisted in order to move around the home e.g. from the lounge to his own room. Rather than have the resident assisted to their room the nurse took blood from them in the lounge. This action did not respect their privacy and was undignified for the resident. The procedure caused them discomfort. After the nurse left no care staff approached him to check that he was OK or to offer him any comfort. Other residents or visitors in the home should not be exposed to the medical treatment of any residents. Beechey House DS0000064864.V347069.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities are improved but need further work to sufficiently meet the range of stimulation that residents need. People are generally encouraged to make choices about their life style and to maintain contact with their family and friends. A balanced and varied diet is provided for the enjoyment of residents. EVIDENCE: After the last inspection the home submitted an improvement plan to the Commission. In this they described how there are now more activities taking place. There are fortnightly visits from an entertainer and a beautician. Craft sessions have also been introduced and some of the artwork residents had done was on display in the lounge. Staff have also been advised to spend more time talking with residents, including when engaged in tasks. ‘Care and canines’ have also visited and due to the enjoyment of the residents will be coming again. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 16 After lunch on the first day of inspection staff played a game of skittles with residents in the lounge. At the second visit an entertainer was playing the accordion. During the morning of the first day of inspection staff were engaged in tasks around the home, e.g. giving out drinks mid morning, helping people to the toilet, cooking etc. Little time was spent socialising or providing stimulation for residents. DVDs were put on; one was about Dean Martin and the other about Frank Sinatra. One resident really enjoyed them and pulled a chair close to the screen to watch. Other residents were in the lounge area and may have been too far away from the screen to see the programmes, but were able to enjoy the music. Whilst there are some things available for residents e.g. piles of books and magazines, soft toys and games staff did not show them to residents to try and interest them in them. Residents either slept or pulled at their clothes or cushions, some sat looking out of the window onto the road. Other residents wandered around seeming to find nothing to interest them. When residents were moved to the dining room table, out of view of the TV they were given nothing to occupy themselves with despite it being up to an hour before lunch for those who were moved early. The visitors book confirmed that residents maintain contact with friends and family. At previous inspections relatives have said that visiting is open and flexible and that they are always made to feel welcome at 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. Good negotiation with a resident was observed who asked for an alcoholic drink and settled for a cup of coffee. 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 the preparation and cooking of all meals, as there is not a designated member of catering staff. On the first day of the inspection residents were observed through lunchtime. All residents in the communal areas ate their meals together at the dining room tables. Residents started to be assembled in the dining area from about midday onwards, after they had been taken to the toilet by care workers. From about this time residents started to be asked if they were hungry and were told what lunch was going to be. When it arrived just after 1pm lunch was beef with mashed potatoes carrots and sprouts. One resident had ham as a alternative to the beef and another had faggots. Portions varied in size to suit individual residents and where residents did not like one of the vegetables on offer they were given extra of something they did like. Some residents needed assistance to eat their meals. Care workers and Ms Dahmar helped them, joining them at the table, sitting at their height and going at their pace. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 17 Examination of food records confirmed a balanced and varied diet is provided and indicate who had had what to eat. During the inspection drinks were available at the planned times of mid morning, lunchtime and mid afternoon. Other drinks served during the day were at the specific request of residents. Meals are served close together with lunch being served from 1- 2pm and the evening meal at 5pm. Some residents ask for a snack later, but not all are routinely given something to eat. Hot drinks are served to all before bed. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 18 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. People who use the service have access to a complaints procedure. Policies and staff training in abuse protect residents from harm. EVIDENCE: The home has a complaints policy. Miss Damhar confirmed that there had been no written complaints since the last inspection. Beechey House has both adult protection and whistle blowing policies in place. The adult protection investigation referred to in the last inspection report has been concluded. This had arisen from concerns relating to poor care practices due to low staffing levels. As a result of this there was an increase in staffing numbers in the afternoon and during the night. This staffing level continues to be maintained. Miss Damhar said that most staff had received adult protection training on 19 January 2007. She said that newer staff would have covered this topic as part of their induction training. Documents seen showed that staff are employed at the home only after the Protection of Vulnerable Adults list has been checked to confirm their suitability. However there was no evidence to show that the same was true of agency staff working at the home. (See standards 27 – 30 below) Beechey House DS0000064864.V347069.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, though 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, still does not have many environmental features to distinguish it from a care home for older people. Features that are in place include a secure keypad system in use to exit the building to ensure the safety of residents and floor pressure mats, which alert staff to residents getting out of bed. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 20 At the last inspection it was noted that improvements were needed to the décor and furnishings, as it was evident that some aspects of the premises were not well maintained. By this visit these have started to be addressed e.g. bedrooms being redecorated, there are now lampshades in all rooms. Ms Dahmar was reminded of the need to ensure that exposed pipes must be covered / guarded to prevent residents / staff harming themselves. Some doors were not closing to latch and Ms Dahmar was asked to check all doors. The laundry door could not be closed at all. Ms Dahmar got this attended to during the first day. A lock has now been fitted on this door. Bedding appeared to be in a better condition than at the last inspection. Some towels and flannels seen could do with replacing as they were stained and worn. A net curtain was ripped in an upstairs bedroom. In another bedroom there was not a main curtain on one of the two windows, just a net that would not block out the light. Continence products were on display in some rooms rather than put away in cupboards. The carpet that was discoloured in a large patch where there had been an accident with bleach falling from a table noted at the last inspection has still not been replaced. The positioning of one of the beds was discussed with Ms Dahmar. Due to the pump the bed was turned so that the headboard backed onto the door, out into the room. The headboard was not secure and poses the resident with a potential risk of getting trapped in it. The resident whose bed it was needs to be hoisted and the bed was not positioned in a way that staff could get either side of it. Inspection of the premises demonstrated the home was generally clean. A part-time cleaner is employed. There is a laundry room with an industrial washing machine and tumble dryer. Concerns have been raised at previous inspections about the home needing to provide liquid soap and paper towels for staff to use in the laundry and WCs to aid infection control and help prevent any possible cross-contamination. These were now available in the laundry room. It is appreciated that availability of paper towels in the WCs needs particular consideration due to the special needs of one resident but resolution is still needed for the protection of others. Discussion was again held with Miss Damhar about the cleaning of commode pans. The home does not have a pan washer-disinfector. It remains the case that 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 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 Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 21 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. Ms Dahmar said that she has been looking into this but the matter remains unresolved. The home’s infection control policy does not include how staff are to clean commodes and bottles. Beechey House DS0000064864.V347069.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. Whilst improvements have been made to the numbers of staff on duty and recruitment of staff to the home shortfalls in practice are still leaving residents at risk of unsuitable people working at the home. EVIDENCE: The community staff nurse, who returned a survey form to the Commission prior to the inspection visit, said that it was always the case that in her view the care staff have the right skills and experience to support individual’s social and health care needs and responded to the different needs of individuals. An assistant care manager who had visited the home for the first time recently said that all staff appeared to be experienced and very supportive. 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 domestic worker is employed. Care staff carry out cooking and laundry duties. The home currently has to rely on agency staff to keep staffing at the home to this level. Rotas did not show the full names of agency staff on duty and at times did not even have their first names noted. However evidence of them Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 23 working at the home was available through individual time sheets submitted by agency staff. Miss Damhar was advised that the staff rota must accurately reflect the staffing arrangements and show all the names of the staff on duty. She had been advised of this at the last visit in January 2007. At that time discussion was held with Miss Damhar about the use of agency staff and the need for her to know what training they had received i.e. specifically dementia care training. Ms Dahmar was advised that she was responsible for finding out this information. On the afternoon of the first day of the visit there were two agency staff on duty along with a permanent member of staff. One had not worked at the home before. Ms Dahmar was asked about their training and pre employment checks and produced a list she had been given by the agency. This list showed that staff had had appropriate pre employment checks and some basic training, but there was no mention of dementia care. Neither member of staff working at the home featured on this list. One of the agency staff said that she had had some dementia care training in her home country, Poland. The home have recruited some new members of staff since the last inspection. The files of two new staff members were reviewed. Documentation as required by law was in place with the exception of one reference from the most recent / current employer. There was evidence to show that new staff were undergoing induction training to the industry standard (Skills for Care). Ms Damhar said that training had recently taken place in the following topics, moving and handling, fire and health and safety. Evidence of staff training is held on individual staff files. A training overview is not kept, so it is not possible to easily access information showing if all staff are up to date with training or when refreshers are due. Of the staff files reviewed for new staff for one this was their first job in care and some evidence of training was available, for the other they are currently employed at another home where they say they have had training essential for their work at Beechey House, there was no evidence on file to support this claim. At the last visit concern was expressed that Miss Damhar had not arranged any training in dementia care for staff since she took over in November 2005. At the time she said that dementia care training had been arranged for March 2007. This took place. The training took 2 hours and was followed by a question and answer session. Whilst it was good that some training had taken place this level of training would be suitable for an ordinary older persons home but is not sufficient for a specialist service which Beechey House residents are paying for. Ms Dahmar said that all staff currently involved in the preparation of food have attended food hygiene training. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 24 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. Ten members of care staff are employed at the home. Miss Damhar employs a number of staff from overseas, some with a nursing qualification. She states that three members of staff have a nursing qualification equivalent to a National Vocational Qualification (NVQ) Level 3, but this has not been verified by an NVQ assessor in this country. One member of staff is currently studying for their NVQ level 2 and two other staff members are studying for NVQ level 3. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 25 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. Despite some improvements the Commission continues to have concerns that Beechey House is not being managed with sufficient care, competence and skill and that the home is not operating as a safe service for the residents living there. EVIDENCE: Miss 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 Ms Dahmar has completed a 12-week long distance course. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 26 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. It is still the case that staff have not received formal supervision since Miss Damhar took over as manager in November 2005. Bearing in mind that poor practice has been seen again at this inspection visit this becomes a priority given that supervision is the best recognised mechanism to improve standards of care and identify training needs with staff. Miss 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. 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. In January 2007, when inspectors visited, the hot water in the wash hand basin in the ground floor toilet, regularly used by residents throughout the day, was excessively hot. At this visit the hot water on the ground floor and first floor was tested and was found to be at a safe and comfortable temperature. Also in January 2007 inspectors noted that moving and handling practices were not being carried out in accordance with care plans or in a safe manner. At this visit some good practice was seen in that staff were talking with residents about what they were going to do and reassuring them, but poor and unsafe practice was again seen and staff were not always following written moving and handling plans. One plan said that the resident should be assisted to move with a moving and handling belt and if unable after 3 attempts, hoist. This resident was seen being moved by staff without any aids / equipment. In the lounge comfortable chairs are placed around the edge of the room. They are very close together resulting in staff not being able to access residents from the side, meaning that when assisting residents to move it is done from the front. Staff were seen straining their backs and pulling residents up under their arms. One resident who had difficulty getting out of a comfortable chair was observed being assisted by staff in the morning, staff were patient and did not rush the resident and she was safely encouraged and assisted to her feet, later in the day the manager was asked to intervene to prevent potential injury to this same resident by a member of agency staff inappropriately pulling her out of her chair under her arms. During the morning one resident was being Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 27 put into a sling, prior to hoisting. To get the sling behind her staff pulled her forward by the back of her neck. After hoisting one resident was lowered into a wheelchair that did not have it’s brakes on. The poor practice was discussed with Ms Dahmar along with how rearranging the room to create space between chairs might make a difference. One resident has bed rails on her bed. The risk assessment was not sufficiently comprehensive and Ms Dahmar was given advice in respect of Medicines and Healthcare products Regulatory Agency guidance on assessing risk of such equipment and carrying out ongoing maintenance and safety checks. At the last inspection there was discussion with Miss Damhar about the potential risks of tubes of denture cleaning tablets being were left out around the home, easily accessible to residents i.e. in a number of residents rooms. Denture cleaning products pose danger residents, for instance, should anyone mistakenly eat one. The risk is greater to Beechey House residents given that most 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 assessments in relation to the tubes of denture cleaning tablets to show how risks to residents were minimised as far as possible. Since that inspection visit Ms Damhar has had metal lockable wall cupboards fitted in all residents’ bedrooms to put, amongst other things, denture cleaning products in. However, on the tour of the premises denture cleaning tablets were found by the hand washbasins in most rooms. Some portable appliances e.g. heaters, were seen around the home. Ms Dahmar said that she was not aware of her responsibility to have them regularly tested for safety. Regulation 37 Notifications are now being submitted to the Commission informing of deaths, illness and other events and Miss Damhar is aware of her duty to report serious injuries under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995. Accident records were viewed. These were numbered but the numbers were not strictly sequential. Ms Dahmar attended to this at the visit. Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 28 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 3 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X x 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 1 x 1 Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 29 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 30/09/07 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. The registered person shall make 30/09/07 suitable arrangements for the recording, handling, safekeeping and safe administration of medicines received in the care home including: Updating the medicines policy with what to do with the medicines of new residents. 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 Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 30 Requirement 2. OP9 13 reason for non-administration of all medicines. 3. OP10 12 The registered person shall make 30/09/07 suitable arrangements to ensure that the care home is conducted in a manager, which respects the privacy and dignity of residents. Exposed pipes must be covered or guarded, all windows must be suitably curtained, all fire doors must close to latch, stained carpets must be cleaned / replaced. Where residents are hoisted from bed their bed must be positioned so this function can be performed safely i.e. staff able to get either side of the bed. Paper towels must be introduced for staff to use in the WCs to aid infection control and help prevent any possible crosscontamination. Previous timescales of 30/09/06 not met. Cleaning of commode pans must meet the decontamination standards as recommended by the Department of Health Infection Control Guidance for Care Homes (June 2006). Previous timescale of 01/03/07 not met. 6. OP27 17 Schedule 4 (7) A copy of the duty roster of persons working at the care home, and record of whether the roster was actually worked must be kept. The staff rota must show the full names of all staff, including any agency staff. 30/09/07 30/09/07 4. OP19 23 5. OP26 13 30/09/07 Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 31 Previous timescales of 01/03/07 not met. 7. OP29 19(1) 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 not met. 8. OP30 18 Miss Damhar must ensure that the agency staff used by the home have had appropriate training, including training in dementia care. Previous timescales of 01/03/07 not met. 9. OP36 18(2) Staff must receive regular formal supervision. Previous timescale of 30/06/06 not met. 10 OP38 13 and 23. 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. You must ensure that care staff assist residents to safely transfer and do this in accordance with their individual care plans. Unnecessary risks to the health and safety of residents must be identified and so far as possible to be eliminated e.g. denture cleaning tablets must be suitably Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 32 30/09/07 30/09/07 30/09/07 30/09/07 stored. Previous timescales of 01/03/07 not met. Equipment in the home must be maintained in good working order e.g. portable appliances must be tested to evidence this. 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 OP7 Good Practice Recommendations Care should be taken to ensure that updated assessments cross reference with care plans so that it is clear what action staff need to take in order to meet residents’ care needs, including night care needs. Continence assessments should be carried out in order to ascertain the needs of individuals and how they are to be met. 2. OP12 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. 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 previous inspections.) 4. OP19 Consideration should be given to incorporate current good DS0000064864.V347069.R01.S.doc Version 5.2 Page 33 3. OP14 Beechey House 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 a previous inspection.) 5. OP28 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 previous inspections.) 6. 7. OP30 OP31 Staff should have training in dementia care to a level suitable for the specialist service provided. Miss Damhar should complete her National Vocational Qualification Level 4 in Care. (This recommendation has been carried forward from previous inspections.) 8. OP38 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. (This recommendation has been carried forward from previous inspections.) Beechey House DS0000064864.V347069.R01.S.doc Version 5.2 Page 34 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. 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