Inspection on 21/05/08 for Beechill Nursing Home

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Adequate service.

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

Beechill Nursing Home 09/02/09

Beechill Nursing Home 09/05/07

Beechill Nursing Home 24/11/06

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Clover House

Langrigg House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Beechill Nursing Home 25 Smedley Lane Cheetham Hill Manchester M8 8XG Lead Inspector Steve O`Connor Unannounced Inspection 21st May 2008 09:30 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 Beechill Nursing Home DS0000066845.V363437.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. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechill Nursing Home Address 25 Smedley Lane Cheetham Hill Manchester M8 8XG 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) 0161 205 0069 0161 205 0165 beechillcare@yahoo.co.uk Skolak Homes Limited No registered manager. Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (12) of places Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 19). Physical disability: Code PD (maximum number of places: 12). The maximum number of service users who can be accommodated is: 31. Twelve residents aged 18 - 60 who fall within the category of physical disability are currently accommodated. Should these residents no longer require the accommodation offered by Beechill Nursing Home the category will revert to OP (old age). The responsible individual must undertake Protection of Vulnerable Adult Training by 15 September 2006. 6th November 2007 2. 3. Date of last inspection Brief Description of the Service: Beechill Nursing Home is owned by Skolak Homes Limited and provides accommodation for a maximum of 31 people. The home is located in the North of the City of Manchester and is situated within easy walking distance of local services and amenities. Limited parking facilities are available to the front and rear of the property. The home is a three storey purpose-built building. Bedroom accommodation for residents is provided on the first 2 floors and the third floor is used as office space. There are 23 single rooms and 4 double rooms. No en-suite facilities are provided but each room has a wash hand basin. There is one lounge, a smoking room, a small quiet room, a hairdressing room and a dining room. The home offers a small garden and patio area to the rear of the property. The charges for fees range from £409.00 to £564.00 per week. There are additional charges for hairdressing, private chiropody and other personal items such as cigarettes and alcohol. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The inspection report is based on information and evidence we (the commission) gathered since the last key inspection in May 2007. Additional information, which has been taken into account, included incidents notified to the commission by the agency and information provided by other agencies. Before visiting the home, we asked the agency to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helped us to determine if the management of the home viewed the service they provide the same way that we see the service. Before the visit to the home people who use the service, their relatives and members of staff were sent surveys and were asked to comment on the agency. By the time of the visit 2 relatives and 6 staff had returned completed surveys. This unannounced visit forms part of the overall inspection process and was conducted by 2 inspectors on Wednesday 21st May 2008. During the inspection site visit time was spent talking to people, to the acting manager and staff. Documents and files relating to people and how the agency was run were also seen. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was used to make a judgement on the quality of the service provided by the agency and to decide how much work we need to do with then in the future. What the service does well: The staff and management team had continued to do well in the way that they recorded and identified people’s needs and how they were to be supported. Reading samples of care plans felt like the person was telling you about their lives and the important information that staff needed to know. In this way the care plans were written with a person centred approach that focused on the positive and what help people wanted themselves. People spoken to during lunchtime said that the meals were ‘nice’ and that they always had enough to eat. People were seen being offered choices of meals and a meal was made specifically for one person when they requested it. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 6 The dining room was a very homely and pleasant environment to have meals with nicely laid tables and good quality furniture. Two relatives responded to us by surveys and their comments about the support their relatives received were generally positive. They knew how to raise concerns and complaints and felt that the staff welcomed them and supported their visits. One relative stated that ‘if any matter arose then I would discuss it with the manager’. What has improved since the last inspection? What they could do better: At the time of the key inspection site visit the manager, who had been in post since October 2007, had not returned from a planned holiday and it was not known when or if he was going to return in the foreseeable future. The senior nurse who would normally act up for the manager had also just left employment at the home. At the time of the site visit, the acting manager had only been in post for a week and was not able to find certain evidence or have all the information asked of them. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 7 From the evidence found through the inspection process the issues identified below needed to be addressed. In addition, the current acting manager was given verbal feedback on all these issues raised and other requirements and recommendations made as a result of the inspection. At the time of the site visit several people were very upset with the staff as they had not been able to buy any cigarettes or other personal items for several days. The acting manager stated that this was as a result of not having access to where people’s funds were stored or any other monies, such as petty cash, to buy items. There was a clear process for people to access their personal monies but this had not worked on this occasion. The nursing staff manage the medication administration system to make sure that people receive the right medication at the right time. There was an area that needed improvement to make sure that the system was as safe as possible. This was to make sure that if people are prescribed with medication ‘as required’ (PRN) then staff have access to clear written guidance on its administration and follow that guidance. If any member of the staff team are acting in a management role then they must have, or have access to, key information in relation to their role and responsibilities. This includes how to make referrals under the Protection of Vulnerable Adults procedures, when and who to notify of events that impact on people’s wellbeing, the management role in maintaining health and safety and the key legislation and regulations affecting the operation of the home. On the appointment of a manager they must make an application to become the registered manager and so show that they are ‘fit’ to manage the home and fulfill their roles and responsibilities as the registered manager in maintaining the standards and quality of the service people received. People must be able to live in a safe environment and so the registered provider must make sure that they provide a smoke free environment as set down in the no smoking legislation. 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. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents’ needs are assessed prior to them being admitted to the home and they are provided with information to help them make that decision. People were given sufficient information in relation to their terms and conditions and fees. EVIDENCE: There had been no new admissions to the home since the last inspection. At the previous key inspection there was documented pre admission assessment forms that were used to ensure that prospective residents are admitted on the basis of a full assessment of needs and for residents who are referred through Care Management arrangements the home obtained a summary of the Care Management Assessment. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 10 The previous key inspection report in May 2007 highlighted changes and improvements that were needed in informing people about the fees that were charged, top-up fee arrangements and how fees were reviewed and changed. These changes had been made to the Terms and Conditions of residence provided to people. Intermediate care was not provided. Beechill Nursing Home DS0000066845.V363437.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 good. This judgement has been made using available evidence including a visit to this service. People’s personal and health needs had been identified and systems and practices were in place to meet those needs. The medication administration system needed some improvements to make sure that people remained well. EVIDENCE: A random selection of people’s care plans and files was examined. The files were well organised and maintained into relevant sections, which made them easy for staff to use. The plans of care were found to be detailed, informative and contained a lot of personal person centred information about how the person themselves wanted to be helped and treated. The files showed that health related assessments and care plans had been undertaken and developed, such as moving and handling, nutritional needs, continence and skin care. Where required, more detailed guidance was Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 12 developed to show staff how to support, for example, a person’s feeding regime and diabetes care (Diabetes Care Pathway). Detailed personal care guidance was also seen, setting out for staff what they do and how the person likes to be supported. The care plans clearly set out the specific religious and cultural needs of people to be met. All the care plans examined had been developed in April 2007 and had been reviewed and updated on a regular and ongoing basis based on people’s changing needs. Examples of risk assessments were seen relating to actions or behaviour that people exhibit that may place them at risk or harm. The staff team supported a number of people who have health and emotional issues around the continued use of alcohol. Risk assessments and care plans were seen that set out how staff were to support people in making choices about their alcohol use and in dealing with situations that arise as a result of alcohol use. The use of bed-rails had been reviewed and risk assessed, as required from the previous key inspection. The care plans sampled did identify people’s health needs and provided guidance to staff in how to maintain people’s health. However, the recording evidence to show that staff were actually carrying out those tasks set out in the care plan was at times not always completed. Examples include recording when a person receives pressure sore relief and continence management and support. It is recommended that staff clearly evidence, through the recording systems, that the actions set out in the relevant care plans had been carried out. Examples were seen in people’s care plans that highlighted to the staff team the importance of maintaining people’s privacy and dignity, especially around the area of personal care. Guidance and clear instructions were provided to staff on how to work with and support people in a dignified way. The medication administration system was assessed and checked and it was found that recording of administering on medication administration records (MAR) was accurate. Examples of staff signatures who administer medication were maintained. Records of deliveries and returns to the pharmacist were being kept. All thickened fluids were being recorded on a separate record as required from the previous inspection report. Through sampling the medication records it was found that a person was being administered a medication prescribed ‘as required’ (PRN) as if it was prescribed to be administered on a regular basis. It was also noted that this PRN and another person’s PRN medication did not have any associated administering guidance for staff to use to establish when to administer. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 13 To make sure that people receive only the medication they require to keep them healthy, staff who administer medication must follow the administering prescription details unless given clear written permission and guidance from a prescribing doctor to do otherwise. Also that staff make sure that every person prescribed with PRN medication has clear written administering guidance that tells staff exactly when the medication is required. Beechill Nursing Home DS0000066845.V363437.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. People appeared to enjoy the meals and mealtimes and could see their visitors when they wished. People’s daily lifestyles were based on repetitive routines with little social and leisure interaction and activities. EVIDENCE: Examples were seen in people’s care plans that described how they like to make choices in their day-to-day lives. People were encouraged and supported to choose their clothing, to maintain their own personal care, the activities that they enjoyed, what meals and drinks they liked and how the person communicated with others. Where possible, and safe to do so, people do control their own personal finances and can access the community independently. Information about an entertainment event in June was displayed in the lounge area. A staff meeting in March 2008 reminded staff to use the activity sheets and records were being maintained on a daily basis. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 15 However, the actual activities recorded for almost every person consisted of events such as ‘watching television’, ‘listening to radio’ and ‘in the smoke room’. All they recorded was people’s daily routines that consisted of the same activities over and over again. The previous key inspection report, in May 2007, identified that an activities co-ordinator had been employed to spend time with residents finding out about their interests and what social and leisure activities they enjoy. They were no longer employed at the home. At the time of the site visit the acting manager and two care staff were on duty to support the twelve residents, at least three of whom required two staff to support their mobility and personal care. During the site visit, when time was spent in the communal areas, it was noted that staff were very rarely seen to have time to sit and talk with people or take part in any meaningful activity with them that was not focused on doing tasks such as personal care, mobility or mealtimes. These concerns were raised with the manager at the time of the Random Inspection in November 2007. The issue of staff supporting people with daily activities was raised in the staff meeting of November 2007. There was no evidence to show that this situation had changed. It is recommended that people be consulted about the social and leisure activities that they enjoy and want to participate in and this is clearly recorded through their care plan. It is also recommended that staff have the opportunity to spend meaningful time with people in the social and leisure activities of their choice. Visitors to the home were welcome and could visit at any reasonable time and spend time in private or in the communal areas. People had the opportunity to take their meals in the dining room or in their own room if they wished. Lunch was being served during the site visit and people spoken to said that they enjoyed the food and had choices if the main meal was not what they wanted. One person asked the cook for a different meal to the one on the menu and she cooked this fresh for them. The previous Random Inspection report in November 2007 highlighted that whereas people preferred having their main meal in the evening this had been changed due to changes in staffing and the main meal was available at lunchtime. The cook confirmed that the main meal was now in the evening, most of the time, and that they would prepare the meal during the day and the care staff would re-heat and serve the meal at teatime. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 16 During lunchtime a staff member was observed who brought a person’s meal to the table and then began to spoon food to them whilst still standing next to them, not speaking to the person. It appeared that it was only as the inspectors were observing this member of staff that they then actually sat down next to the person to assist them with feeding. This issue will be raised again in the staffing section of the report. A tour of the kitchen was undertaken and it was found to be clean and well organised. The local authority environmental health team had recently visited and made some recommendations about cleaning and recording and these had been followed. Good supplies of food stocks were seen, which included fresh fruit and vegetables. The cook had a good knowledge of people’s nutritional needs regarding diabetes and soft diets and a record was being maintained of the meals that people ate. Beechill Nursing Home DS0000066845.V363437.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. Staff were aware of their roles in protecting people but not all the necessary procedures were in place to make sure that staff responded appropriately. EVIDENCE: Information provided by the manager in the AQAA self-assessment form stated that no formal complaints had been made in the past 12 months. The Complaint Policy and procedures, with time-scales, was available to people in the Service User’s Guide. The previous key inspection report in May 2007 found that the manager had access to the local authority multi-agency adult protection procedures. The current acting manager was aware of the issues around adult protection but could not find any reference to these procedures and had not been provided with the relevant contact details for making a Protection of Vulnerable Adults (POVA) referral to the local authority. The home’s Adult Protection Policy and procedures, that was available to see, did not contain a clear procedure for the actions staff and management need to follow in the event of an allegation or concern. It made no reference to the local POVA procedures or the role of the local authority and the police. The policy had been signed by some of the staff team. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 18 Staff records sampled showed that those staff had attended POVA training and staff spoken to during the site visit were aware what abuse was and what they would do if they had any concerns. The staff and management team must be fully aware of their roles and responsibilities and the procedures to follow in responding to incidents and allegations of abuse. Beechill Nursing Home DS0000066845.V363437.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 adequate. This judgement has been made using available evidence including a visit to this service. The building was generally clean and tidy and homely in nature. Failure to address the no smoking legislation and other health and safety concerns meant that the environment was not totally beneficial for people’s safety and wellbeing. EVIDENCE: We looked around the building and outside and found that communal areas appeared generally clean and today and well maintained. The small grassed area at the rear of the building was still untidy and did not provide a pleasant environment for people to use. It is recommended that the garden area is made more attractive for people to use. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 20 Since the last key inspection in May 2007 a number of changes had been made to the layout and usage of the communal areas. An area had been set up as a sensory room but was not in use at the time of the site visit. A small lounge had been made the designated smoking room with an extractor fan for ventilation. The lounge had been divided into two areas using a large sliding door. In one area was seating with the television and music centre and on the other side was more seating with a pool table and computer. The smoking room was not very large. It was observed that three people were in the room and one person was a wheelchair user, which meant that the door leading to the rest of the communal areas could not be closed. Smoke could be seen and smelt throughout the communal areas. This was pointed out to the current acting manager and the issue has been raised under the Management section of this report in relation to the impact on the health and safety of people and staff. The local authority environmental health department must be contacted to gain advice on how to address this issue. Several people had their own televisions and personal items in their bedrooms to make them more homely. Several bathrooms contained both portable and fixed hoists to aid people’s mobility. Whilst talking to a person in their bedroom it was noticed that the emergency call alarm had the cord missing and from where they sat they could not reach the alarm on the wall to activate the system. The emergency call systems must be accessible for people to use at all times. Whilst walking around the building the following problems were found that needed to be addressed. The cover of the cistern of the toilet opposite room 10 was broken in half. This was raised with the manager and had been addressed. Part of the fly screen in the kitchen was not fitted in front of an open window; this posed a risk of insects entering the meal preparation area. The local environment health authority must be contacted regarding an appropriate system for the control of insects and the ventilation of the kitchen area. There was no alcohol gel in the dispenser outside the toilet near room 10 and other dispensers, situated outside bathrooms and toilets, were also low on gel. Staff must be able to access the necessary facilities to reduce the risk of cross infection. A radiator in the corridor, nearest to room 10, had no protective cover and was very hot to the touch. This was pointed out to the manager and has been addressed and made safe. At the bottom of the stairwell on the ground floor two large cloth beanbags and parts for the lift were being stored. These were removed following the inspection. The carpets on the stairs from the 1st to 2nd floors were very worn Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 21 and frayed in places and could potentially present a trip risk. Action was taken to make the carpet safe. Staff training records sampled showed that they had participated in infection control training. The laundry facilities were suitable for the service and number of people supported. Clinical waste was disposed correctly. Beechill Nursing Home DS0000066845.V363437.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 adequate. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff available appeared sufficient to meet people’s primary assessed needs and focused mostly on tasks such as personal care. EVIDENCE: At the time of the site visit the staff rota showed that during the day (8am to 8pm) there was always at least one nurse and two care staff on duty. Between 1pm and 4pm two nurses were on duty. During the night there was one nurse and one care staff. They supported 13 people (one person was in hospital at the time of the inspection) three of whom required 2 staff to support them for their mobility and personal care needs. During the Random Inspection in November 2007 it was found that the owners had reviewed and reduced the domestic worker’s hours for the home. The member of staff responsible for the laundry had been asked to undertake the cooking and the laundry tasks were being carried out by the care staff. Staff on duty were also preparing and serving meals in the evening. The domestic worker worked part-time Monday to Friday. Outside of those hours and at weekends the care staff on duty were responsible for maintaining the cleanliness of the home. The acting manager at the time explained that this was in response to the reduction in people being supported at the home from Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 23 18 to 14. As highlighted above, there were 13 people living at the home at the time of the site visit and the building did appear clean and tidy. The issue raised at the time of the Random Inspection and highlighted in the Daily Life and Social Activities section of this report is that the nursing and care staff have to focus totally on carrying out tasks and they were not seen having any time to spend talking to or socialising with people. The recommendation that the staffing levels and deployment of staff be reviewed to ensure that care staff have the opportunity and time to spend with residents is reiterated. According to the staff rota the staff team consists of 4 registered nurses and 8 care staff who work days and 5 registered nurses and 4 care staff who work nights. The information provided by the manager in the AQAA self-assessment stated that 6 care staff had achieved the NVQ Level 2 and 2 care staff were currently undertaking the course. A sample of staff files were seen to see whether the required documentation was in place and the necessary checks had been made. A system was in place to check the registration details of the nurses employed at the home to make sure their details were up-to-date. All the files sampled contained an original Criminal Records Bureau certificate. It is recommended that a record of the certificate number, type and date be kept on record and the original can be destroyed. Some of the references provided for staff did not make it clear whether they came from current/previous employers. It is recommended that all references from current/previous employers should be authenticated through providing a company stamp or letterhead or through a telephone check. Some of the identification records in staff files were photocopies of the originals. It is recommended that written evidence be maintained that the original documentation had been seen, the date and by whom. It has already been raised in the Daily Life and Social Activities section that a staff member was observed standing next to a person and spooning food into their mouths without talking or interacting with them in any way until they noticed that they were being observed. A member of staff was also seen earlier pushing a person in a wheelchair that did not have the footrest plates in place and so the person’s feet had no support. One of the inspectors spoke to the staff member as they walked past regarding this. They did not acknowledge the inspector but stopped and put the footplates in place and the person’s feet onto the plates and walked on into the lounge area. Throughout the visit, when the inspectors were in the communal areas, one member of staff did not Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 24 appear to speak to any of the people they were supporting or those around them. All the staff team must have the knowledge, skills and values to support vulnerable people with high levels of need in a dignified and respectful way. Training records were sampled to find out what training staff had participated in. The records showed that staff had participated in a range of training activities including POVA, moving and handling, health and safety, alcohol awareness and continence support. However, four of the staff surveys highlighted the need for them to be able to access more training and so it is recommended that an audit of training be undertaken to establish what training staff have received and to establish what further and/or refresher training staff required. The previous key inspection highlighted that a new Induction programme was being introduced. The current acting manager was not aware of where this information was kept. The staff surveys returned showed that staff felt that their Induction was a positive experience and covered all the information they needed to know ‘very well’. Beechill Nursing Home DS0000066845.V363437.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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements, systems, practices and policies were not fully sufficient to ensure that people were supported effectively and safely. EVIDENCE: On arrival at the home for the inspection site visit it was found that the manager had not returned to work from holiday. The nurse that was acting manager informed us that she had started work on the 15th May 2008. She was aware that the manager had not returned and was unable to confirm when he would be returning to work. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 26 The acting manager stated that they had no management handover or Induction to go through the management role or issues facing the home. However, the Responsible Individual stated that the previous deputy manager had returned to work specifically to go through a management handover. She stated that she had been employed as a nurse and was ‘surprised’ to be asked to undertake the acting manager role. The acting manager had worked at the home 5 years previously and had worked in nursing roles in other care homes since then including as a deputy manager and had acted up as manager in the care homes she had worked in. The Responsible Individual stated that at interview and in the application form the acting manager showed that she did have relevant managerial experience. Any member of staff acting in a management capacity must have the information and knowledge needed to perform their management role to make sure that the home runs as it should and that people receive the care and support they need. The acting manager informed us that a resident had recently died. The previous Random Inspection, in November 2007, had highlighted that events, such as the death of a resident, must be notified to the commission. There was no evidence that we had been informed of this recent death. To meet their responsibilities under the Care Homes Regulations 2001 the registered person must inform the commission of any death of a resident. The registered provider undertakes monthly visits where they speak to residents and gain their views on the service. In addition they also speak to relatives and staff and look at the standard of the environment. Part of the quality assurance system was to ask relatives and other visiting professionals to complete a survey of their views of the home. An example was seen where a relative had completed a survey. However, this was dated December 2007 and no other surveys were available. The previous key inspection report of May 2007 found that regular residents meetings were being held to support people to raise and discuss issues that affect them. However, no evidence was available to show any recent resident meetings. It is recommended that a system for reviewing the quality of the service being provided be implemented and that the results of such a quality review are analysed and a report is produced and published based on the results. Since the last key inspection the management of people’s personal money has been reviewed and now the majority of people have an appointee (either a relative or the purchasing local authority). Systems have been put in place to make sure that people’s personal monies are sent to the home and there were now systems for auditing records of spending and cash balances on a regular basis. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 27 However, a cash balance check for one person found the cash to be slightly over the recorded balance with the last recorded balance check being the 24th April 2008. The administrator could not explain the incorrect cash balance record. However, the absence of the manager has made the auditing process more difficult and the administrator had not had the opportunity to go through the finance system with the acting manager. To ensure that the finance system for people’s personal monies is accurate and safe all the relevant staff must be made aware of the systems and apply the auditing and monitoring checks. At the time of the site visit it was found that several people had run out of cigarettes and personal items because no member of staff was able to access their personal monies. A person was observed asking for his own money and over two and half hours later they were still waiting. Another person was asked to go and ask other people to give them a cigarette as theirs had run out and no member of staff had any money to order these personal items. When it was arranged for a local shop to deliver personal items no money was available to pay for the goods. There was a system for staff to access either petty cash or people’s personal monies but this had not worked on this occasion. Some people had access to their personal monies or alcohol restricted to make sure that they were kept safe and not place themselves at risk. Risk assessments and agreements on these restrictions were in place and recorded through the care planning process. Staff supported a number of people to purchase personal items from local shops. Finance records were maintained and receipts were checked but there was no evidence of any record of agreement that people had given their permission for staff to make purchases on their behalf. It is recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person. From the AQAA self-assessment provided by the manager and information seen on the site visit confirmation was seen of regular checks and servicing of gas and electricity services and equipment, hoists, waste disposal and fire equipment and alarms. Although the information could not be found, staff confirmed that the manager did regularly check the temperature of hot water sources. Several people living at the home were heavy smokers. During the site visit it was noticed that a person was smoking in his bedroom with an ashtray situated close to continent pads and clothing/curtains. The bedroom had not been allocated as a designated smoking room. There was a risk assessment Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 28 relating to this person smoking but this needed reviewing and updating to reflect the risks observed. The legislation and regulations relating to smoking in care homes must be adhered to so that people are not placed at risk. Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 29 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 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 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13(2) Requirement To make sure that people receive only the medication they require, to keep them healthy, staff must follow the administering prescription details unless given clear written permission and guidance from a prescribing doctor to do otherwise. The staff and management team must be fully aware of their roles and responsibilities and the procedures to follow in responding to incidents and allegations of abuse. Timescale for action 30/07/08 2 OP18 13(6) 30/07/08 3 OP19 12(1)(a) The emergency call system must 30/07/08 be accessible for people to use at all times. To make sure that people live in a safe environment the local authority environmental health department must be contacted to gain advice on how to address the issues of meeting the no smoking legislation and regarding an appropriate system DS0000066845.V363437.R01.S.doc 4 OP19 23(5) 30/07/08 Beechill Nursing Home Version 5.2 Page 31 5 6 OP26 OP30 13(3) 18(1)(a) for the control of insects and the ventilation of the kitchen area. Staff must be able to access the 30/07/08 necessary facilities to help reduce the risk of cross infection. All the staff team must have the 30/07/08 knowledge, skills and values to support vulnerable people with high levels of need in a dignified and respectful way. When appointed the manager 30/08/08 must make an application to become the registered manager and so show that they are ‘fit’ to manage the home and fulfill their roles and responsibilities as the registered manager in maintaining the standards and quality of the service people received. Any member of staff acting in a management capacity must have the information and knowledge needed to perform their management role to make sure that the home runs as it should and that people receive the care and support they need. To meet their responsibilities under the Care Homes Regulations 2001 the registered person must inform the commission of any death of a resident. Residents must be able to have access to their own personal monies based on agreed risk assessments at any reasonable times. The legislation and regulations relating to smoking in care homes must be adhered to so that people and staff are not DS0000066845.V363437.R01.S.doc 7 OP31 9(1)(2) 8 OP31 18(1) (c) (i) 30/07/08 9 OP31 37(1)(a) 30/07/08 10 OP35 12(1)(a) 30/07/08 11 OP38 23(4)(a) 30/07/08 Beechill Nursing Home Version 5.2 Page 32 placed at risk. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations It is recommended that staff clearly evidence, through the appropriate recording systems, that the actions set out in the relevant care plans relating to people’s health needs had been carried out. It is also recommended that staff make sure that every person prescribed with PRN medication has clear written administering guidance that tells staff exactly when the medication was required. It is recommended that people are consulted about the social and leisure activities that they enjoy and want to participate in and clearly record this through their care plan. It is recommended that the garden area is made attractive for people to use. It is recommended that the staffing levels and deployment of staff be reviewed to ensure that care staff have the opportunity and time to spend with residents. It is recommended that a record of the CRB certificate number, type and date be kept on record and the original can be destroyed. It is recommended that all references from current/previous employers should be authenticated through providing a company stamp or letterhead or through a telephone check. It is recommended that written evidence be maintained that the original documentation had been seen, the date and by whom. 7 OP30 It is recommended that an audit of training be undertaken to establish what training staff have received and to establish what further and/or refresher training staff DS0000066845.V363437.R01.S.doc Version 5.2 Page 33 2 OP9 3 OP12 4 5 OP19 OP27 6 OP29 Beechill Nursing Home require. 8 OP33 It is recommended that a system for reviewing the quality of the service being provided be implemented and that the results of such a quality review are analysed and a report is produced and published based on the results. It is recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person. 9 OP35 Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Beechill Nursing Home DS0000066845.V363437.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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