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Inspection on 19/02/09 for Beggars Roost Nursing Home

Also see our care home review for Beggars Roost Nursing Home for more information

This inspection was carried out on 19th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beggars Roost Nursing Home Old Park Lane Fishbourne Chichester West Sussex PO18 8AP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sheila Gawley     Date: 1 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Beggars Roost Nursing Home Old Park Lane Fishbourne Chichester West Sussex PO18 8AP 01243573750 01243576064 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Colville Care Limited care home 28 Number of places (if applicable): Under 65 Over 65 28 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 28 The registered person may provide the following category of service : Care home with nursing (N) t service user of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Beggars Roost is a care home able to provide personal care and nursing care for up to twenty-eight residents over sixty-five years of age. Two of the twenty-eight residents may also have a physical disability. The home is situated in a rural area of Fishbourne on the outskirts of Chichester. The accommodation is on two floors, the upper floor having passenger lift access. Three bedrooms on part of the upper floor can presently only be accessed by steps. Communal accommodation consists of a lounge and a conservatory, which open out onto private gardens. Private accommodation consists of twenty single bedrooms and four double bedrooms. The double bedrooms have ensuite facilities and are currently being used for single accommodation. Care Homes for Older People Page 4 of 26 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit as part of the inspection was carried out on 19th February 2009. The inspection was carried out by Lead Inspector Sheila Gawley and she was accompanied by a CSCI Pharmacy Inspector Sunita Chotai. The deputy manager facilitated the inspection. The Commission for Social Care Inspection was in receipt of an Annual Quality Assurance Assessment from the home, which contained the information we required. Documents required for the inspection process were made available. Prior to the inspection all files held by the Commission including comments and complaints and safeguarding issues were reviewed. Most records or documents Care Homes for Older People Page 6 of 26 required on the day were made available. Surveys were received from one staff member and three relatives completed surveys on behalf of three people who use the service. People who use the service were spoken t as were staff. Comments received were positive. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area because they are fully assessed prior to admission Evidence: The AQAA states that All prospective clients and their relatives are encouraged to visit the Home for a preliminary meeting with Matron or a senior member of staff. This meeting is used to provide information to the client or their relatives in order that they may make an informed decision about the choice of a Home. Pre admission assessment is in place and was seen in the care plans. A survey received confirmed that the person had been visited at home and that this was much appreciated For those admitted with a care management assessment and full information is requested prior to admission. The service user guide is available in large print. Care Homes for Older People Page 10 of 26 Evidence: Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area because personal care need are met but there are shortfalls in administration of medicines which could put people at risk. Evidence: Three people who use the service were case tracked. Their care plans were inspector as were their medicine administration charts. The care plans inspected contained information on health, medical, personal and social need. The care plans were drawn up following an assessment of these needs. This assessment included social, psychological, communication, elimination, sleep, skin and dietary needs. The risk assessments covered moving and handling and falls. Details of the management of a gastronomy feed were seen in one room as were the instructions on using a glide sheet. Pressure wounds are photographed and their management is recorded. A recent safe guarding investigation was held by West Sussex County Council who take the lead in safeguarding matters when concerns in wound care were highlighted. Wounds on this occasion were managed correctly. Care Homes for Older People Page 12 of 26 Evidence: There was evidence of daily records, monthly review and a record of general Practitioner visits in the plans. We were in receipt of two surveys from people who use the service and one staff member, comments were positive. A key worker system is in place and staff and people who use the service spoken to understood what this meant. Medicines were inspected by a pharmacy inspector. The storage arrange for medicines in this home are good. There is a controlled drugs cupboard, which is used to store homely remedies as well. This can be an added risk as there will be an added number of times this cupboard is accessed and security could be compromised. Medicine administration record charts are a mixture of in house documents or generated by the pharmacy. Some items of medicines are not included on the pharmacy generated ones and staff hand write these onto the chart. There were examples where not all the prescribed medicines was on the chart. This could mean that prescribed medicine is not given. In all cases this was for medicines prescribed for only when needed. Medicines were sometimes out of stock and this means that continuity of treatment is not possible. Concerns were identified on half the charts viewed. For quarter of the charts viewed the actual amount given for a variable dose was not recorded. This means that an audit would not be possible. Other records for audit around medicine receipt and disposal are kept. Medicines were disposed off for one person who had passed away in the past week. It is recommended by the coroner to keep these for one week. The controlled drugs cupboard had other items stored within which were not controlled drugs. A recent safe guarding investigation was held by West Sussex County Council who take the lead in safeguarding matters when concerns in medication management were raised. These problems in medication management are not resolved as yet. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area because the lifestyle in the home suits the people who live there. Evidence: An activities coordinator is employed four days a week from 09:30 to three pm. On the fifth day another person is responsible for activities and usually brings a Pat a dog. The activities schedule is listed in the dining room on a weekly basis. There are activities records available for all people detailing the activities they enjoy and the ones they have participated in. There are also photographs and example of art work they have completed such as an embroidered cushion or art work. There is music, going out, chairobics, sewing, knitting, trips to a center for disabled which has a shop, and quizzes to name some. People who use the service confirmed enjoyment of the activities, one did say he would like to go on outings more. There is involvement in the garden and people who use the service have been involved in potting some plants in the conservatory for planting out later in the season. People who use the service spoken to stated that they were happy with the activities. One stated I like what -the activities coordinator- does, another confirmed liking Care Homes for Older People Page 14 of 26 Evidence: gardening and puzzles. There is one to one sessions advertised on the activities notice but one survey received commented that the activities programme is not applicable to this person who uses the service due to being bed bound. There is a variety of nutritious food available and menus have recently been reviewed. The meal seen prepared and served on the day was as advertised. People spoken to stated that they enjoyed the food. One person spoken to stated said there is a very good cook and the food is very good and a survey received commented The freshly cooked food is always appetising. Staff were observed interacting with people who use the service in a respectful manner and used their preferred form of address. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area because they are not safeguarded in the management of medicines Evidence: There is a clear complaints procedure which is on display and which is included in the Statement of Purpose and Service User Guide. The procedure clearly identifies whom a complaint should be addressed to and the timescales in which a complaint would be addressed. People who use the service to were clear as to whom they can raise concerns with The people spoken to stated that there is no need to complain. There are safeguarding policies and procedures in place and staff have ongoing safeguarding training. Staff spoken to demonstrated an awareness of safeguarding procedures. There have been some recent safeguarding referrals made and the home has cooperated with the process. They supplied an action plan to social services detailing how they would address shortfalls. The action plan also laid out measures to address concerns in relation to medication and these are yet to be fully rectified and are the subject of requirements of this inspection. Issues in relation to wound care have been addressed and standards in relation to this were met today. Care Homes for Older People Page 16 of 26 Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area because they live in a safe and well maintained environment. Evidence: There are comfortable, well-furnished communal areas comprising of a sitting room, conservatory and dining room. There is a further sitting room in the extended part of the home. The furnishings are domestic in style. There are recently landscaped accessible garden and grounds. The home on this occasion was neat clean and free from offensive odours. There are 27 single bedrooms on two floors. The bedrooms are personalised and people spoken to stated that they are happy with their rooms. Equipment required to meet assess need is in place. There are suitable toilet and bathing facilities throughout the home and there are suitable laundry facilities with the correct machines sited away from areas of food preparation and storage. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area because needs are met by suitable trained staff. Evidence: Staff rota showed staffing levels were sufficient to meet the needs of residents. There are one or two registered nurses on duty at all times with five carers in the morning and four carers in the afternoon and evening. There is housekeeping, kitchen, and maintenance support. Recruitment procedures are not followed correctly in that it is stated that written references will be taken but two staff files inspected did not evidence this. One had two references taken by telephone and the other had one written reference and one reference taken by telephone. There was evidence of application forms with employment history. Criminal Records Bureau Clearance and Protection of Vulnerable Adults (POVA) check, identity documentation, and photograph were all in place. POVA First is used appropriately. Staff spoken to stated that the home is a pleasant and supportive place to work and that there are good training opportunities. Care Homes for Older People Page 19 of 26 Evidence: People who use the service find the find the staff helpful. One person said Staff look after us very well. Staff were observed offering care and attention in a timely and respectful manner. All staff receive induction and there is a staff training programme in place which covers all mandatory training. Staff confirmed supervision is in place. Eight of the 15 care staff have attained the National Vocational Qualification Level 2 in care. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area because the home is mostly managed in the best interests of the people who live there. Evidence: The manager who has been in post since the end of 2007 is applying to the commission for registration. Quality assurance systems are in place to ensure that the home is run in the best interests of the people who use the service. The home sent us the AQAA when we requested it and it contained the information we needed. Surveys are sent anually to relatives and pople who use the service. Responses to these were seen in service user files. Monies are not held for any person who uses the service and people are invoiced for all costs incurred. Care Homes for Older People Page 21 of 26 Evidence: Staff stated that this is a supportive place to work and confirmed training and supervision is in place. The health and safety of people who use the service is protected by the provision of policies ans procedures and mandatory training. Written references must be obtained prior to appointing a member staff. Immediate requirements have been made in relation to management of medicines. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person to 09/03/2009 ensure sufficient stocks of medicine are available and to have clear records of medicine use for audit purposes To ensure continuity of treatment 2 9 13 to have a medication profile 31/03/2009 that reflects the current medication prescription from the doctor for each person in the home to make sure that treatment is current Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 The registered person to ensure a plan of care on the use of medicine prescribed only when needed So that a consistent approach is followed 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Older People Page 24 of 26 improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The controlled drugs cupboard to be reserved to store controlled drugs only to minimise risk of misappropriation. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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