Inspection on 27/05/08 for Elmcroft Care Home Ltd

This inspection was carried out on 27th May 2008.

CSCI found this care home to be providing an Poor 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

Elmcroft Care Home Ltd 20/11/08

Elmcroft Care Home Ltd 20/06/07

Elmcroft Care Home Ltd 04/07/06

Elmcroft Care Home Ltd 07/02/06

Elmcroft Care Home Ltd 17/08/05

Elmcroft Care Home Ltd 22/03/05

Elmcroft Care Home Ltd 04/02/05

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOMES FOR OLDER PEOPLE Beckingham Court Brickhouse Road Tolleshunt Major Maldon Essex CM9 8JX Lead Inspector A Thompson Unannounced Inspection 27th May 2008 09:00 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 Beckingham Court DS0000063361.V365119.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. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beckingham Court Address Brickhouse Road Tolleshunt Major Maldon Essex CM9 8JX 01621 893098 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) jan@festivalcare.com Elmcroft Care Home Limited Manager post vacant Care Home 54 Category(ies) of Dementia (26), Learning disability (1), Learning registration, with number disability over 65 years of age (1), Physical of places disability (28) Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, aged 18 years and over, who require nursing care by reason of a physical disability (not to exceed 28 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 54 persons) One named person, aged 40 years and over, with a learning disability, who requires nursing care by reason of a physical disability. One named person, over the age of 65 years, with a learning disability, who requires nursing care by reasons of a physical disability. The total number of service users accommodated in the home must not exceed 54 persons. Persons of either sex, aged 50 years and over, with a terminal illness (not to exceed 6 persons) 20th June 2007 Date of last inspection Brief Description of the Service: Beckingham Court provides nursing and personal care with accommodation for up to 54 older people and younger adults. The home also provides rehabilitation. The registered provider/company name for Beckingham Court is Elmcroft Care Home Limited, which is owned by a company called Festival Care. There appears to be some confusion over the name of this home, as most staff refer to it as Elmcroft. The Commission is seeking clarification from the owners on this is issue to ensure that registration details, required by regulation, are correct. The home comprises of a purpose built building which was opened in 1989 and new additional accommodation which opened in 2007. There are 28 bedrooms of which 3 are double rooms in the original building and 26 single bedrooms in the new accommodation. All rooms have en-suite facilities. Many areas of the home have views across open countryside and the surrounding gardens are attractive and accessible to service users. Beckingham Court is located in a rural location near to the village of Tolleshunt Major which is several miles from Maldon. There are no public transport links within easy walking distance. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 5 Vehicle parking for visitors is available in the large car park of the home. The fees range from £457.00 -£750.00 weekly. Additional costs apply for physiotherapy, chiropody, toiletries, hairdressing and newspapers. CSCI inspection reports are available from the manager or are accessible on the CSCI internet website: www.csci.org.uk . Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection site visit. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people to have a lifestyle that is acceptable to them. The site visit took place over a period of 8 ½ hours and was carried out by one inspector (A.Thompson) and one regulation manager (D.Roberts) from CSCI. Since the last inspection on 20/6/2008 there have been two changes of managers at this home. In addition to this for a short period of time in 2008 there was an interim manager managing the home. The current manager had only been in post for two weeks when this inspection took place. A tour of parts of the premises was undertaken, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff and visitors. After the visit the new manager completed and sent in to the Commission the home’s Annual Quality Assurance Assessment (AQAA). However this document should have been completed by the previous manager prior to the inspection taking place. As a result information provided in the AQAA did not give sufficient details of how the service feels they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. The views expressed during the site visit and in survey responses have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. What the service does well: The accommodation found in the ‘dementia’ wing was of a good standard in decoration, furnishings and fitments and the home overall is comfortable and bright. The home is in a quiet rural location with many rooms having good views of the surrounding countryside. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: 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. Beckingham Court DS0000063361.V365119.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 Beckingham Court DS0000063361.V365119.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): 1,2,3,6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People cannot be confident that information provided by the home enables them to make an informed choice, or be confident that assessments provide sufficient details on their personal and healthcare needs. EVIDENCE: A statement of purpose and service users guide are both in place. These were reviewed and seen to be in need of updating, as they do not give a current view of the home. The format should also be reviewed, as it is not seen as user friendly for the resident group(s). The new manager stated that she planned to review both documents. Comments from residents and relatives regarding availability of these documents was variable with some saying that they had not seen the guide and others were unsure. Brochures for the home are also currently unavailable. Again responses were varied as to whether people felt Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 10 that they had enough information prior to moving into the home, with some saying that they thought that they had been given information and others stating that they had not. One resident stated that ‘they were made to feel very welcome’ and another spoken to felt that they had ‘settled in very well’. Records evidenced that families had been able to visit the home prior to the residents’ admission. Confirmation is also needed from the proprietors as to the name of the home. The home is legally registered with the commission as Beckingham Court Nursing Home but documentation and staff refer to it as Elmcroft Care Home. This could be misleading for prospective residents and limit their access to past inspection reports. From review of the records it is clear that some residents, including those paying privately, do not always have contracts in place and this system needs to be improved upon, to ensure that residents are aware of their rights and that they are respected. The manager has an assessment system/documentation in place for all prospective residents. At the current time, she is the only person who undertakes pre-admission assessments, but hopes that in the future that a deputy manager or head of care will also undertake this task. Two recent assessments were reviewed and were seen to be completed fully and included information from the referring social services department where appropriate. The assessment documentation requires reviewing. The assessment forms are very nursing and care needs led and do not take into account the social needs of the person. The form is also limiting with regard to the assessment of people with dementia, who may be admitted to the specialist unit. The form is not person centred and does not cover the strengths and abilities of the individual along with any behavioural factors that may need to be taken into account. This was discussed with the manager on the day of the inspection as the assessment could give a limited ‘picture’ of a new resident. At the current time, with the high use of agency staff in the home, this could be compounded and one resident commented that ‘agency staff do not know my needs’ and another respite resident stated that ‘ agency staff don’t always appreciate what my needs are’. At the current time the manager does not send a letter to the resident or their representative confirming that they can meet their needs and the manager stated that this needed to be developed. Relatives who commented said that ‘the manager carries out a very thorough assessment’. The home does not provide intermediate care. Beckingham Court DS0000063361.V365119.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 poor. This judgement has been made using available evidence including a visit to this service. Not all staff are successful in delivering appropriate care or treating residents with respect when providing for their care needs. Care needs may not always be documented or recorded appropriately which means that residents cannot be assured that their needs will be met. EVIDENCE: The manager has a care planning system in place. This was seen to consist of care plans, risk assessments, activities of daily living checklist, social profile and daily notes. Three care plans were reviewed in detail and 2 other plans provided further supporting evidence. Within the care plans residents had a variety of risk assessments. From the plans it shows that there are two risk assessing systems in place and this is causing confusion. On discussion with nursing staff they confirmed that the system was ‘muddled’. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 12 This needs to be reviewed as it was also noted that some risk assessments were contradictory of others, which does not give a clear assessment of the risk. Risk assessments did not have dates on them in many cases, so it was not possible to assess how old they were, although some were dated June 2007. Care plans were variable in quality. Some were detailed and up to date whilst others gave limited information and were out of date. From discussion with the nursing staff, it is clear that there is a proactive approach to care but this is not always supported by documentary evidence. Agency staff spoken to one the day, who had been working in the home regularly and caring for the same residents, gave very poor accounts of the needs of residents that they had been caring for, compared to the information available in the care plan. These staff were very task orientated and could give little or no information regarding the residents themselves. Some social/person centred information was available on some files. From discussion with staff and from the daily records, it is clear that not all the residents’ care needs have a care plan in place. Examples of this are pain management, confusion, asthma management, continence management and dietary needs. Nursing staff spoken to stated that at the current time the care planning is not as it should be because they are drawn out on to the floor more than usual to monitor the standards of care provided by agency staff. Care plans are very nursing needs led and only give little information on the person, their social needs and preferences. Whilst there are some documents in place, these are not always completed by staff. This aspect of care needs to be developed in order to improve outcomes for residents. Records show that residents have access to their doctor in a timely manner and that other healthcare professional visits as required. This includes the continence nurse, dental technician etc. Relatives commented on communication with staff at the home concerning their relatives care or health and these comments included; ‘communication is poor between staff on shifts and staff and relatives’, ‘I have not been notified where there have been concerns about my relatives health until after the event and only when I have visited’, ‘we have been informed if there are difficulties or if my relative has not been well’ and ‘nursing staff are always very willing to discuss matters’. Many residents in the home are assessed as needing bedrails in place. At the time of the visit the home had bedrails in place that were noted to be used without the protective padding and also bedrails on some specialist beds created significant gaps, both creating a risk of entrapment. The manager was aware of this and trying to remedy the situation with the manufacturers. Risk assessments were seen to be in place and up to date. Records show that residents were not being weighed consistently despite being identified as nutritionally at risk on risk assessments. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 13 One resident had not been weighed since admission in February 2008. Falls risk assessments were seen to be in place, but again not always dated. At the time of the inspection, nursing staff reported that one resident had a pressure sore and was about to be put on a pressure -relieving mattress. With regard to the prevention of pressure sores, a review of the assessment of risk and equipment in place would be of benefit to residents, to reduce the risk of sores occurring in the first place. Nurses spoken to stated that they felt that the home had plenty of pressure relieving equipment. Risk assessments were seen to be in place for pressure sores but some had no dates and it was not possible to assess how up to date these were. Wound management care plans were in place but were found to be inconsistent at times and would not always allow a full review, in order to map the progress of the wound. Records also showed that many different dressing are being applied to wounds within a short period of time. This does not allow for an objective evaluation of the efficacy of the dressing. The management of wounds in the home needs to be reviewed to ensure a consistent and possibly more streamlined approach. The medication system was inspected and the staff use a blister pack and bottle to mouth system. Medication policies and procedures were easily available for staff reference and an up to date list of signatures was maintained. Overall medication was checked in satisfactorily and there were no omissions in signing for medication. Staff do need to improve upon checking medications in, that are supplied during the month as this was often omitted. Not all residents had a photo to accompany their medication record. This needs to be addressed as a priority as the use of agency staff at the home is currently high and this increases the risk of mis-administration. Stock levels were seen to be acceptable although it was noted that some old medication from 2007, had not been destroyed and the resident was no longer in the home. Staff must also be mindful of ensuring that emergency medications, such as adrenaline injections for allergic reactions, are renewed as these were noted to be out a date. This was highlighted to the nurse in charge. Controlled drugs were checked and found to be in order but dates of opening should be recorded on liquid medications. It was noted that a lock is needed on the spare medication cupboard in the clinic room. Residents and relatives both expressed concerns that there was no choice with regard to female residents, both young and old, having to be helped with personal care by male care staff. The manager was aware of this and was doing her best to address the issue with limited staff resources. Comments included; ‘ I am a woman aged (xx) and was not very happy to have a young male carer sent to assist me with my personal toilet’ and ‘single male carers are expected to bathe young females’. Other comments from residents and relatives regarding care and care delivery included; ‘there seems to be a lot of agency staff – permanent staff would be better so people get to know the residents’, medical and nursing care is good’, ‘the new wing was closed and Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 14 residents were moved in a very callous manner’, ‘there are massive communication difficulties which results in my (xx) not having their care needs met – there are a huge number of foreign agency staff who do not have a command of English’, ‘residents are unable to build up trusting relationships with agency staff’, ‘sometimes I have to wait for a commode – agency staff don’t always appreciate what my needs are’, ‘my one worry is the constant change of staff, I never know who is going to get me up or put me to bed – I thought we were supposed to have key-workers’, ‘I have observed some agency staff who evidently have no lifting and handling training’, ‘Spiritual needs are not taken into account’, ‘as far as my relative is concerned she has received very good general care’ , ‘I don’t always get my (xx) medication’ and ‘ too many agency staff that don’t know my personal needs’. The AQAA assessment under ‘what we do well’ states ‘maintain privacy dignity and respect’. In the next 12 months the manager plans to ‘introduce a key worker system and establish a solid staff base to deliver high quality personal care’. Beckingham Court DS0000063361.V365119.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 poor. This judgement has been made using available evidence including a visit to this service. People living in Beckingham Court cannot expect to have a lifestyle that matches their expectations through good opportunities for activity, and enjoyable food. EVIDENCE: On inspection of the care plans and from comments from residents and relatives, it is clear that at the current time, residents social care needs are generally not being met. It is positive to note that an activities co-ordinator has just been appointed and from discussion with her, she has a person centred approach and is beginning to understand the needs of the residents in the home, but it is early days. She has also started a recording system and this was discussed. The care plans are primarily nursing needs led and not person centred. There is limited information on residents’ preferences and their own goals and therefore not evident that the staff team are resident led. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 16 Some have more information than others but on discussion with staff, it is clear that they retain information about residents that they have gained and it is not shared with the wider team for the benefit of the resident. On discussion with residents, they confirmed that staff are task led and one resident stated that there is ‘no choice regarding getting up, going to bed or when you have a wash – staff just come and do it’ and a relative stated that ‘I see no evidence of them offering choice to support people to live the life they choose’. Staff were seen to be sitting in lounges with residents but not taking the opportunity to interact with them. Residents and relatives comments regarding the provision of activities included; ‘no activities are provided’, ‘no activities’, ‘no sensory stimulation or activities, my relative rarely comes out of their room’, ‘the relatives and residents feel that the home should provide more entertainment. For the past 18 months there has been none’ and ‘there is very little activity to help people stimulate their minds. The AQAA states under ‘what we do well’ with regard to daily life and social activities ‘new activity person full time appointed’. This is a key area for improvement within the home in order to increase the quality of life for all the residents who live there. Residents’ spoken to confirmed that their visitors are welcomed to the home but from records and discussion and feedback from surveys, opportunities for time spent away from the home are minimal. Information is displayed around the home with regard to contacting local advocacy services. The service users guide states that all residents will be offered advocacy. There is not evidence that this is or needs to take place. The current chef has worked at the home for over 2 years. During that time the menu has not changed apart from odd alterations. On discussion the chef is in tune with residents preferences and makes alternatives such as curry and pasta etc. It is unclear as to why the menu is not regularly reviewed with input from the residents. There was evidence that the kitchen uses fresh fruit and vegetables and fresh fruit was seen freely available around the home. The chef also confirmed that all the cakes are homemade. From surveys and discussion, residents and relatives are generally happy with the meals provided and comments include; ‘ the food is quite good’, ‘food is nice’, ‘food appears to be quite good’, ‘the quality of the food is good and varied and ‘the food punctuality and quality is very good’. However, from observation and discussion there are issues affecting the experience for residents relating to the delivery of the food. Chef confirmed in discussion that residents had complained to her that their dinners were not hot enough, although chef feels that they are hot when they leave the kitchen. Residents also said ‘the food is not always hot’ and ‘food is often spoilt at the point of delivery because it is cold and drink are tepid’. Food was observed to be served from a trolley, on the unit separate from the main building, although a hot trolley was available in the same room. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 17 Cooked vegetables were seen to be stored in plastic tubs and not in the hot trolley, which means that it will go cold quickly. Staff confirmed that they take it out of the hot trolley to serve. Residents who are able to go to the dining room to eat did not have a problem with the food temperature but residents eating away from this room have a different experience. The meal service needs to be reviewed in order to overcome this issue. It was positive to see that a hot breakfast is offered every morning and residents were seen to be enjoying this. One resident said that ‘ I struggled to get the breakfast that I wanted in spite of repeated requests’. Lunch was observed in the separate unit at 13.20. One lady was due to go to a hospital appointment at 13.00 for a plaster cast removal and staff had not given her any lunch. On questioning, They then decided to give her lunch as ‘it was mean’, but staff they had already sat the lady in the dining room, where she was calling out for food. The ambulance came at 13.30. No arrangements had been made for her to have her lunch early. It was also noted that those with soft diets were having their lunch served up in desert bowls. On questioning the nurse in charge said that this is ‘because their food is sloppy’ . It was observed to be no different from other meals offered and this should be reviewed in order to maintain residents dignity On the nursing unit agency staff were observed to be very perfunctory when helping residents with their food/feeding. There was no interaction and feeding was seen to be very quick and uncaring. One resident was observed to be being seen by a healthcare professional over the lunch period. During this time her lunch was left and not put back in the hot trolley to keep warm. Residents were observed at breakfast time being fed by agency staff in bed, laying down and therefore at risk of inhalation. Residents were also seen trying to eat in bed and as tables are not long enough they are either leaning right over the bed rails or trying to manage on their laps. Beckingham Court DS0000063361.V365119.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 poor. This judgement has been made using available evidence including a visit to this service. People are able to raise concerns about the service however the staff’s training provision and past managements’ response to complaints and safeguarding concerns has not always promoted peoples’ safety and well being. EVIDENCE: The current manager’s AQAA did not confirm that all staff were trained in matters relating to safeguarding vulnerable adults and that Beckingham Court promoted and applied zero tolerance with regard to any form of abuse. Training records seen at the inspection indicated that since the previous inspection in 2007, training had been provided to staff on adult safeguarding, however this did not evidence that all staff had received this training. Staff members spoken with were aware of adult safeguarding procedures and were able to tell us what they would do if they had any concerns. Although the inspector was told that concerns raised with a previous manager had not been dealth with properly by following the home’s ‘whistleblowing’ procedure, and that the procedure did not include upto date information as to whom to contact with concerns. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 19 Evidence of the registered provider not always following adult safeguarding procedures has been identified by CSCI in relation to concerns raised not being referred imediately to the appropriate authority. At the time of the inspection Essex Social Care (Essex County Council social services) were reviewing/investigating three safeguarding alerts regarding medication practice, staff attitudes and staff practice. The current manager reported that any concerns raised would be dealt with following the complaints procedure, seen displayed in the home, and that full records would be kept of complaints and outcomes. Unfortunetely there was no information available at the time of this inspection, nor was any information included in the AQAA, as to the numbers and outcomes of complaints received/made to previous managers since the last CSCI inspection. Family members reported in surveys: ‘when I made written enquiries regarding invoices I received no reply to my letters’. Other comments when asked if the service responded appropriately to concerns raised included ‘always’. Further comments in surveys indicated that some people did know how to complain but others did not. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. People can expect to live in a pleasant and clean home that is suitable to meet their needs. EVIDENCE: Beckingham Court provided a comfortable and bright environment for people to live in. The site visit included a tour of the premises when it was noted that the home was clean and tidy, and generally well decorated and maintained throughout, with no evidence of any unpleasant odours. Although some bedrooms and corridor areas would benefit from redecoration and some doors and frames had chipped/damaged paintwork, these were all in the older building. Carpets and furnishings were of a good quality but colour schemes and signage in the new building could be changed to suit the needs of people living there (service users with diagnosed dementia). Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 21 The bathrooms were in good order and included aids and adaptations to meet the needs of the people using the service, although comments from relatives surveyed included: ‘some baths (could) be changed to accommodate varying disabilities’, ‘not all toilets raised and (had) surround bars’. ‘Tables in dining room too low for wheelchair users’. There were sufficient toilets to enable immediate access, and all private bedrooms had en-suite wc. Communal lounges and dining rooms were provided in both buildings and were generally bright and spacious. It was noted that the dining room in the original building was also the main staff access route to and from the kitchen, this resulted in a fairly continuous movement of staff through this room at mealtimes. People living at the home were happy with the way their home is kept clean; their comments included ‘the home is always clean and tidy’, and ‘in general the home is clean and there are no unpleasant odours’. When asked in the home was fresh and clean other residents replied ‘usually’ or ‘always’. Comments from relatives about the environment and services included ‘the home is generally clean and reasonably well cared for’. ‘The laundry service is of a high quality and the residents personal clothing is well cared for’. The laundry was sited in the original building with close access to the new building. Equipment and space provided was regarded as fully suitable for the numbers of residents accommodated in Beckingham Court. Beckingham Court DS0000063361.V365119.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. People living at Beckingham Court may not be supported by staff who have up to date training to ensure they have the skills for their roles. The recruitment practices used may not have promoted and protected residents welfare and safety. EVIDENCE: The home’s staffing rota was inspected and showed daytime staffing levels in the main (original) building as one nurse and five carers in the mornings, with one nurse and four carers afternoons. Night staffing was one nurse and two carers. Staffing in the new building was: one nurse and three carers mornings, one nurse and two carers afternoons and one nurse and one care at night. In addition to the care staff ancillary staff include a cook in charge seven days a week, two kitchen assistants, a housekeeper and domestic staff, two part time maintenance people, an administrator and a new activities coordinator. The current manager reported that there are a number of staff vacancies and she is trying to recruit new staff. In the meantime there are a large number of agency staff being employed. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 23 This situation has had a negative effect on the consistency and quality of care provided. Actual comments from residents and relatives about the care and staff attitudes experienced have been included in earlier sections of this report. Files were inspected for three staff employed since the last inspection. Evidence was seen to confirm that application forms had been completed, interviews held an interview record completed, written terms & conditions issued (after completion of a probationary period), and criminal records checks undertaken. Copies of proof of ID and photographs were also on files, but one file did not have two written references, as is required. Evidence was not available to confirm that new staff undergo induction training which followed the recommended Skills for Care Common Induction Standards format. In addition some staff records had no mention of even the home’s basic induction training. The current manager said that in future all staff would receive this training. Surveys and discussions with staff regarding training and induction resulted in comments of: (I ) ‘only had to watch a video for my induction’, there’s ‘not enough training’ (here), have had manual handling training but ’not happy with the equipment provided’, ‘there have been three managers here in a year’, I started dementia training with the last manager but the company have ‘not allowed this to continue’ (since she left), (there are) ‘lots of agency staff (who have) poor standards’. Training records were seen but these did not evidence that training had been provided to all staff on: medication, health & safety, fire safety, manual handling, food hygiene, infection control, abuse/POVA (safeguarding), first aid, dementia awareness and NVQ. The AQAA did not provide any evidence of numbers of staff with or training towards NVQ awards. A random selection of staff files inspected did include some training certificates on the above subjects and other courses including: pressure care, risk management, diabetes, passive and active movements, dementia awareness, mental capacity, safe use of cot sides and care planning. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living at Beckingham Court cannot be assured that the management have been working towards improving the service and that their opinions are central to how the home is run. EVIDENCE: Since the last inspection of Beckinhgam Court in 2007 there have been three different managers in post. The current manager at the time of this inspection had been in post for only two weeks. She is a nurse and said she had management experience in residential settings since 2003. The change in managers at this home and lack of provider management support has resulted in deteriorating standards at this home which now has a limited core staff team, high agency use, unacceptable care delivery standards and overall poor outcomes for residents. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 25 The AQAA was due to have been completed and sent to the Commission prior to this inspection, but this did not happen. The current manager attended to this after this site visit but the document provided did not contain clear and relevant information that was supported by a wide range of evidence. It is recognised by the inspectors that the manager had only been in post for a very short time before this inspection and the AQAA had not been fully completed by the outgoing manager. Feedback to CSCI from staff, residents and relatives has included concerns regarding the number of different managers at Beckingham Court over the past year. They also include comments that communication from the registered provider to residents and relatives on the reasons for so many management changes has been poor. The service has a quality assurance process involving the residents and their relatives. This is supposed to involve survey forms being sent to service users which are entitled: ‘Resident & Family Satisfaction Survey’. Forms seen covered questions on accommodation, nursing, care , catering, domestic services and activities. However only two of these had been completed since June 2007, and there was no record that any review of responses had taken place nor of any resulting actions. The administrator advised that the home holds some personal allowance monies for safe keeping for the majority of residents. Records had been kept of the balances held and of receipts for expenditure. A random sample were checked and found to be in order. There was a staff supervision process and format in place at this home but supervision had not been given regularly to staff. In fact records seen only evidenced that three supervision meetings had taken place since the last inspection, and feedback from staff spoken with included a comment that (I have) ‘never had supervision in all the time I have been here’. Regulations require that staff are appropriately supervised and records of this must be available for inspection. The current manager said she was aware of this shortfall and planned for regular supervision of all staff in future. Records of regulation 26 reports (monthly reports required to be carried out by the registered provider) were examined and found to be unsatisfactory. There was only one available report and this covered a period of three months overall. Monthly reports must be available for inspection. Discussions with staff, management and inspection of records could not confirm that training is provided to all staff in moving and handling, fire safety, food hygiene, first aid and basic training in infection control. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 26 The maintenance person had kept records of service and repairs to fire alarms, fire equipment, emergency lights, passenger lifts, gas boilers and portable electrical appliances. However these did not include copies of documentary evidence from contractors that fire alarms and fire equipment had been tested since the last inspection, nor that the home’s electrical installation supply have been examined by electrical contractors within the past five years. One other shortfall regarding health & safety relates to there being insufficient evidence to confirm that regular fire drills had taken place. The last recorded drill before this inspection was in October 2007. Hot water supply is regulated, the maintenance person said he regularly carries out manual checks on the water temperature, records of this were seen. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 2 2 Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1) Requirement Residents must have a care plan in place that identifies all their needs and gives staff clear information on how those needs are to be met so that outcomes for residents can improve. Residents healthcare needs must be met in full, in relation to nutrition, wound management, pressure sore prevention and use of bedrails to promote good outcomes for residents. Medication records and systems need to be properly applied to ensure the safe administration of medicine to residents. Residents must be treated with dignity at all times to provide a good quality of life. This relates to choice in care planning, the provision of a competent staff team and equipment. Timescale for action 31/10/08 2 OP8 12(1) 31/10/08 3 OP9 13(2) 12(1) 30/09/08 4 OP10 12 (4)(a) 31/10/08 5 OP12 16(2)(m) The range of activities and 30/09/08 recreational interests available to residents must satisfy their DS0000063361.V365119.R01.S.doc Version 5.2 Page 29 Beckingham Court expectations and needs so that they experience a better quality of life. 6 OP16 22(3)(8) Records of complaints received since the last inspection, and of the findings and outcomes relating to each complaint must be provided to the Commission. To evidence that management respond to and deal with complaints appropriately. All incidents that could involve a POVA (safeguarding adults) investigation must be notified to the Commission and appropriate bodies to ensure that residents are safeguarded. Recruitment procedures must ensure that two written references are obtained for all new staff employed. To evidence that proper checks take place. All new staff must be provided induction training which includes the Skills for Care common induction standards subjects. So that they receive appropriate initial training and know what their roles and responsibilities are. Staff must be trained for their roles to ensure they are equipped to meet the needs of residents. 30/09/08 7 OP18 13(6) 37 31/07/08 8 OP29 19 31/07/08 9 OP30 18(1) 31/07/08 10 OP30 18(1) 30/09/08 11 OP33 24 A system must be developed and 30/11/08 implemented for periodically reviewing and improving the level of services provided by the home taking into account the views of residents, their relatives and other stakeholders such as DS0000063361.V365119.R01.S.doc Version 5.2 Page 30 Beckingham Court health & social care professionals. This is a repeat requirement from 20/6/2007 12 OP36 18(2) All staff must be provided regular recorded 1-1 supervision to ensure they are supported in their roles. Regulation 26 visits (registered provider visits) must take place on a monthly basis with reports available for inspection. To evidence the appropriate support from the providers and ensure improvement in the home. Evidence must be available that contractors have tested/serviced the home’s fire systems and fire equipment, and that the home’s electrical installation system has been tested within the past five years. To verify that these checks have taken place. Regular fire drills must take place to ensure staff are aware of the procedure to follow in an emergency. 31/10/08 13 OP37 26 31/08/08 14 OP38 13(4)(a) 31/07/08 15 OP38 23(4)(e) 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service users guide should be reviewed so that they provide up to date information in a format suitable for the resident group. Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 31 2 OP2 All residents should have an up to date signed copy of their contract so that they know their rights. The pre admission assessment would benefit from a review so that all aspects of residents needs ( dementia and social) and preferences can be assessed in a person centred way. Opportunities for accessing the community should be made available for residents where possible to improve quality of life. Mealtime delivery for residents should be reviewed so that meals are hot, can be reached and are presented in a dignified manner. The whistleblowing procedure should provide up to date details of whom staff should report concerns too. Consideration should be given to re-decorating the dementia unit to provide a less ‘institutionalised’ colour scheme and improved signage to the benefit of residents who have dementia. Redecoration should take place to areas of walls and doorways in the main building that are marked and scratched to provide residents with a homely environment. There should be consistency regarding staff who work in the home to ensure residents know who the staff are who are providing their care. This relates to the regular use of agency staff. 3 OP3 4 OP13 5 OP15 6 7 OP18 OP19 8 OP19 9 OP27 Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Beckingham Court DS0000063361.V365119.R01.S.doc Version 5.2 Page 33 - 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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