CARE HOMES FOR OLDER PEOPLE
Beckingham Court Brickhouse Road Tolleshunt Major Maldon Essex CM9 8JX Lead Inspector
Diana Green Unannounced Inspection 7th February 2006 01:55 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.V282910.R01.S.doc Version 5.1 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.V282910.R01.S.doc Version 5.1 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) Elmcroft Care Home Limited Mrs Jean Dolmor Care Home 33 Category(ies) of Dementia - over 65 years of age (1), Learning registration, with number disability (3), Learning disability over 65 years of places of age (1), Physical disability (33), Physical disability over 65 years of age (33), Terminally ill (3) Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Persons of either sex, aged 18 years and over, who require nursing care by reason of a physical disability (not to exceed 33 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 33 persons) Three named persons, aged 40 years and over, with a learning disability, who require 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 reason of a physical disability One named person, over the age of 65 years, who requires nursing care by reason of dementia The total number of service users accommodated in the home must not exceed 33 persons Persons of either sex, aged 50 years and over, with a terminal illness (not to exceed 3 persons) 17th August 2005 Date of last inspection Brief Description of the Service: Beckingham Court Rehabilitation and Specialist Nursing Centre provides nursing and personal care with accommodation for up to 33 younger adults and older people. The home also provides rehabilitation.Beckingham Court is owned by a private organisation, named Elmcroft Care Home Limited.The home is located in a rural location near to the village of Tolleshunt Major, Maldon. The home is a purpose built single storey building and was opened in 1989. There are 19 single en-suite bedrooms and 7 double en-suite bedrooms. The home has extensive views across open countryside and the surrounding gardens are attractive and accessible to wheelchair users. Beckingham Court is accessible by road and rail and the nearest station is in Witham, a short drive away. Parking is available in the large car park of the home. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 7/02/06, lasting 4.5 hours. The inspection process included: discussions with the registered manager, senior manager, six staff, the cook, laundry assistant, a district nurse, nine residents and six visitors; a partial tour of the premises including a number of residents’ rooms, bathrooms, communal areas, the kitchen and the laundry; and inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Eleven standards were inspected and five requirements and two recommendations made. Action had been taken promptly to address previous requirements and recommendations. It was evident that Beckingham Court continues to provide a good standard of personal and nursing care for residents. The manager and staff were welcoming and helpful throughout the inspection. What the service does well: What has improved since the last inspection?
Residents have more choice of GP, with three GP practices now providing support to the home. The in-house physiotherapist has been integrated into
Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 6 home, providing staff with ongoing training and intensive rehabilitation programmes for residents where indicated. An ongoing staff’ development training programme has been implemented. Changes have been made to the supply of medication and systems of recording, whilst not perfect have improved. Updated advice has been made available for staff and training on the new monitored dosage system provided. Kitchen ventilation has been upgraded and new fly screens have been fitted in the kitchen. A quality assurance programme has been implemented. Records are now made of residents’ personal items on admission to the home. Lockable facilities have been provided in all residents’ rooms. The homes’ policies/procedures are in the process of update. What they could do better:
Assessment records need to include all residents’ care needs including social interest/hobbies and mental health and cognition. Residents and their relatives’ involvement in care plan needs to be confirmed by signature where possible. Daily records need to provide more detail to clearly demonstrate that residents’ needs are well monitored and appropriate action taken. The monitoring and recording of treatment of pressure sores could be improved by use of a more accurate measurement tool. Further and sustained improvements in the recording of medicines administration are needed. Staffing levels require review to ensure appropriate deployment of staff and safety of residents when training sessions are being held. There are no call bells in lounge and until the new system is installed, staff must be in attendance to monitor and provide assistance to residents, particularly where drinks have been provided. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 7 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. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 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.V282910.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 The admission procedure is not sufficiently robust to assure residents all their care needs can be appropriately met. This home does not provide intermediate care EVIDENCE: Three residents’ care plans were inspected. All had an assessment of need that included the main elements under this standard. However social interests and hobbies were not detailed and mental state and cognition was recorded in only two of those sampled. There was evidence however, that whilst no record was made on the initial assessment, residents’ mental health needs were being assessed and regularly reviewed. Copies of care management assessments where relevant were held. This home does not provide intermediate care Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 Residents health and personal care needs are consistently well met within the home. The storage, administration and recording of medicines has improved but further action is needed to ensure the safety of residents. EVIDENCE: Three care plans were inspected. All contained care plans that covered all key needs (physical and social), provided good detail of the action required of staff to meet residents’ needs and demonstrated a good understanding of their needs. There was no evidence that care plans had been agreed with the resident/relative in any of the three care plans sampled. Assessments for moving and handling/mobility, pressure areas, continence needs and risk assessments for falls were recorded in the files inspected. Daily records demonstrated good monitoring of residents’ needs but were brief in detail. Residents spoken with said that staff were kind and caring towards them. Residents said they were well cared for and their personal care needs were met. Records showed appropriate and prompt referral to health professionals,
Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 11 and GP’s. There were now three GP practices who supported the home and visited on request. The home has a physiotherapist who undertakes assessment and provision of physiotherapy for residents, training for staff and intensive rehabilitation programmes for specific residents. Profiling mattresses were provided as relevant for promotion of tissue viability and the prevention and treatment of pressure sores. Pressure sores were measured to monitor progress but this could be improved to provide a more accurate measurement by the use of a measurement grid. District nurses had raised some concerns that registered nurses at the home were not competent to undertake some tasks. The manager had therefore requested training to be provided to enable staff to achieve competencies in these areas. The home had a policy and procedures for administration of medicines that were under review. An updated copy of the British National Formulary for staff advice had been obtained since the last inspection. However there was no copy of the Royal Pharmaceutical Guidance for Care Homes available. Medication was stored in a clinical room in a trolley that was secured to the wall. A controlled drugs cupboard and drugs refrigerator were also available. Monitoring and recording of temperatures was in place. Changes in the supply of medication were planned to include a monitored dosage system under a contract with Boots pharmacy. Training was being provided to all registered nurses who administered all medication. The standard for receipt and recording of controlled drugs was in the main good. However one entry did not include the witness signature. Temazepam was treated as a controlled drug, which is acknowledged to be good practice, however the address was not recorded on discharge from the home. Several omissions were evident in the administration record with no reason recorded. One resident said that they were not being given prescribed medication at the given time. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 Visiting arrangements are open and relaxed; staff encourage contact with the local community. EVIDENCE: Six visitors spoken with said they were able to visit at anytime and found the home and staff very welcoming and they were always offered a drink. Relatives said they found the manager and staff friendly and supportive and communication was very good. The service users’ guide and record of activities confirmed that links were made with the local community. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Appropriate policies, procedures and practices were in place to promote the protection of residents from abuse. EVIDENCE: The home had a protection of vulnerable adults policy and procedures and a whistle blowing policy. All staff had received copies of the revised local Essex multi-agency guidance. The records provided evidence that staff had received training in protection of vulnerable adults. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26, Beckingham Court was safe, well maintained and had a homely environment; residents’ rooms were individually furnished and equipped for their safety, comfort and privacy. The home was clean and hygienic with safe infection control practices evident. EVIDENCE: A partial inspection of the premises was made that included communal areas, two bathrooms, a number of residents’ rooms, the kitchen, clinical room, the sluice and the laundry. The home was in a good state of maintenance and decoration. There were plans to develop the home to provide an additional wing with twenty-six bedrooms. Communal rooms were clean and well decorated and furnished to provide a homely environment for residents. Residents spoken with said their rooms were always kept clean. The gardens were well maintained and provided a pleasant outlook with good access for residents. Records provided evidence that the building complied with the requirements of the local fire and environmental health department.
Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 15 The home was clean and hygienic throughout with no malodorous smells. Staff hand washing facilities were provided throughout and safe practices in infection control were evident. The laundry was clean and well organised with appropriate equipment in place. Some sheets were noted to be worn and thin. However the laundry assistant confirmed that new sheets had been ordered. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 Staffing levels are generally appropriate to meet the dependency needs of residents and the layout of the building. However additional staff are needed at specific times to ensure the safety of residents. An ongoing programme of staff training is in place to meet the specific needs of residents. A competency framework needs to be developed and staff assessed to ensure they are competent in the identified areas. EVIDENCE: There were 28 residents at the home. Staffing levels were confirmed at 2 registered nurses and 5 care assistants. Whilst these levels met the minimum levels agreed with the previous registration authority, they were not sufficient to ensure residents were appropriately supervised. All registered nurses were attending an in-house training, leaving none to attend to residents. Drinks had been provided to several residents in the lounge and there were no care staff available for some time to provide assistance or to ensure their safety. The registered manager, physiotherapist, administrator, laundry assistant, cook, kitchen assistant, and 2 domestic staff were also on duty. The home maintained a staff rota confirming the number of staff on duty and the capacity in which they work. The staff records confirmed that no one under the age of eighteen was employed to provide personal care. The home had a comprehensive training programme in place. Records summarising training were seen, and showed that most staff were up-to-date
Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 17 with all mandatory training including health and safety, fire safety, basic first aid and moving and handling. Training had also been provided in care planning, medicines administration, management of supra pubic catheters, abuse awareness. Training was also planned for bowel care, continence care, male catheterisation and record keeping. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 37, 38 The quality assurance programme has commenced but further development is needed to establish an annual plan for the home. Health and safety procedures are in place and practices well monitored to ensure the safety of residents and staff. EVIDENCE: The quality assurance system was in early development. Since the last inspection a residents’ questionnaire had been developed and distributed to residents. The questionnaires had been reviewed and action taken to address some of the identified issues. However no report had yet been produced. Visits required under regulation 26 had been undertaken monthly and reports sent to the CSCI. Records held on behalf of residents were kept up to date and stored safely in secure facilities in a locked office in accordance with the Data Protection Act 1998.
Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 19 There was evidence from observation, inspection of the records and in discussion with staff and residents, that the manager made efforts to ensure the health and safety of staff and residents as far as reasonably practicable. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x x 3 3 Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO 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 The registered person must ensure that the administration of controlled drugs is confirmed by signature of a witness. The registered person must ensure that the reason for omission of medication is recorded on the MAR chart. The registered person must ensure that records of medicines controlled under the Misuse of Drugs Act 1971, bear the name and address of the supplier/disposer. This also applies to temazepam where treated as a controlled drug. The registered person must ensure that adequate staffing levels are provided at all times to meet the dependency needs of residents. The registered person must ensure that a quality development plan is produced annually for the home. Timescale for action 31/03/06 2 OP9 13(2) 31/03/06 3 OP9 13(2) 31/03/06 4 OP27 18(1) 31/03/06 5 OP33 24 30/06/06 Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 22 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 2 Refer to Standard OP3 OP7 & OP8 Good Practice Recommendations The registered person should ensure that the social interests/hobbies and mental state and cognition are recorded on the assessment record. The registered person should ensure that the treatment of pressure sores is more accurately monitored by the use of a measurement tool. Beckingham Court DS0000063361.V282910.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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