Inspection on 27/07/09 for Homebeech

This inspection was carried out on 27th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

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.

Other inspections for this house

Homebeech 18/11/08

Homebeech 08/01/07

Homebeech 31/01/06

Homebeech 09/08/05

Homebeech 26/01/05

Homebeech 01/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Homebeech 19/21 Stocker Road Bognor Regis West Sussex PO21 2QH Lead Inspector Lesley Webb Key Unannounced Inspection 27th July 2009 09:15 DS0000024153.V376382.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homebeech Address 19/21 Stocker Road Bognor Regis West Sussex PO21 2QH 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) 01243 823389 01243 841295 homebeech@saffronland.co.uk www.homebeechltd.co.uk Homebeech Ltd Mrs Sarah Boote-Cook Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Physical disability (PD). The maximum number of service users to be accommodated is 66 . Date of last inspection 18th November 2008 Brief Description of the Service: Homebeech is a care home registered to provide accommodation and nursing care for up to 66 people in the categories older people and physical disability. Homebeech Limited owns the home and the responsible individual is Rebecca Jane Page. Mrs Sarah Boote-Cook is the registered manager in charge of the day-to-day running of the home. Homebeech is located in Bognor Regis, close to the seafront, shops and other amenities. It is a large extended property. The majority of rooms have ensuite facilities and are for single occupancy. There is a separate unit forming part of the home known as the Daffodil Suite, which is purpose built for the physically disabled. It has its own communal space, living accommodation and staff complement. Catering and laundry facilities are shared with the main home. Homebeech has two passenger lifts. Fees currently charged for living at the home range from £410.00 to £4,000.00 per week. Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people that use this service experience poor quality outcomes. We visited this home on Monday the 27th July 2009, arriving at 9.15am and staying until 5.30pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The registered manager was present during our visit and assisted us throughout by providing documentation and answering any questions we raised. During our visit to the home we had conversations with eight residents and four staff. We examined the care records of four residents and recruitment records of three permanent staff. We also looked at other documentation maintained in the home such as staff training records, quality audits and complaints. In addition to this we looked around the home and indirectly observed interactions between residents and staff. Prior to our visit the home supplied us with copy of its Annual Quality Assurance Assessment (AQAA) and a copy of an action plan completed as a result of a safeguarding investigation. Eight residents completed questionnaires and returned them to us before our inspection. Information from all of the above sources was assessed and used to help us form judgements on the quality of service people living at the home receive. What the service does well: Staff treat residents with dignity and respect. Residents are able to maintain contact with their friends and families so that they can continue to lead a fulfilling life style. All residents that we spoke with during our visit to the home confirmed they know of someone they would approach if unhappy. For example one resident said, “If unhappy would say something to the manager or our family”. Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 6 Residents have a clean and comfortable environment to live in. They are encouraged to personalise their bedrooms so that they can have familiar things around them. Residents expressed satisfaction with the staff that support them. For example comments recorded in surveys returned to us include ‘carers very good’ ‘the staff are kind, caring, friendly and willing’ and ‘nice staff and carers’. The home has facilities for safe storage of residents personal items and money. What has improved since the last inspection? What they could do better: Residents care plans must describe in sufficient detail the support that staff need to give to meet identified needs in order that residents needs can be met consistently and safely. Medication practices must be reviewed to ensure that people in the home receive their medication safely. Particular attention must be paid to hygiene practices in handling medication, accurate recording of all medication administered, observing people actually taking their medication before recording that have done so, maintaining a record of all medication entering the home and ensuring the temperature is monitored in any facility that medication is stored. All Controlled Drugs must be stored in facilities that comply with the law. Recruitment practices for agency staff must include obtaining evidence that the required checks, which include CRB, 2 references and POVA FIRST, are in place before employment commences to protect people who use the service. Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 7 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 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. Homebeech DS0000024153.V376382.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 Homebeech DS0000024153.V376382.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main residents have their needs assessed so that staff understand what areas individuals require support. EVIDENCE: Prior to our inspection the home sent us its Annual Quality Assurance Assessment (AQAA). With regard to assessment processes it states ‘We have a comprehensive pre admission procedure and forms are completed by the manager or suitably qualified person if possible with the clients and their families.If clients are referred from social services hospital we obtain a summary of their care management assessment if possible and a copy of their care plans. For hospital assessments, the assessing person requests access to Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 10 the clients notes to ensure that the needs criteria of the client can be met. We support and encourage individuals to be involved in the assessment process as far as possible wthin the remit of their medical condition, and carers intersets are also taken into account’. During our visit to the home we looked at the admission documentation for four residents, including the newest person to move into the home and spoke with the registered manager. Evidence from these sources supports some of the homes statement regarding admissions but not others. For example we found that some sections of the homes assessment documentation had not been completed in full. For example the sections for sleep routines, social needs and religion on one persons assessment had not been filled in. The same person had a dietary requirements form but this was also blank. Another person’s assessment had been completed in full in all but the sections asking about ethnic origin and mouth care. There was no reason for this given. The admission records for a person who moved into the home as an emergency included a copy of the placing authorities’ statement of need and care plan. Eight residents surveys were completed and sent to us before our inspection. Six state they received enough information to help them decide if the home was right for them before they moved in, one that they did not and one person did not respond to this question. Intermediate care is not provided at this home. Homebeech DS0000024153.V376382.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not in place for all identified needs and some of those in place do not contain sufficient information. This means that the personal and healthcare needs of residents might not be met consistently and safely. Medication practices do not safeguard residents. Residents are treated with respect and their rights to privacy are upheld. EVIDENCE: With regard to health and personal care the homes AQAA states as what it does well ‘Based on detailed assessment and ongoing evaluation we use indepth person centered care plans to ensure that our residents receive the appropriate care to meet their needs. In order for these needs to be met we have extensive in-house and external training sessions. We liase with GPs, District Nurses, Specialist Nurses in areas of Tissue Viability and Palliative Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 12 Care. We have an extensive medication policy. All aspects of care is carried out in a dignified and private manner. By carrying out this system we can be confident that the assessed needs of the individual are met completely’. We sampled four residents care plans and were able to evidence some elements of the AQAA but not others. For example residents files contained care plans that describe individual residents needs, objectives and actions that staff must undertake to meet individual needs. All those sampled had been reviewed on a monthly basis. We did note that none of the care plans have been signed by the resident or their representative and the home was unable to evidence if care plans have been discussed and agreed with residents. The registered manager agreed to take action in this area. A resident is currently receiving palliative care. An end of life plan has not been completed by the home. Records and discussions with the registered manager evidence that appropriate health care intervention is being sought. None of the care plans for this individual give a holistic approach to meeting the individuals changing needs. Risk management forms part of the care planning system that is in place. These include falls assessments, moving and handling and pressure care. One of the residents files we examined contained pre printed assessments for continence, falls and pressure areas however none had been completed. The home uses monitoring forms in conjunction with care plans for areas such as nutrition and pressure care. Those we sampled had been completed in full and demonstrated appropriate monitoring of individuals needs. Eight residents surveys were completed and returned to us prior to our inspection. Four state they ‘always’, two they ‘usually’ and two they ‘sometimes’ receive the care and support they need. All files that we examined contained evidence that residents have received the required treatment from relevant health care specialists such as general practitioners, opticians and chiropodists. Eight residents surveys were completed and returned to us prior to our inspection. Four state they ‘always’ and three they ‘usually’ receive the medical care they need. One person did not respond to this question. Since our last inspection a safeguarding investigation has been undertaken at the home with medication issues substantiated. As a result of this the home completed an action plan that states all trained nurses will receive further medication training, will be given copies of the homes policies and procedures and the Nursing and Midwifery Councils standards, that medication shadowing will be undertaken and a full medication audit undertaken. Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 13 At this inspection the registered manager confirmed that all nurses have undertaken medication training and have been given copies of the policies and procedures. She also informed us that initially medication administration records were being checked daily but that this is now undertaken monthly “as issues resolved”. Also that for a period of time two staff covered the drugs rounds but that this has now stopped as “over the worse, felt not needed”. During this inspection we sampled residents medication records and medication stored on both the Daffodil and Homebeech units. For one resident we found the nurse who had administered a medication on the 23rd July 2009 had not signed the medication administration record and that for the same resident a signature was in place on the 26th July 2009 but the medication that the nurse had signed to say they had administered was still in the blister pack. We could find no record of five of the residents medications being recorded when entering the home or the quantity received. The same residents medication administration records included handwritten entries by the nurses at the home for Midazolam and Diazepam rectal. The recordings by the nurses state these are to be administered ‘as directed’. The resident has a care plan for epilepsy that informs that these medications can be administered. The care plan does not give any instructions regarding dosage, timeframes between dosages or at what point these medications should be administered. We spoke with two nurses, one of whom was able to describe in detail when these medications should be given and one who did not. The nurse who was able to describe in detail when the medications should be given confirmed this information was not documented in any care planning records, stating they know this information “from experience”. The lack of a care plan detailing when to give the Midazolam and Diazepam means that, as each individual nurse is left to make their own clinical decision, this person is at risk of not being given the right medicine when they need it or being given a medicine when they dont need it. Two other residents medication records that we examined did not include records detailing when their medication entered the home and the quantity. A nurse informed us that for one resident this may be due to the medication being ordered mid cycle. The poor standard of record keeping means that we are not able to tell if people always get the medicines that have been prescribed for them. A medication fridge is in place in both units of the home. On one the nurse informed us a record of fridge temperatures is not maintained and the other that a record is maintained but they did not know where this was and could not locate it for us during our inspection. Both rooms used for storing medication on Daffodil and Homebeech units were very warm on the day of our inspection. Two nurses that we spoke to Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 14 confirmed the temperature in medication rooms is not monitored. The lack of temperature monitoring for the fridge and medicines storage rooms means that the home cannot show that the medicines that they keep for people will be fit for use when they are given. A controlled drugs cabinet is in place on one of the units in the home and not in the other. We were informed that as medication is kept behind four locked doors a controlled drugs cabinet is not required on the one unit. Both have controlled drugs registers. Stock that we sampled accurately reflected records in place on both units. We witnessed the lunch time medication being administered in the lounge by a nurse. It was seen that a portable medication trolley was used. This was locked when the nurse was away from the trolley. However we saw that a blister pack containing eighteen tablets was left out on top of the trolley. Secure storage was provided in which to keep medicines. However they way that medicines were left unattended whilst the nurse was giving people their medicines means that people are not fully protected at all times. We observed the nurse administer medication for four residents. They administered this from the blister packs into medication containers in all cases then for two residents the nurse took the medication from the container using her fingers and placed into the residents mouths. For another resident the nurse placed the medication into the residents hand and walked away without observing the resident take their medication. For the forth resident the nurse placed the medication on the table where the resident was sitting and returned to the medication trolley, again without observing the resident take their medication. After each of these situations the nurse signed the individual residents medication administration records to say that she had administered their medication. The medication administration practices we witnessed mean that they are signing the MAR charts to indicate that people have taken their medicines when the may not have done so, leading to inaccurate records being made. Staff were observed speaking and assisting residents with dignity and respect. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they wished. Homebeech DS0000024153.V376382.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main residents can choose how they want to spend their day and the home arranges activities they can participate in if they choose. Residents are able to maintain contact with their friends and families so that they can continue to lead a fulfilling life style for as long as they are individually able to. In the main the home provides a choice of well balanced and nutritious meals. EVIDENCE: With regard to daily life and social activities the homes AQAA informs us under what we do well ‘We actively promote independence of our residents within their capabily and confines of risk assessments. We encourage active participation of family and friends in the various activites we have at Homebeech. We have open visiting times and encourage children to visit as well as adults. Residents rooms are personalised as much as possible by encouraging them to bring personal possessions. We have a varied menu which is seasonally adjusted. We faciltate special diets and cater for residents Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 16 likes and dislikes The clients have regular services of a visiting chiropodist, and a hairdresser visits on a weekly basis. We arrange for visits from church ministers. We hold a monthly church service with communion at Homebeech which is well attended and enjoyed by all age groups. We listen to residents and relatives suggestions thus being able to provide the type of activity and environment that the clients would choose themselves ensuring optimum contentment’. Evidence gained through our inspection process supports some elements of this statement but not others. For example eight residents surveys were completed and returned to us prior to our inspection. Four state the home ‘always’, two the home ‘usually’ and two the home ‘sometimes’ arranges activities they can participate in. When asked the question ‘what does the home do well’ additional comments were recorded of ‘well organized activities’ ‘there is always a cheerful atmosphere in the home and visitors are made very welcome’ and ‘there is regular entertainment and activities are provided which do well to lessen the daily worries of being in a care home’. When asked the question ‘what could the home do better’ additional comments were recorded of ‘some of the bed bound residents do not seem to have much time spent on interaction during the course of the day’ and ‘reduce noise especially by residents who have TV much too loud’. We discussed the contents of the residents surveys with the registered manager. She informed us that activities take place including pampering sessions, cards and a men’s club. She also informed us that at Christmas two local schools visited the home to sing carols and that a ladies lunch scheme has been introduced as an incentive for those trying to lose weight and follow a healthy eating regime. We spoke with seven residents regarding activities. Some expressed satisfaction, others did not. For example one person said, “they have quiz once a fortnight, our families do lot, go pub once week if lost weight, it’s a treat to get out” and another, “activities are alright sometimes, sometimes not, we don’t get any choices at the moment. Exercise man comes in mainly for the elderly’. An activity timetable was on display on the day of our inspection advertising board game during the morning and films on the afternoon. Neither of these activities took place during our visit. The people living at the home who we spoke to told us that their visitors could come at any time and were made to feel welcome. A relative spoken with during our visit said that there are no restrictions about visiting and that they are made welcome. Eight residents surveys were completed and returned to us prior to our Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 17 inspection. Four state they ‘always’, three they ‘usually’ and one they ‘never’ like the meals provided by the home. Three residents that we spoke with during our visit to the home confirmed their satisfaction with meals provided and one expressed dissatisfaction. We indirectly observed lunch being served to residents. Some residents sat at dinning tables, others in chairs in the lounge. We noted that staff transferred meals from the kitchen to individual residents on trays. Food items were not covered and both the main meal and hot dessert were served on trays at the same time. Residents appeared to enjoy the meals provided and the atmosphere was relaxed and informal. Homebeech DS0000024153.V376382.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives know how to make a complaint and have access to a formal complaints procedure. Safeguarding procedures are in place so that people are protected. EVIDENCE: Eight residents surveys were completed and returned to us prior to our inspection. Six confirmed they know of someone they can speak to informally if they are not happy and one states they do not. All state they know how to make a formal complaint. The homes AQAA informs us that two complaints have been received by the home since our last inspection. We examined the records for these and found that they demonstrated that the registered manager has investigated and responded to the complainants appropriately. We saw that the complaints procedure is displayed in the home. Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 19 All residents that we spoke with during our visit to the home confirmed they know of someone they would approach if unhappy. For example one resident said, “If unhappy would say something to the manager or our family”. Since our last inspection a safeguarding investigation has been undertaken at the home with medication issues substantiated. As a result of this the home completed an action plan and supplied a copy of this to both CQC and West Sussex Adult Services. Evidence from this inspection confirms that the contents of the action plan have been complied with but that further work must be undertaken with regard to medication practices in order to safeguard residents. When giving feedback to the registered manager we were informed that disciplinary action would be taken with regards to trained nurses and medication practices we had observed during this inspection. The homes training matrix informs us that twenty nine of the forty three staff employed at the home have undertaken protection of vulnerable adults training. Homebeech DS0000024153.V376382.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a clean and comfortable environment to live in. They are encouraged to personalise their bedrooms so that they can have familiar things around them. EVIDENCE: With regard to the environment the homes AQAA states when asked what we do well ‘At Homebeech we ensure that our residents live in a comfortable, homely and safe environment. Our staff are trained in infection control procedures and have access to PPE. Everyone is aware of COSHH. The home is kept clean and odour free by domestic staff who work 7 days a week. We have a large dining room and lounge where the majority of residents take their Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 21 meals. Our maintainence team respond to our requests to correct any problems within the home that occur. They also carry out compulsory check along with outside agencies to ensure that Homebeech continues to be a safe place for our residents to live. Appropriate certification and records are maintaintained. We have a well maintained garden and balcony area for our residents and families to enjoy’. In the main evidence gained through our inspection process supports this statement. For example during out visit we looked around some of the home and we were able to see communal areas such as the dining room and lounges. We also viewed four bedrooms and bathrooms. As at our previous inspection residents are encouraged to furnish their rooms with personal belongings such as furniture and pictures, to make it feel like home. Generally the home was seen to be clean throughout. We did note that some areas of the home had odours. The registered manager said she was aware of this and that once the decoration of communal areas had been completed new flooring was going to be provided that would eliminate the odours. Residents that we spoke with confirmed their satisfaction with the environment. For example one person said, “I have got a lovely room”. Eight residents surveys were completed and returned to us prior to our inspection. Five state the home is ‘always’ fresh and clean, one ‘usually’ and one ‘sometimes’. One person did not respond to this question. When asked the question ‘what does the home do well’ additional comments were recorded of ‘reasonably high standards of cleanliness’ ‘provides safe, clean friendly home’ and ‘provides a pleasant environment’. The registered manager informed us that thirty six staff completed infection control training in August 2008. Homebeech DS0000024153.V376382.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Monitoring systems ensure sufficient numbers of staff are trained to care for residents. Some recruitment practices place residents at risk. EVIDENCE: The registered manager informed us that the staffing levels at the home consists of thirteen care assistants and two nurses of a morning, twelve care and two nurses of an afternoon. At night we were informed there are seven care assistants and one nurse. There are currently thirty six older persons living on Homebeech unit and fifteen people with physical disabilities living on Daffodil unit. The registered manager informed us that she increases the numbers of trained nurses as and when the numbers of residents increase. We examined the staff rotas and found that on some occasions the care staffing levels have not been maintained to the stated levels. We were informed that this is due to staff sickness. Eight residents surveys were completed and returned to us prior to our Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 23 inspection. Two state staff are ‘always’ available when needed, five ‘usually’ and one ‘sometimes’. When asked the question ‘do staff listen to you and act on what you say five state ‘always’, two ‘sometimes’ and one ‘usually’. When asked the question ‘what does the home do well’ additional comments were recorded of ‘carers very good’ ‘the nursing sisters are excellent. A distinct effort has been made over recent months to always if possible use regular agency staff to cover periods of leave thus enhancing confidence and continuity of high quality care’ ‘the staff are kind, caring, friendly and willing’ and ‘nice staff and carers’. When asked the question ‘what could the home do better’ additional comments were recorded of ‘sometimes staffing levels seem low, even bearing in mind that breaks are necessary. I have waited twice in the last week for ten minutes or so for the call bell to be answered’ and ‘more staff, day and night carers’. Three residents that we spoke with informed us that at times communication with some staff can be difficult. For example one person said, “There’s a lot of Polish staff and this can make communication quiet difficult sometimes” and another, “Nearly all staff are Polish, some understand English, some don’t, they ask us what we mean, we try and explain to them”. We discussed these comments with the registered manager who confirmed the home employs a high level of Polish staff. She informed us that they have received communication training from a local college. The registered manager said that further training would be explored. On the afternoon of our visit we observed a member of staff sitting at a table on Daffodil unit with their head on table. They appeared to be asleep. We called the registered manager who woke the member of staff. The member of staff said that she was on her lunch break. The registered manager confirmed that a staff room is available and that the staffs conduct was inappropriate. Later the registered manager informed us the member of staff had been feeling ill and didn’t like to say anything because the home was being inspected. The registered manager informed us that she sent the member of staff home. We viewed the homes training matrix. The training matrix details seventy two staff employed at the home. It states fifty six hold up to date training in moving and handling, sixty one fire, six food hygiene, thirteen first aid, two dementia awareness, eight Huntington’s disease, seven Parkinson’s disease and six epilepsy. We were also shown evidence that of the thirty five care staff employed at the home twelve hold a National Vocational Qualification (NVQ) at level 2 and four at level 3. A further seven are in the process of completing level 2 and five completing level 3. Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 24 We examined the recruitment records for three of the newest staff to commence working at the home. All contained the required documentation including completed application forms, references, satisfactory POVA first and or Enhanced Criminal Records Bureau (CRB) disclosures. The homes AQAA informs us that agency staff are used by the home. During our inspection the registered manager informed us two agencies are used for both nurses and care assistants. The rota in place for the week of our inspection details four agency nurses and three agency care assistants who have undertaken shifts at the home. Written confirmation was available in the home with regard to the agency nurses Personal Identification numbers (PIN). For one of the agency nurses written confirmation from the agency was also in place confirming their CRB disclosure, two references and training. This information had not been obtained by the home for the other agency nurses. No recruitment records or confirmation of these was in place for the agency care assistants. Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of this home is not meeting the needs of residents safely with regard to medication practices. Quality monitoring systems allow the home to measure if it is achieving its aims and objectives. Residents’ financial interests are safeguarded. EVIDENCE: The registered manager was present during our inspection and demonstrated knowledge and understanding of her role and responsibilities. Evidence gained at this inspection show that improvements must be made with regard to some Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 26 elements of care planning, medication and recruitment practices for agency staff. When giving feedback to the registered manager regarding our inspection findings she assured us action would be taken immediately to address the shortfalls. The home has facilities for safe storage of residents personal items and money. Individual records are also maintained for residents. The registered manager informed us that staff receive regular, formal one to one supervision. In addition to this staff meetings take place. During our visit we were informed that the views of residents, relatives and staff are sought annually. Records were not in place evidencing actions taken by the home to address comments made within the surveys. We were shown an annual quality audit report completed by the registered manager. The action plan implemented as a result of a safeguarding investigation has been incorporated into this. However evidence gained from this inspection with regard to medication indicates the homes quality monitoring systems are not ensuring continued safe medication practices. The home sent us its AQAA when requested. This was detailed and informative. With regard to health and safety management the homes AQAA informs us that all services and equipment have been serviced in 2009. The AQAA did not state when the electrical wiring for the premises was last inspected. During our visit to the home the registered manager said she was unable to locate this. Contact was made with the organisations head office and we were assured a certificate of completion was available and a copy would be forwarded to us. Homebeech DS0000024153.V376382.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement The registered person must ensure residents have clear individual care plans describing in sufficient detail the support that staff give to meet identified needs. This must happen in order that residents needs can be met consistently and safely. The registered person must review the homes medication practices to ensure that people in the home receive their medication as prescribed. Particular attention must be paid to – * Hygiene practices in handling medication * Accurate recording of all medication administered * Observing people actually taking their medication before recording that they have done so * Maintaining a record of all medication entering the home * Ensuring the temperature is monitored in any facility that medication is stored. All Controlled Drugs must be DS0000024153.V376382.R01.S.doc Timescale for action 27/08/09 2. OP9 13(2) 27/08/09 3. OP9 13(2) 27/10/09 Page 29 Homebeech Version 5.2 4. OP29 19 Schedule 2 stored in a cupboard that complies with the Misuse of Drugs (Safe Custody) Regulations 1973. This must happen to ensure the home complies with the law. The registered person must have written confirmation from the recruitment agency that agency staff have satisfactory up-todate CRB and POVA checks in place before individuals undertake shifts at the home. This must happen to protect people who use the service. 01/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Homebeech DS0000024153.V376382.R01.S.doc Version 5.2 Page 30 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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