Inspection on 17/06/08 for Southgate Beaumont Nursing Home

This inspection was carried out on 17th June 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

Southgate Beaumont Nursing Home 01/12/08

Southgate Beaumont Nursing Home 23/10/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Southgate Beaumont Nursing Home 15 Cannon Hill Old Southgate London N14 7DJ Lead Inspector Susan Shamash Unannounced Inspection 17th, 19th & 25th June & 1st July 2008 2:00 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 Southgate Beaumont Nursing Home DS0000069498.V365791.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. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southgate Beaumont Nursing Home Address 15 Cannon Hill Old Southgate London N14 7DJ 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) 020 8882 9222 020 8886 5381 barbara.rees@barchester.net www.barchester.com Barchester Healthcare Homes Ltd Mrs Barbara Lyn Rees Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Rooms 1;7;20;27 & 40 may not be used by heavily dependent persons. 23rd October 2007 Date of last inspection Brief Description of the Service: The Southgate Beaumont is a care home registered to provide nursing care for up to 52 people over the age of 65. A section of the first floor has been converted into a residential unit for seven service users who do not need nursing care. The service is provided in a listed building, which has been converted for use as a care home. There are five communal lounge areas, a dining room and a hairdressing salon. All bedrooms have en suite facilities. The home is owned and managed by Westminster Health Care Limited which is now a part of a larger group called Barchester. The home is located close to public transport links and is walking distance to Palmers Green and Southgate. The stated aim of the home is to create circumstances in which residents can maintain their dignity, identity and independence and also to provide an environment for individuals that supports their physical and mental well being. Weekly fees as at June 2008 are £800 for residential care and £998 -£1200 for nursing care. The most recent CSCI inspection reports can be obtained from the manager’s office or at www.csci.org.uk Southgate Beaumont Nursing Home DS0000069498.V365791.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 who use this service experience poor quality outcomes. This inspection lasted approximately sixteen hours over four days, including an evening visit lasting until approximately 8.30pm, during which I was able to observe evening routines within the home. All visits, with the exception of the visit on 19th June 2008, were unannounced. I received every assistance from the manager, nurses and care workers on each unit. I also had the opportunity to eat an evening meal with people living on the ground floor of the home. Approximately eighteen residents, three relatives and eight staff members were spoken to independently during the inspection. A tour of the building was conducted and residents’ and staff members’ records were inspected in addition to a number of maintenance and health and safety records. Information provided in the Annual Quality Assurance Assessment completed for the home was also taken account of as part of this inspection. What the service does well: The home is situated within easy access of local facilities and includes large grounds that residents can access. The home itself is consistently maintained and decorated to a very high standard, with large communal areas and en suite rooms available. There is a high standard of cleanliness and hygiene provided. In addition to residential and nursing care provided, the home provides residents with the opportunity to purchase private accommodation in the home prior to requiring such care, so that continuity of support can be provided should additional support be needed in time. Residents speak highly of the care and nursing provided to them at the home and generally provide positive feedback about the quality and variety of food served. The home has a dedicated activities organiser who is very popular with residents. Residents have detailed care plans that are reviewed regularly, and are consulted about these as far as possible. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 6 Staff members are knowledgeable about their role and responsibilities within the home. Staff members receive a range of appropriate training including support to undertake relevant NVQ training at the home. What has improved since the last inspection? What they could do better: It remains required that up to date photographs and wound assessment records must be maintained with the records of treatment for service users with pressure areas or ulcers. Clear records must be available for when people received Influenza, or other vaccinations, to ensure that their health needs are met safely. Significant improvements are needed in the recording and administration of medicines to people living at the home. The home must not run out of any prescribed medicines for service users, people must be given their medicines as prescribed, and recording on medication administration records must be Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 7 clear and accurate to ensure that people’s medication needs are met safely. The Commission is taking enforcement action regarding this issue. People must be provided with sufficient stimulation on a daily basis for their social, intellectual and emotional wellbeing. All concerns brought to the attention of staff should be recorded, alongside action taken to address them, to evidence that people’s views are being taken into account Sufficient staffing must also be available to ensure that people’s physical care needs are met appropriately at all times, adequate support for service users in joining in activities inside and outside of the home and sufficient stimulation for service users who need to remain in bed. The Commission is taking enforcement action regarding this issue. There must not be any gaps in individual supervision sessions provided to staff members, and staff records must include a training profile for each staff member alongside evidence of all training provided to ensure that they are appropriately trained to meet people’s needs safely and effectively. It is recommended that more rigorous monitoring be undertaken regarding recording of people’s weights on the ground floor of the home, and that clear records be maintained of all healthcare appointments offered to people living at the home that are refused. It is also recommended that further ways be considered to develop the home’s gardens so that more people living at the home can enjoy these areas, and that up to date written information on ‘who’s who’ in the home be provided, so that people are aware of who to contact about any issues of concern. 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. Southgate Beaumont Nursing Home DS0000069498.V365791.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 Southgate Beaumont Nursing Home DS0000069498.V365791.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): 3, 5. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before they move into the home, so that they can be assured that their needs will be met appropriately. They have the opportunity to visit the home or have relatives/friends do so on their behalf, in order to make a more informed decision about whether to move into the home. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 10 EVIDENCE: Eight people’s care files were inspected and these all contained comprehensive pre-admission assessments of their needs. People’s signatures indicated that prospective residents or their representatives were involved in undertaking these assessments. There were also dates and signatures indicating that the care plans were being reviewed at least monthly. The manager advised that people are visited in their own homes, or at hospital (depending on their circumstances) in order to carry out an initial assessment of the home’s ability to meet their needs. Staff members told me that prospective residents or their family members are invited to visit the home and provided with information about the home to aid their making a decision about whether to move in. Interviews with people living at the home indicated that their needs were generally being met in accordance with their choices, and that they had been involved in the initial assessment procedure. They also advised that they had been given the home’s brochure giving them information about the home as appropriate. In the majority of cases it had been their relatives who had visited the home to gain an impression of it prior to their admission, as they had been unable to do so themselves due to ill health. Southgate Beaumont Nursing Home DS0000069498.V365791.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, 10. People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home generally feel that they are treated with respect by the staff team and that their privacy is maintained. Residents’ health, personal and social care needs are addressed in care plans, however insufficient recording of action taken to prevent pressure sores may place residents at risk of harm. People cannot be assured that their medication needs will be met effectively. EVIDENCE: All residents spoken to confirmed that their privacy was being maintained and that staff addressed them with respect at all times. My own observations of interactions between staff and residents confirmed that this was the case. Inspection of a sample of the care plans for residents on each unit in the home (eight care plans in all) showed that their health, personal and social care needs are recorded and most had been signed by residents or their advocates Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 12 where appropriate. Records showed clear details of when people had received healthcare professional visits such as chiropodist, physiotherapy, dentist and optician appointments. However not all people living at the home had seen the optician or dentist within the last year. Discussion with residents indicated that they had the opportunity to see healthcare professionals of their choice but did not always choose to attend such appointments. Staff members spoken to confirmed that this was the case. It is therefore recommended that staff record all healthcare appointments offered to people living at the home, including those refused, to evidence that people are offered these opportunities. Nutritional and Waterlow assessments (regarding tissue viability used for the prevention of pressure sores) remain available for each resident. As required at the previous inspection people’s weights were being recorded at least monthly including the date on which they were weighed. Records showed that staff were noting any significant changes in people’s weights and seeking medical advice accordingly as necessary. However more rigorous record keeping was in place for people living on the first floor of the home than on the ground floor. It is therefore recommended that there be increased monitoring of records of people’s weights on the ground floor of the home. A small number of people had pressure ulcers, and appropriate care plans appeared to be in place for them. However I was concerned that in two care plans for people with pressure areas, there were not up to date photographs of the current state of these wounds alongside their records of treatment. The manager advised that he had recently purchased a new Polaroid camera for this purpose. Directions regarding the care and treatment of pressure ulcers were generally clear and detailed, and records indicated that these were being followed as required at the previous inspection. However full wound assessments were not recorded for each time dressings were changed (as is the home’s policy). Clearly internal monitoring procedures also need to address such issues on a regular basis. I was however pleased to note more detailed recording of mouth care for people living at the home, and there was also an improvement in recording when people are turned over in bed (where this is needed) indicating that this was occurring regularly as appropriate. Records of peoples Influenza or other recent vaccinations were not available at the time of the inspection. Clear records of all vaccinations must be maintained on people’s files to ensure that their health needs are met safely and appropriately. A requirement had been made at the previous inspection that the home must not run out of any prescribed medicines for residents; recording on medication Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 13 administration records (MAR charts) must be clear and accurate e.g. where one or two doses of a medicine may be given, the quantity of medicine administered on each occasion must be recorded; assessments for people who are self-medicating must be reviewed at least monthly; and that medicines requiring refrigeration must be stored securely within the home, to ensure that residents medication needs are safely met. Arrangements for the storage of medicines throughout the home were generally found to be appropriate, with no medicines being stored in the refrigerator in the home’s servery, following the requirement made at the previous inspection. A new clinical room had instead been provided on the ground floor with air conditioning and adequate space for medication storage. It was not yet fully in use at the time of the inspection, with some additional shelving still to be installed, but will be a significant improvement in comparison to the previous medication room available. Appropriate storage and recording of controlled drugs was also in place. However I was concerned to note the following issues of poor practice: A number of residents continue to self-medicate at the home, which is generally seen as positive, in that it encourages them to maintain their independence as far as possible. However on my initial two visits to the home (on 17th and 19th June 2008) as part of this inspection, no relevant risk assessments were available for four people who were fully or partially selfmedicating. A medicine prescribed as ‘one or two tablet to be administered’ for an identified resident in the residential area of the home, was signed for on the MAR chart without recording which dose was administered on each occasion. Several residents had missed doses of medication on 17th June 2008 due to the late arrival of medicines from a new pharmacist provider on this date. There were unclear records regarding an identified resident who was due to receive Codeine Phosphate three times daily, but only one was given on most days, despite the nurse on duty assuring me that this was not an ‘as and when’ medicine in this particular case. Finally another resident was prescribed Nicoradil one tablet twice daily, but was only receiving this once daily. I reported these concerns to the manager, and a letter of serious concern was hand delivered to the home on 23rd June 2008, regarding the above issues, requiring that action be taken to address all these areas by 24th June 2008, with a written report to be sent to the CSCI by 27th June 2008 explaining what had been done to address this area of concern. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 14 I conducted a short unannounced visit to check the home’s medication on 25th June 2008. During this visit I noted some improvements including risk assessments now in place for residents who are self-medicating, a review of some peoples medicines undertaken by the GP, and records now stating the dose of Celocoxib being administered to a person on the residential unit. The error with the identified person’s Nicoradil had been rectified and they were now receiving this twice daily and the identified resident receiving Codeine Phosphate had been reviewed and was now receiving a dose of this medicine four times daily. There were still some missing signatures, but the medicines did appear to have been administered (i.e. were not in the blister packs) for three identified residents. I was however very concerned to find that a new medicine (Azathioprine) had been prescribed for an identified resident, however they had not received this tablet that morning, because the nurse had not noticed it on the MAR chart and in the blister pack. The nurse corrected the error that morning - but I was concerned that had I not been checking the medication, this omission would not have been noticed until the next day, if at all. I was therefore still not satisfied that people’s medication needs were being met safely within the home. The manager wrote to the CSCI within the timescale set advising that new and more rigorous monitoring procedures were in place and detailing these. On 1st July 2008 I conducted a further unannounced visit to the home and was concerned to find more errors in the recording of medication on this occasion. There were gaps in the MAR charts for the majority of an identified person’s medication on the morning of 23rd June 2008, although the blister packs indicated that these medicines had been administered. In addition this person was prescribed either one or two doses of Celecoxin once daily, however the dose administered to them on 20th and 26th June 2008, was not specified. There were also gaps in the MAR chart for another identified person on 25th June in the morning, with no evidence available that the gaps had been noticed or any action taken to address these. Another resident had been prescribed Enalapril twice daily on 24th June but this was not administered until 30th June, despite them being on the same dose of this medicine prior to this prescription. This is unacceptable practice which is detrimental to the health and welfare of people living at the home. A further resident had been prescribed Baclofen three times daily but this was administered until 28th June, then appeared to run out for two days and then restarted in the evening of 30th June. One nurse told me that this resident had been quite stiff in their wrists due to stopping this medicine over this time period. This had clearly impacted negatively on the wellbeing of a person living at the home. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 15 The manager accepted the issues that I raised. He was cooperative and helpful throughout the inspection visits, and has since advised that further improvements have been made in monitoring procedures at the home. In addition a Director from the provider organisation has also been in contact with the home and undertaken to ensure that the issues raised are addressed without delay. The CSCI is taking enforcement action against the home regarding poor standards of recording and administration of prescribed medicines to people living at the home, placing them at risk of harm to their health and wellbeing. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 16 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. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged to maintain contact with their family members and friends, and a programme of activities is provided at the home to address social, cultural and recreational needs. However residents do not always have adequate stimulation at other times of the day. Residents are given choices about the way in which their care is provided so that their independence is maintained as far as possible. The home is commended for the high standard of food served to residents for which there is a high level of satisfaction. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 17 EVIDENCE: There is a varied activities timetable and residents spoke highly of the support provided to them by the activities organiser. Activities available to them include film nights, toasted sandwiches evenings, entertainers, light exercise, ‘Booze mornings’, flower arranging, arts and crafts, cookery and trips out of the home in the van. One resident told me that they had enjoyed the file ‘Mrs Brown’ that week, and also regularly attended the Booze Mornings, during which people got together to enjoy a glass of sherry or other alcoholic and soft drinks. Outings included trips out to local parks, restaurants and the pub with trips further afield planned for later in the summer. Staff still advised that there were rarely sufficient care staff on duty to assist with these trips, so the activities organiser tends to take small numbers of people out herself on each occasion. One person living at the home arranges regular book club meetings which are incorporated on the activities schedule for the home. The manager advised that he had changed the emphasis of activities at the home, so that it was now the responsibility of nurses and care staff and not just the activities organiser. He had likewise changed the accountability structure within the home so that the activities organiser now reports to the nurses. In addition he had introduced separate activities and entertainments schedules for each week, to encourage greater choice for people living at the home. Whilst the thinking behind this is clearly positive, feedback from staff and residents indicated that they were somewhat confused by the two separate schedules, and the manager agreed to review their layout accordingly. At a previous inspection it was recommended that the care staff at the home be encouraged to be more involved in meeting social, religious and recreational needs of residents, including greater flexibility in the staffing rotas so that they can take individual residents out in the local area. Staff and residents spoken to confirmed that care staff still do not have much time to provide residents with support to be stimulated and engage in activities within the home. Some staff members indicated that this had become even less possible within the last few months due to staffing shortages, so that they rarely have time to spend much time with residents who are unable to leave their rooms, nor provide them with any stimulation. This issue is addressed under Standard 27 of this report. It remains required that residents must receive sufficient stimulation on a daily basis for their social, intellectual and emotional wellbeing. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 18 Regular residents meetings are now occurring within the home, to which residents and their relatives are invited. This has been a popular development with people living at the home, replacing the previous forums to which only one representative was invited from each unit. Topics discussed have included food provision, activities, maintenance of the building and areas for improvement. Church services are provided in-house for those who wish to attend. One resident was supported to visit the Neasden Hindu temple on their birthday, and one resident goes to church regularly with support from their relatives. The Jewish Women’s League and two bridge clubs hold regular meetings at the home, which residents may also attend if they so wish. The menu for the home offers a choice of meals including special diets and the majority of residents spoken to advised that the food is of a very high standard. Asian food options are available for an identified person if they wish. Hostesses are employed to serve the food to residents on each unit, and also provide feedback to the chefs regarding residents’ satisfaction with each meal. The home is commended for the high standard of food provision for residents. I had the opportunity to join residents for the evening meal in the dining room which is maintained and decorated to a high standard. The meal was tasty with a vegetarian option available. Staff supported residents appropriately although those having their meal in the dining room were generally able to manage independently. One resident had requested that music be played in the dining area, and those eating the evening meal felt that this was a pleasant change. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 19 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. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s do not feel that their informal concerns about the home are taken seriously. Staff training is in place to ensure that the risk of residents being abused is minimised. EVIDENCE: Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 20 There is a complaints policy in place that has all the required information, and the record of complaints is maintained appropriately. Several residents spoken to told me that they felt they were listened to, and that their concerns were addressed appropriately. They noted that the new manager is very approachable, and makes an effort to see them all. All residents spoken to felt that they could speak to someone at the home if they were unhappy with their care. However a significant number of people living at the home and relatives of people living at the home had concerns about the staffing numbers in the home, and did not feel that these were being addressed appropriately. The majority of staff members that I spoke to also indicated that staffing was a problem, and that despite bringing this to the attention of the home’s management, the home remained short staffed. I received a total of three anonymous concerns and one concern from a relative, about staffing levels at the home, prior to and following my inspection visits. These were made directly to the regional CSCI area office. It was of concern to me that people were contacting the CSCI directly rather than making formal complaints to the home’s management, indicating a lack of confidence in the home’s complaints procedure. This needs to be addressed by the home’s management. It is recommended that all concerns brought to the attention of staff members should be recorded, alongside action taken to address them, to evidence that the home takes all concerns seriously. Although there were concerns files on each nurses station, there were no records of complaints within the last year, despite a number of residents telling me about issues they had raised with staff. Although complete records were not available for all staff regarding training undertaken, evidence was seen at the previous inspection confirming that the vast majority of staff members had undertaken training in adult protection as appropriate. The home has a copy of the adult protection policy for the local authority, in addition to its own adult protection policies and procedures. Staff spoken to were confident about action to be taken in the event of a disclosure or suspicion of abuse, and confirmed that they had undertaken training in this area. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 21 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. People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a safe and pleasant environment that is consistently decorated to a very high standard, well furnished, clean and hygienic. They have comfortably furnished individual rooms and access to a range of inviting communal areas both inside and outside of the home. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 22 EVIDENCE: On all four days of this inspection the home was cleaned and decorated to a very high standard with no offensive odours and the large garden areas were well maintained. The housekeeping staff are commended for the high standards of cleanliness that have consistently been maintained in the home. The home has sufficient communal areas that are furnished and decorated to a very high standard. In addition to en suite toilets for every bedroom, there are also adequate shared bathroom and toilet facilities, which are kept clean and in a good state of repair. Residents had personalised their own rooms, which were well furnished and decorated. Following a previous inspection, keypads had been installed both inside and outside of the main entrance to the home to address the issue of security, and this appeared to be operating successfully. The manager had also arranged further cover of the reception area so that the main entrance is kept open for longer periods of day, and thus welcoming to visitors. The manager advised that he was intending to provide several larger television sets for the home, so that residents can watch films or television programmes as a group, more comfortably. There are large garden areas outside the home and I saw people enjoying these areas during some of my visits. However the majority of the gardens consist of clear lawns, and it remains recommended that further ways in which the gardens might be used for the recreation of service users, should be considered. As required at the previous inspection, lockable drawers had been provided on each nursing stations, so that residents’ files can be locked away when the nursing stations are unoccupied, to protect people’s confidentiality. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 23 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. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home operates safe recruitment practices and staff receive training to ensure that they carry out their roles competently to meet residents’ needs safely. Residents do not feel confident that there are sufficient staff available at all times to meet their needs. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 24 EVIDENCE: A sample of seven staff files were inspected. Each contained the required level of Criminal Records Bureau (CRB) disclosure checks, references, recent photos and evidence of each staff member’s eligibility to work, as appropriate. Evidence of current pin numbers were also available for all registered nurses, and there were details of their immunisations. Approximately two thirds of care staff have an NVQ level two qualification or higher, which exceeds the national minimum standard of fifty percent trained staff. Discussion with staff indicated that they had received a wide range of training. However the manager is in the process of commencing a new system of recording staff training. Therefore whilst computerised training records indicate training undertaken, the certificates and staff training profiles for each staff member are not yet available in the new format. Discussion with the manager indicated that the new system will allow appropriate monitoring to ensure that all staff keep up to date with mandatory training courses. The trained nurses are also qualified first aiders, and at the previous inspection it was noted that a large number of staff had undertaken training in adult protection and eight staff had undertaken training in person centred dementia care. At the current inspection I saw evidence that a further 14 staff members had undertaken training in person centred dementia care, a further 24 staff had undertaken adult protection training, 23 staff had undertaken manual handling training, 24 staff had undertaken infection control, and three staff undertook food hygiene and health and safety training within the last few months. At the previous inspection it was required that staffing levels within the home be reviewed to ensure that residents receive sufficient stimulation. Prior to the inspection I received one anonymous complaint and one complaint from a relative of a person living at the home, regarding staffing numbers in the home. I received a further two anonymous concerns relating to insufficient staffing, in between inspection visits and following the inspection visits of the home. Discussion with staff members and residents indicated that there was a general impression that there were not sufficient care staff working in each unit to meet the care needs of residents, or engage residents in activities or stimulation. This area of need therefore continues to be left primarily to the activities organiser. Residents were unanimous in feeling that the care staff Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 25 worked hard, and were always helpful and respectful to them, however most felt that there were frequently too few of them working. On 1st July 2008 following receipt of an anonymous concern indicating that there were not sufficient staff in the home, I conducted a visit in the afternoon. The manager confirmed that there had been a problem with staffing on that day, with two members of staff not coming into work that morning, one calling in sick at the last moment, and the other not contacting the home at all. He advised that despite contacting four different care agencies, he had not been able to obtain replacement workers to work with the team. He also noted that there had been some disquiet amongst the staff team due to the staffing problem in the morning. The situation had been managed by rearrangement of staff duties that morning, with all the team helping out, and he praised the staff for their hard work. Discussion with various residents indicated that some had not noticed any major disruption that morning, however there were several who had been very anxious about the situation. One person told me that they had noticed the lack of noise, you generally hear in the morning, and become very worried about what was going on, and this was shared by some of their neighbours. They had asked a staff member for assistance and been told that they would need to manage without as that staff member was going home. The resident was very clear that they did not want this staff member to get into any trouble, and understood that they must have been upset about the prospect of working without sufficient team support. This clearly indicates that people at the home were being negatively affected and placed at risk, due to insufficient staffing present in this area of the home. Another resident told me that the situation had been ‘pretty grim today’ and that they had been promised a shower, but could not have one as there were insufficient staff. They told me that they remembered a similar situation approximately a month ago, when they were ‘forgotten’ in the dining room after dinner for almost an hour, as the staff were all busy. This is clearly an unacceptable level of care and support. Another resident told me that the carers were quite good, but ‘you do have to wait sometimes – they can be a bit pushed.’ They told me that ‘the other day I had to wait for a wash until 3.30pm because there were insufficient staff’. One noted that the manager had told them that he was recruiting more staff, but there hadn’t been any signs of many coming in yet. Several residents told me about previous times when the home had been short staffed within the last couple of months, although they were not always clear of the exact dates. One told me ‘they just don’t seem to have any contingency plans when people don’t turn up.’ Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 26 Eight staff members confirmed to me that they had had similar staff shortages previously within the last few months, and were feeling very frustrated. Inspection of the staffing rotas, indicated that these are not accurately maintained to show which staff were working in particular areas of the home on each day. Thus when I pointed out to the manager that there had been insufficient staff on particular days according to the rota, he looked at staff timesheets for that day that showed more staff working on that day. A requirement is made accordingly that the staff rota must be maintained accurately. The manager advised that he had increased the number of staff working in some parts of the home. However staff members advised that this was not helpful without sufficient staff members to fill these positions. Following the inspection the manager advised that he is now using agency workers more frequently to cover staff absences and that he is conducting a study of the level of need, in order to identify optimum staffing. A director from the provider organisation is also looking into this area, and will be reporting back to the CSCI. The CSCI is taking enforcement action against the home regarding staffing levels not being sufficient at all times to meet people’s physical care, emotional and intellectual needs. The manager advised that due to changes in the management personnel at the home, there had been a gap in the individual supervision arrangements for staff members. Evidence was available of some recent supervision sessions with staff, however several months had elapsed since the previous supervision sessions were held. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A new qualified and experienced manager is in place at the home, however he has yet to gain the confidence of people living there. There are forums for residents and their advocates to express their views about the home, however many are not confident that their concerns will be addressed. Service user’s finances are safeguarded appropriately. There have been gaps in staff supervision, which may impact on the quality of care experienced by residents. There is a high standard of health and safety procedures to protect residents, visitors and staff from risk of harm. EVIDENCE: Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 28 The manager of the home is experienced and advised that he was appropriately qualified. He is in the process of applying to become the registered manager of the home with the CSCI. He showed an openness to suggestions and was helpful throughout the inspection visits. Since commencing work at the home, he has held two resident and relative meetings which were very successful. Residents told me that they were pleased to have a meeting to which they were all invited, rather than just representatives from each unit. Several commented to me that they found the manager to be very approachable and ‘sociable’ coming to see them around the home rather than based in his office. Staff meetings had also been held, and the manager advised that he was conducting regular morning meetings with relevant personnel to aid effective management of the home. As suggested by the relative on one person living at the home, it is recommended residents and their relatives be provided with up to date written information on ‘who’s who’ in the home, following the most recent staff changes, so that they are aware of who to contact about any issues of concern. Regular unannounced visits to the home are undertaken by the responsible individual, with reports sent to the CSCI outlining the findings. The results of the most recent customer satisfaction survey, undertaken by the provider organisation, were seen at the last inspection, indicating a high level of satisfaction, and strategic priorities for 2008. Information in the Annual Quality Assurance Assessment also indicated that a comprehensive review had been undertaken regarding the service. Discussions with residents and staff revealed that they were generally happy with the management style of the home. Residents administer their own finances, with no monies being held on behalf of any people accommodated. Staff supervision records were available indicating that these had started again recently. However there was a considerable gap since the last staff supervision sessions. The manager advised that this was due to the change in several of the management personnel in the home including both ‘Sisters’ who had been responsible for this area. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 29 Health and safety documentation was inspected in detail and was maintained to a high standard. Appropriate safety certificates and monitoring records were available for relevant equipment including current satisfactory gas safety, portable appliances testing and emergency lighting certificates. The manager provided evidence of work being undertaken to meet the requirements made during the last electrical installation inspection, including works to a large number of flats within the home which received ‘unsatisfactory’ electrical installation certificates. He also advised that a large number of emergency lighting fittings had been replaced, and that a new boiler was due to be installed in the home. A detailed fire risk assessment was available for the home alongside an appropriate emergency plan. Weekly fire alarm call point tests were also being undertaken as appropriate, and there were records of regular fire drills. Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 30 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 31 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 OP8 Regulation 12(1) 15(2) Requirement The registered person must ensure that up to date photographs are maintained with the records of treatment for service users with pressure areas or ulcers, and directions regarding their treatment must be kept up to date and followed. Records of wound assessments must include the time of assessment, to ensure that people receive appropriate nursing care. (Previous timescale of 30/11/07 not met). The registered person must ensure that clear records are maintained on people’s files for when they were offered/or received Influenza, or other vaccinations to ensure that their health needs are met safely and appropriately. A report confirming the situation with regard to vaccinations at the home in the last year, must be sent to the CSCI regional office. The registered person must ensure that all medicines received into the home are DS0000069498.V365791.R01.S.doc Timescale for action 25/07/08 2. OP8 12(1) 25/07/08 3. OP9 13(2) 18/08/08 Southgate Beaumont Nursing Home Version 5.2 Page 32 appropriately recorded handled, safely stored, administered and disposed of, and that, all service users are administered their medication as prescribed. Statutory Enforcement Notice served. The registered person must ensure that service users receive sufficient stimulation on a daily basis for their social, intellectual and emotional wellbeing. (Previous timescales of 02/03/07 and 25/01/08 not met). The registered person must ensure that all concerns brought to the attention of staff members are recorded, alongside action taken to address them, to evidence that people’s views are being taken into account. The registered person must ensure that at all times there are sufficient staff working at the care home in such numbers, as are appropriate to meet the health and welfare needs of service users. Statutory Enforcement Notice served. The registered person must ensure that a current and accurate record is maintained of all staff working at the home and the area in which they are deployed, to evidence that sufficient staff are available to meet people’s needs at all times. The registered person must ensure that there are no gaps in regular staff supervision sessions provided. These must be provided at least six times annually to ensure that people living at the home are supported appropriately. DS0000069498.V365791.R01.S.doc 4. OP12 16(2mn) 25/07/08 5. OP16 22 18/07/08 6. OP27 18(1a) 18/08/08 7. OP27 18(1c) 18/07/08 8. OP36 18(1c) 18(2) 08/08/08 Southgate Beaumont Nursing Home Version 5.2 Page 33 The new staff training records must include a training profile for each staff member alongside evidence of all training provided to ensure that they are appropriately trained to meet people’s needs safely and effectively. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations It is recommended that more rigorous monitoring be undertaken regarding recording of people’s weights on the ground floor of the home to ensure that their health needs are monitored and met appropriately. It is recommended that clear records be maintained of all healthcare appointments offered to people living at the home that are refused or not taken up, including dentist and optician appointments, (with residents’/advocates’ signatures to evidence this) to demonstrate that they are provided with appropriate healthcare choices. It is recommended that further ways be considered to develop the home’s gardens so that more people living at the home can enjoy these areas. It is recommended that all people living at the home and their relatives be provided with up to date written information on ‘who’s who’ in the home following the most recent staff changes, so that they are aware of who to contact about any issues of concern. 2. OP8 3. 4. OP19 OP32 Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Southgate Beaumont Nursing Home DS0000069498.V365791.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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