Inspection on 23/10/07 for Southgate Beaumont Nursing Home

This inspection was carried out on 23rd October 2007.

CSCI 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 CSCI judgement.

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 17/06/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Southgate Beaumont Nursing Home 15 Cannon Hill Old Southgate London N14 7DJ Lead Inspector Susan Shamash Key Announced Inspection 23rd – 26th October 2007 10:00 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.V346494.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.V346494.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 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.V346494.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. 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 November 2007 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.V346494.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection lasted approximately twelve hours over two days. The home had received notice regarding the first day of the inspection due to an administrative error at the CSCI. However the second day’s visit was unannounced. I was assisted by an ‘expert by experience’ during the first day of the inspection. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. We received every assistance from the manager, administrator, activities organiser, nurses and care workers on each unit. The expert by experience had the opportunity to take lunch with people living on the ground floor of the home. Approximately twelve residents, and nine 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 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. There is a high level of satisfaction with the staff team and the support that they provide to individual residents. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 6 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. 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: Accurate weights must be recorded for people living at the home, and any discrepancies must be addressed appropriately without delay, to ensure that people’s health is appropriately safeguarded. Up to date photographs must be maintained alongside records of treatment of people who have pressure areas or ulcers, and directions regarding their treatment must be kept up to date and followed. People living at the home must be encouraged to attend regular dentist and optician appointments. The home must not run out of any prescribed medicines for people living at the home and recording on medication administration records must be clear and accurate. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 7 Medicines requiring refrigeration must be stored securely within the home, to ensure that residents’ medication needs are safely met. All complaints must be investigated promptly and thoroughly, to ensure that people’s views are taken into account regarding the way the home is run. It remains recommended that all concerns brought to the attention of management should be recorded, alongside action taken to address them. Residents must receive sufficient stimulation on a daily basis. Residents’ files kept in nursing stations must be stored in a manner that protects their confidentiality. It is recommended that a larger television or projector and screen be provided for people living at the home to watch films and that larger television screens be provided in people’s bedrooms to take account of some people’s failing eyesight. Further ways in which the gardens can be used should also be considered for people’s recreation. Further staff must undertake training in working with residents diagnosed with dementia, to ensure that their needs are fully met, and receive individual supervision sessions at least six times annually. A risk assessment must be undertaken regarding the risk to people living at the home, of the servery not being locked when it is unoccupied and action must be taken to address the unsatisfactory electrical installation certificates obtained for a large number of flats within the home. Finally the fire panel was in need of repair at the time of the inspection but the registered manager advised that this had been repaired shortly after the inspection. 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.V346494.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.V346494.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. 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. EVIDENCE: Seven people’s care files were inspected and these all contained comprehensive assessments of their needs prior to admission. People’s signatures indicated that prospective service users or their representatives were involved in undertaking these assessments. Records indicated that care needs were being reviewed on a regular basis (at least monthly). Interviews with people living at the home indicated that their needs were being met in accordance with their choices. A copy of the most recently updated statement of purpose was provided to the CSCI as appropriate. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. 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. Residents’ health, personal and social care needs are addressed in care plans, however insufficient recording of action taken to prevent pressure sores and ensure adequate nutrition may place residents at risk of harm. Insufficiently rigorous medication administration may also place residents at risk of not having medication needs met safely. People living at the home feel that they are treated with respect by the staff team and that their privacy is maintained. EVIDENCE: Inspection of a sample of the care plans for residents on each unit in the home (seven care plans in all) indicated that their health, personal and social care needs are addressed and the majority of care plans had been signed by residents or their advocates where appropriate. Although healthcare professional visits are recorded for each resident, records Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 11 indicated that several residents had not seen an optician or dentist within the last year. Whilst it is appreciated that some people may choose not to attend such appointments, all residents should be offered such appointments and this must be recorded, to ensure that their healthcare needs are monitored appropriately. Nutritional and Waterlow assessments (regarding tissue viability used for the prevention of pressure sores) were available for each resident. There had been an improvement in recording the actions to be taken to address the needs of residents scored as high risk in these areas. However although people’s weights were being recorded monthly, the date on which they were weighed each month was not recorded. Hence it was not clear whether the weights recorded e.g. for September was measured on the 1st or 30th of the month. More concerning was my observation that one service user appeared to have lost a significant amount of weight in the last month, and no appropriate actions were recorded in their care plan to address this issue. The nurse in charge advised that this appeared to be either an error or a result of using a different weight measuring device from the device used previously. Whilst this explanation did appear to be the case – as it could not have gone unnoticed that a service user had lost approximately one fifth of their weight in such a short time – I was concerned that no action had been taken to check this reading nor to highlight a possible area of significant concern. A requirement is made accordingly. 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 inspected there were not up to date photographs of the current state of the ulcers maintained alongside their records of treatment. Directions regarding the care and treatment of pressure ulcers were generally clear and detailed, however in a small number of cases, these directions did not appear to be followed. For example one care plan included instructions from the tissue viability nurse that the dressing should be changed every other day – however it was being changed far more rarely than this – sometimes after six days. I understand that there may be therapeutic reasons for this change in regime, however this must be recorded on the person’s care plan alongside the reasons for this change. In another case the mouth care for a particular person was recorded in the care plan as needing to be taking place four times daily, however daily records indicated that this was being undertaken twice daily. Once again, the care plans must reflect the actual care being given. Clearly internal monitoring procedures also need to address such issues on a regular basis. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 12 Records were available of wound assessments each time a dressing is changed, as appropriate. However these should also include the time at which the dressing is changed and the wound is assessed, so that the time between changing dressings can be more accurately measured. Arrangements for the storage, administration and disposal of medicines throughout the home were generally found to be appropriate. As recommended the use of the symbol ‘O’ on medication administration records (MAR sheets) was now being accompanied by an explanation on each occasion. There was a clear improvement in the recording of medicines administered in the residential unit. Medication profiles were completed for each resident and these now included records of existing stocks of each resident’s prescribed medicines as well as those received each month as required at the previous inspection. I was pleased to see that a number of residents continue to self-medicate following appropriate risk assessment. However in a small number of cases these risk assessments are still not been reviewed monthly. However I was extremely concerned to note that in at least two cases the home had run out of a prescribed medicine for identified service users. Discussion with nursing staff and the manager indicated that this may be due to problems or an error on the part of the pharmacy company that supplies that home. However it is the responsibility of the home to ensure that people are provided with their prescribed medicines at all times. The Sister in charge advised that these issues would be addressed swiftly following the inspection, and the manager confirmed that this was the case when I spoke to her after the inspection. There were several instances when recording on medication administration records was not clear, for example in one case a medicine was prescribed to be administered ere one or two doses of a medicines may be given, the quantity of medicine administered on each occasion must be recorded. Medicines requiring refrigeration were being stored in the refrigerator in the home’s servery, which is not kept locked when not in use. Nor are medicines stored in a lockable container inside the refrigerator, which amounts to insufficiently secure storage of these prescribed medicines. The manager advised that she was considering providing small refrigerators within the medication rooms to address this problem. Following discussion with the manager regarding administration of injections and changing dressings for people living on the residential unit, it is recommended that a review be undertaken to ensure that nursing care is not provided to service users on this unit without delegation from the local district nurse service, so that they are covered by the home’s insurance. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 13 All residents spoken to confirmed that their privacy was being maintained and that staff addressed them with respect at all times. Independent observations of interactions between staff and residents, by myself and the expert by experience, confirmed that this was the case. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 14 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 good 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.V346494.R01.S.doc Version 5.2 Page 15 EVIDENCE: At the 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. 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 films, toasted sandwiches evenings, entertainers, light exercise, ‘Booze mornings’, arts and crafts, cookery and trips out of the home in the van. On the day of the inspection the activities organiser was holding a drinks morning with residents which the expert by experience was able to attend. Outings included trips out to Hatfield, Southend-On-Sea, local restaurants, the pub and a museum. One resident is supported to go swimming on a regular basis. 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. There had also been a races night, Italian day and musical evening arranged at the home. 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. Several residents indicated that they would like to be able to go out of the home more often and have more activities available to them at the home. Several staff have voluntarily given their own free time to assist the activities organiser on trips out, when they are not working, so that more residents can go out. The requirement is restated under Standard 27 that staffing numbers be reviewed so that more residents can be supported to engage in activities inside and outside of the home and those requiring one-to –one time can receive sufficient stimulation. Observation of interactions within the home indicates that staff may not always be recording the support and stimulation that they provide to residents. It remains recommended that staff receive training in the provision of activities for residents who have dementia or confusion. Regular residents meetings are now occurring within the home, using representatives from each area of the home discussing areas such as activities, maintenance of the building and areas for improvement. Most recently the topic of recycling was discussed. In addition residents advised that through Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 16 one-to-one meetings they were able to make decisions relating to all aspects of their health and welfare in the home. A big celebration was held over the summer to mark the home’s tenth anniversary including a garden party with a marquee installed and live music. Church services are provided in-house for those who wish to attend. One resident was supported to visit the Neasden Hindu temple last year, and one resident goes to church regularly with support from their relatives. One resident attends a local daycentre, and the Jewish Women’s League and two bridge clubs hold regular meetings at the home, which residents may also attend if they so wish. However none do so at present. 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 a particular 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. The expert by experience had the opportunity to join residents for lunch in the dining room which is maintained and decorated to a high standard. He noted that the meal was nicely cooked and staff supported residents appropriately although those having their meal in the dining room were generally able to manage independently. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 17 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 concerns about the home are not addressed sufficiently rigorously in the absence of the manager, so that insufficiently swift action is taken to raise standards of care at the home. Staff training is in place to ensure that the risk of residents being abused is minimised. EVIDENCE: There is a complaints policy in place that has all the required information, and the record of complaints is maintained appropriately. The majority of residents spoken to told me that they felt they were listened to, and that their concerns were addressed appropriately. All residents spoken to felt that they could speak to someone at the home if they were unhappy with their care. However the CSCI was copied into a complaint about the home prior to the inspection, and I was not satisfied with the speed at which it was addressed, nor had all areas of the complaint been investigated fully several weeks after the complaint was made. This was partially explained by the manager being on leave at the time that the complaint was raised. However the home must have a sufficiently rigorous management structure in place to ensure that complaints are addressed as a priority irrespective of personnel issues. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 18 The findings and action taken to address the most recent complaint must be sent to the local CSCI area office by 23/11/07. It remains recommended that all concerns brought to the attention of management should be recorded, alongside action taken to address them, to evidence that the home takes all concerns seriously. As required at the previous inspection, evidence was seen confirming that a further large number of staff had received training in adult protection. The manager had obtained a copy of the adult protection policy for the local authority, and ensured that the home’s policy was compliant with it. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 19 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 good 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 decorated to a 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. EVIDENCE: Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 20 On the day of the 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. As required at the previous inspection, the flooring in an identified ground floor assisted bathroom had been renewed and the tap on the basin in this room had been repaired. At the previous inspection it was also required that security procedures within the home be reviewed to ensure that the main entrance door is locked when nobody is available within the entrance area. New 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. It remains recommended that a larger television or projector and screen be provided for residents to watch films or television programmes as a group. It is also recommended that the size of television sets provided in each person’s bedroom should be reviewed, as they are quite small for use by people whose eyesight may be failing. There are large garden areas outside the home and a permanent gazebo had been installed outside the front entrance. However the majority of the gardens are consist of clear lawns, and it is recommended that further ways in which the gardens might be used for the recreation of service users, should also be considered. Finally I was concerned to note that residents’ files kept in nursing stations are not locked away when the nursing stations are unoccupied. This infringes upon the confidentiality of people living in the home, with regard to their personal information. This issue was discussed with the manager, and she advised that she would investigate the possibility of fitting lockable cabinets in these areas. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 21 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 good 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. A review of staffing numbers is still needed to ensure that the varied needs of residents with regard to stimulation and activities are met. EVIDENCE: Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 22 A sample of eight staff files 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. According to information supplied by the registered manager in the Annual Quality Assurance Assessment, 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, and this was confirmed by the computerised training records available for the home. All trained nurses are also qualified first aiders and appropriate monitoring is in place to ensure that all staff keep up to date with mandatory training courses. As required at the previous inspection a large group of staff had undertaken training in adult protection and eight staff had undertaken training in person centred dementia care. However more staff need to undertake training in this area to ensure that specialised activities and communication mechanisms are put in place for this client group. Discussion with staff members and residents indicated that some still had concerns over the number of care staff working in each unit to meet the needs of residents, having little time to engage residents in activities or stimulation. This area of need therefore continues to be left primarily to the activities organiser. It is therefore required again that the number of carers working in the home throughout the day be reviewed. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 23 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. An appropriately qualified and experienced manager is in place at the home. People living at the home are generally happy with the way the home is run however insufficiently rigorous complaints procedures mean that it may not always be run in their best interests. Service user’s finances are safeguarded appropriately. Staff do not receive adequate supervision to ensure that residents’ needs are met in line with best practice at all times. Inadequately rigorous health and safety procedures in a small number of areas may place people living or working at the home at risk of harm. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 24 EVIDENCE: Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 25 The manager of the home is experienced and has just completed the registered manager’s award at NVQ level 4 as appropriate. She is involved in arranging individual resident review meetings during which residents and relatives (where appropriate) are encouraged to give their views about the home. She had recently introduced regular morning meetings with relevant personnel to aid more effective management of the home. Regular unannounced visits to the home are undertaken by the responsible individual, with reports sent to the CSCI outlining the findings. The results of a recent customer satisfaction survey, undertaken by the provider organisation, indicated a high level of satisfaction, and strategic priorities for 2008 were available. 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. Regular residents’ forum meetings were being held at the home involving a representative from each unit attending. Evidence was seen (in the form of meeting minutes) that these meetings addressed a range of issues relevant to residents in the home. More regular general staff meetings were being undertaken as required at the previous inspection and staff spoken to confirmed that they had opportunities to give their views about the way the home is run. Residents administer their own finances, with no monies being held on behalf of any people accommodated. Staff supervision records were available and staff confirmed that they were receiving supervision sessions, these records are maintained both on paper and on the computer system. However these remain insufficiently frequent to meet the national minimum standard of six times a year, and a requirement is made accordingly. A new policy of not keeping records of the content of supervision was in place. I was concerned that there may be problems with this system in terms of monitoring staff member’s performance in supporting people living at the home. It is recommended that the policy regarding nonrecording of actions agreed in supervision meetings, be reviewed accordingly. Health and safety documentation was inspected in detail and was generally maintained to a high standard. There was an improvement in the way records were stored so that information needed could be obtained more easily. Appropriate safety certificates and monitoring records were available for relevant equipment including current satisfactory gas safety, portable appliances testing and emergency lighting certificates. Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 26 The electrical installation certificate for the building is not due until December 2007, however the electrical installation certificates for a large number of flats within the home were ‘unsatisfactory.’ This must be addressed for the protection of all people living and working at the home. A detailed fire risk assessment was available for the home alongside an appropriate emergency plan. However weekly fire alarm call points tests had not been undertaken for approximately one month prior to the inspection. I was told that this was because there was a fault with the alarm panel, which was to be addressed shortly. However it is not acceptable that the alarm panel should have been left with a fault for so long potentially placing a large number of vulnerable people at risk. The manager advised that the fire panel was repaired shortly after the inspection. It is also required that a risk assessment be undertaken regarding the risk to vulnerable people living in the home, of the servery not being locked when it is unoccupied. Southgate Beaumont Nursing Home DS0000069498.V346494.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 X X X X X X 4 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12(1) 15(2) Requirement Timescale for action 30/11/07 2. OP8 12(1) 15(2) The registered persons must ensure that accurate weights are recorded for service users, and that any discrepancies, such as significant weight loss or gain, are addressed appropriately without delay and that this is recorded. Weight records must include the actual date (not just the month) to ensure that people’s health is appropriately safeguarded. The registered persons must 30/11/07 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, and Care plans must be kept up to date regarding mouth care provided, and turning regimes e.g. recording when it is not possible/advisable for somebody Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 29 3. OP8 12 4. OP9 13(2) to be turned regularly to ensure that service users are supported with health and social care needs safely and appropriately. The registered persons must 21/12/07 ensure that service users are encouraged to attend regular dentist and optician appointments and that this is recorded, to ensure that their healthcare needs are fully met. The registered persons must 21/11/07 ensure that the home does not run out of any prescribed medicines for service users. Recording on medication administration records must be clear and accurate e.g. where one or two doses of a medicines may be given, the quantity of medicine administered on each occasion must be recorded. Assessments with regard to service users who are selfmedicating must be reviewed at least monthly, and Medicines requiring refrigeration must be stored securely within the home, to ensure that residents’ medication needs are safely met. The registered persons must ensure that service users receive sufficient stimulation on a daily basis for their social, intellectual and emotional wellbeing. (Previous timescale of 02/03/07 not met). The registered persons must ensure that all complaints are investigated promptly and thoroughly, to ensure that people’s views are taken into account regarding the way the home is run. DS0000069498.V346494.R01.S.doc 5. OP12 16(2mn) 25/01/08 6. OP16 22 23/11/07 Southgate Beaumont Nursing Home Version 5.2 Page 30 7. OP19 12(4a) 8. OP27 18(1a) 9. OP30 18(1ci) 10. OP36 18(2) 11. OP38 23(4cv) The findings and action taken to address the most recent complaint must be sent to the local CSCI area office by 23/11/07. The registered persons must ensure that service users’ files kept in nursing stations are stored in a manner that protects their confidentiality. The registered persons must ensure that staffing numbers within the home are reviewed, to ensure 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. (Previous timescale of 02/03/07 not adequately met). The registered persons must ensure that staff undertake training in working with service users diagnosed with dementia, so that specialised activities and communication mechanisms can be provided to this client group. (Previous timescales of 12/05/06 and 16/03/07 not met). The registered persons must ensure that staff members receive individual supervision sessions at least six times annually to ensure that people living at the home are supported appropriately. (Previous timescale of 16/02/07 not met). The registered persons must ensure that the fire panel is repaired and weekly fire alarm testing is resumed without delay for the safety of staff and residents at the home in the event of a fire. The registered manager advised that this had been completed DS0000069498.V346494.R01.S.doc 21/12/07 25/01/08 22/02/08 25/01/08 16/11/07 Southgate Beaumont Nursing Home Version 5.2 Page 31 12. OP38 13(4a) 13. OP38 13(4a) shortly after the inspection. The registered persons must ensure that a risk assessment is undertaken regarding the risk to service users, of the servery not being locked when it is unoccupied, and any identified actions are taken for the protection of people living at the home. The registered persons must ensure that action is taken to address the unsatisfactory electrical installation certificates obtained for a large number of flats within the home for the protection of staff and residents. 21/12/07 25/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations It is recommended that a review be undertaken to ensure that nursing care is not provided to service users on the residential unit unless this is delegated to them by the local district nurses, so that they are covered by the home’s insurance. It is recommended that all concerns brought to the attention of management should be recorded, alongside action taken to address them, to evidence that people’s views are being taken into account. It is recommended that a larger television or projector and screen be provided for service users to watch films and that larger television screens be provided in people’s bedrooms to take account of some people’s failing eyesight. Further ways in which the gardens can be used should also be considered for service users’ recreation. It is recommended that the policy regarding non-recording of actions agreed in supervision meetings, be reviewed to ensure that the support of service users is not compromised. DS0000069498.V346494.R01.S.doc Version 5.2 Page 32 2. OP16 3. OP19 4. OP36 Southgate Beaumont Nursing Home Southgate Beaumont Nursing Home DS0000069498.V346494.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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.V346494.R01.S.doc Version 5.2 Page 34 - 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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