Inspection on 13/01/09 for The Epsom Beaumont

This inspection was carried out on 13th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Epsom Beaumont 20-22 Church Street Epsom Surrey KT17 4QB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 1 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Epsom Beaumont 20-22 Church Street Epsom Surrey KT17 4QB 01372747999 01372739335 epsom@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 55. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The Epsom Beaumont is situated on a main road in a residential area near to the centre of Epsom. There is limited car parking space to the front of the property. The home provides care and accomodation for fifty-five older persons. Accomodation is provided in single bedrooms with en-suite facilities which is situated on the ground and first floors of the building. There is a passenger lift giving access to the first floor. 0 Over 65 55 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector, carried out the inspection and the registered manager represented the service. The inspector arrived at the service at 10:00 and was in the home for five hours. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that CSCI has received about the service. The inspector was assisted at this inspection by an expert by experience. Their role is to bring a different and independent view to the inspection process by working alongside inspectors observing and gaining the views of the people using the service. Experts by experience are people who have either used or are using services or have a physical or sensory impairment or are family carers. Information about the expert by experience can be accessed through the CSCI website. Care Homes for Older People Page 5 of 26 The home supplied CSCI with an AQAA (Annual Quality Assurance Assessment) in May 2008 and as this document is still current it was used to assist with this inspection. The inspector also spent time talking with some of the people using the service, the person in charge and other staff members. The inspector looked at how well the service was meeting the key national minimum standards and complying with the regulations and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, medication procedures, staff files, some training records, and the homes safeguarding adults and complaints policies and procedures. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service only move into the home following an assessment of their needs by a suitably experienced member of staff. The understanding of members of staff of the particular requirements of each new person admitted needs to be strengthened. Evidence: During the inspection three care plans were sampled and all contained detailed preadmission assessments. The person in charge stated that the manager or a senior nurse carries out the assessments prior to admission.These assessments are holistic and can be undertaken in the persons own home, hospital or care setting. The completed AQAA states that an area of improvement would be to assist the staff to have a more comprehensive understanding of an individuals apprehension when moving into a care home. The expert by experience talked to two people recently Care Homes for Older People Page 9 of 26 Evidence: admitted to the home. From observation of interactions with staff and conversations with the two individuals staff had not addressed the distress of one individual and did not assist another with a visual problem. The staff involvement with these two individuals had not not eased the distress and in the case of the person with a visual impairment the other residents were the ones to assist with her drink. The home does not offer intermediate care. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people using the service receive is based on their individual needs. Some areas of privacy and dignity need to be strengthened by the staff. Evidence: Three care plans were sampled. They contained detailed information about the people who use the service which enables the care staff to deliver the care that is needed to each individual. All care plans sampled had been reviewed every month and there was evidence that the person using the service or their relative had been consulted. The completed AQAA states that people using the service have comprehensive care plans in place which identifies their personal and social care needs. The nurse in charge said that the home has started a resident of the day. This ensures that on that day all observations are checked and the bedroom has a spring clean. The care plans sampled did not show evidence that they were person centred. They did not state what the people using the service may want or need or their opinions. Care Homes for Older People Page 11 of 26 Evidence: The expert by experience spent some time talking to the people who use the service. Some of these people did not know who their key worker was or that they could have opinions about how their personal care could be delivered. The care plans contained detailed risk assessments for example the skin integrity of the people using the service, nutrition and the use of bed rails. All were reviewed monthly. Equipment that includes hoists and height adjustable beds are provided to encourage independence for the people using the service. There are specialist mattresses available for those people who are at risk from pressure sores. The person in charge said that people who use the service are registered with three GPs. One surgery, where the majority of people are registered, visit every week and the other GPs will visit when requested to do so by the home. People using the service can retain their own GP if the surgery agree and they are in the catchment area. The person in charge also said that the home has support from other healthcare professionals and they include chiropodist, optician and physiotherapist. One person who uses the service said that the physiotherapist had shown her the type of frame that would be suitable for her needs now that she could walk again. She told us that she would be happy to purchase it. The person in charge said that a local pharmacy is used for the supply of medications to the home and they are delivered in blister packs. The homes policy and procedures for the safe handling of medicines was sampled and staff have access to this documentation. The AQAA states that medication administration is safe as the nurses that administer are assessed for competency at the end of their induction period and then annually. During the inspection both the inspector and expert by experience observed things which did not ensure that the privacy and dignity of the people using the service was maintained. On one bedroom door there was a sign which informed people visitng the home that that particular person was not to be offered anything by mouth. It was also observed that some people had their bedroom doors open but were exposed because the blanket had fallen from their legs or they had not been offered one. The call bell for a few people in their own bedroom was not within their reach. Staff spoken to said that they all knocked on bedroom doors before entering. Care Homes for Older People Page 12 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in social, and recreational activities and are able to exercise choice in their daily lives. Some people using the service are not permitted to have full choices in their daily lives. Evidence: During the inspection the expert by experience spoke with the activity organiser.The home employs two organisers who between them cover Monday to Friday. There is a monthly programme of activities that is then broken down into a weekly schedule and these schedules are then displayed on the wall and in the lift. People who use the service told us that they were appreciative of the good quality concerts that were given fairly frequently. There had been an outing prior to Christmas to see the lights in local houses, they had experienced a pantomime and there had been a recent visit to a garden centre. the home has its own mini bus to enable these trips to take place. Some people using the service told us that they were visited often by relatives and all people spoken with stated their relatives had chosen the home on their behalf. A new computer had recently been installed and we were told that staff were in the process of assisting people who use the service to set up email addresses so they could Care Homes for Older People Page 13 of 26 Evidence: correspond with their family and friends if they wanted to. People using the service told us that they do not have complete freedom of choice. One person prior to lunch asked if they could have a biscuit but this request was denied. Another said they were put to bed at 18:00 each night for a clinical need. We spoke to the staff who explained the clinical need but the person using the service did not understand the reason. Staff at the home need to ensure that people who use the service are enabled and encouraged to make choices in their daily lives. The dining room was laid out attractively with linen tablecloths and napkins. There is a hostess in the room a meal times who serves the food. People using the service spoken to on the day stated that the food was alright or ok. All people using the service can choose what they eat and there is a menu on the table. One person was asked what fish they would like for lunch. The wrong meal was then bought from the kitchen to the dining room but the hostess believed it to be the wrong meal and requested that the correct fish be bought. This person told us that they only ate a certain type of fish due to their dietary constraints. Menus were available on the tables for the people using the service to refer to. Care Homes for Older People Page 14 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listened to but the safeguarding adults procedures need to be strengthened to protect the people who use the service from abuse. Evidence: The person in charge stated that all people using the service has access to the homes complaints policy.The AQAA states that the home addresses concerns and complaints in an appropriate manner and in accordance with the organisations policies and procedures. The nurse in charge said that she was dealing with one complaint at present and in the complaints log there was documented three other complaints that had been investigated last year. The homes trainer stated that all staff receive safeguarding adult training every year. The records were kept on the computer and then individual certificates were printed. On the day of inspection the computer records were checked and this did not demonstrate that all staff in the home had received this training. The trainer stated that each new employee is instructed in safeguarding adults procedures and this is reinforced three months later. The home has copies of the local authoritys safeguarding adults procedures. In the training room the had the February 2001 copy. The downstairs nurses office had the Care Homes for Older People Page 15 of 26 Evidence: April 2005 copy. In the managers office there was the most recent 2008 copy. It is recommended that the old copies are destroyed and all staff have access to the 2008 safeguarding adults procedures to minimise any confusion for staff. Staff spoken to on the day had knowledge of safeguarding in respect of recognising an incident but did not have knowledge of how to report an incident and none were aware of the local authoritys twenty-four hour contact number. The person in charge did not have knowledge of the current safeguarding investigation currently taking place. The manager who was providing support to the home was the person to contact if we required details of this incident the nurse in charge told us. The staff spoken to confirmed that they had received training in safeguarding but could not remember when this was and did not think it took place annually. There will be a requirement at the end of the report for all staff to be given safeguarding adult training to ensure their knowledge is current and that they are then aware of how to report an incident if necessary. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe, well-maintained and comfortable environment. Evidence: The people who use the service are able to personalise their bedrooms and this was seen during a tour of the building. The home is easily accessible for wheelchair users and there was plenty of equipment to enable the staff to care adequately for the people using the service. For those people using the service that have mobility problems there are accessible baths and showers available.The bathrooms and toilet areas were noted as being clean and hygienic. The homes indoor and outdoor communal areas were well maintained and appropriate access was available to all people in the home if they chose to visit the gardens. There is a small car park available at the front of the home which becomes full very quickly. There is a full time maintenance person employed at the home who is responsible for all aspects of health and safety both internally and externally It was observed that liquid soap, hand gel and paper towels were all available for staff to aid infection control procedures. There is also a laundry room and the washing machines have a sluice programme. The homes trainer stated that staff receive Care Homes for Older People Page 17 of 26 Evidence: training in infection control procedures. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers and recruitment practises at the home should be reviewed to ensure the safety and well being of all people using the service. Evidence: The person in charge said that the numbers of staff on duty for each shift is decided by the management team at head office. All people who use the service have dependency levels completed in their care plans but the person in charge did not think that these were used as an indication as to the number of staff that were required. Staff stated that nurse numbers had been dropped from two per shift to one with carer support. The staff said that they had expressed their concern about these numbers and this had recently been increased to two nurses on the morning shift. The number of night staff on had been reduced to three per night and sometimes it meant that two nurses would be on duty with the support of a carer. The staff said that they believed the staff numbers had been reduced as the home had a lot of empty beds. Currently the homes registered manager is not available along with the deputy manager/senior sister. The home is on two floors and bedrooms are situated on both floors. Staff that are usually in charge told us that it is difficult to cover both floors when they are in charge as very often they have more that one person who is sick. Care Homes for Older People Page 19 of 26 Evidence: Staff said that due to the staffing numbers stress levels were high between them. A requirement will be made a the end of the report for staffing levels at the home to be reviewed given the dependency of some of the people using the service and the layout of the building. Comments received on the day of the inspection regarding the staff at the home were mixed one person said we have wonderful staff very caring. Another comment was staff are good but sometimes you wait a long time when you ring the bell. Three recruitment folders were sampled and two contained the information required to safely employ staff. One folder sampled had two references from previous homes that had been worked in but the references had not been received from the registered manager but from nurse who worked at the home The trainer for the home said that currently the national vocational qualification (NVQ) training had stopped due to problems with the company that supplies this training. The staff members stated that they hoped this training would start again very soon. One member of staff asked if we could check when the NVQ programme would start again as they were anxious to gain this qualification. All staff receive induction when they first start at the home and they are then followed up three months later to reinforce their knowledge. Records were not completely up to date as the trainer was new in post. The trainer stated that six hours of the week are dedicated to the training so that they were trying to catch up with the records. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home need to be strengthened to ensure that people who use the service can be confident that suitably experienced people are left in charge of the home at all times. Evidence: The management arrangements for the home on the day of inspection were poor with staff saying they felt stressed by the situation they found themselves in. The nurse in charge had been given very little supernumerary hours so was finding it very difficult to cover the management duties and to cover nursing duties in the home. A letter was sent to the responsible individual following the inspection asking that they review the current arrangements. The nurse in charge thought that the registered manager sought the views of people using the service every year. The results of the last survey could not be found and the nurse in charge said that she was not made aware of the results of the survey. The Care Homes for Older People Page 21 of 26 Evidence: completed AQAA states that monthly audits are undertaken as directed by the the director of quality of care for Barchester. The arrangements in place for the home to ensure that people who use the service financial interests are safeguarded was not examined during this inspection. Previous visits to the home and the AQAA did not identify this as an area for concern. The home employs a full time maintenance person who is responsible for the day to day health and safety checks. This included the water temperature checks and the fire alarms. All this recordings are documented and are available for examination. The submitted AQAA identified that all required health and safety certificates including the gas and electricity were current. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 All staff to receive training in 13/03/2009 safeguarding adults to ensure all staff members are aware of how to report an incident if witnessed at the home. This ensures that all people who use the service are fully protected from incidents of abuse. 2 27 18 The staff numbers at the home should be reviewed to ensure there is adequate staff to meet the needs of the people using the service and having regard to the layout of the home. This ensures that people that use the service have adequate numbers of staff to meet their assessed needs at all time 13/02/2009 3 29 19 Employment folders to be 13/03/2009 reviewed to ensure that staff are fit to work at the care home. Care Homes for Older People Page 24 of 26 This ensures that people working at the home have the correct pre-employment checks to safeguard the people using the service. 4 31 18 To ensure that at all times there is a suitably qualified, competent and experienced person in charge of the home. To ensure that the people who use the service receive the care and management suitable to their needs. 13/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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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