Care Home: Beacher Hall Nursing Centre

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What the care home does well Prospective residents are provided with comprehensive information about the home to inform their decision regarding its suitability. Residents are thoroughly assessed prior to admission to establish their needs and whether the home can meet them. Residents health and social care needs are documented in their care plan together with details of their individual wishes and preferences and other information to enable staff to support their individuality and dignity. Appropriate medication management systems are in place to manage the medication on behalf of residents. Residents have excellent opportunities to engage in a varied and fulfilling lifestyle within the home and through the outings provided. Contact with family is supported and encouraged and relatives and residents are consulted for their views and kept informed of events in the home. Residents are supported to make day-to-day choices and decisions and to express their views on the service provided. They are provided with a varied menu which provides choices at every meal. Residents/relatives have access to an appropriate complaints procedure and concerns raised are addressed. The home has appropriate procedures to safeguard residents from abuse. The home provides a safe and homely environment for residents, and equipment and adaptations are available to meet residents` needs. The home has sufficient permanent staff and provides appropriate training to them, in order to meet residents` needs. Residents are consulted via annual customer satisfaction surveys and in a range of other ways to seek their views on the day-to-day operation of the home. What has improved since the last inspection? The depth of the pre-admission assessment and its link to the initial care plan have been developed. The care plan system has been improved. The activities programme has been developed and improved. Recruitment and retention of staff have improved since the last inspection. What the care home could do better: The level of NVQ attainment is improving but needs to be increased further. The reporting of feedback from residents and staff within monthly management monitoring visits should be improved. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beacher Hall Nursing Centre 42 Bath Road Reading Berkshire RG1 6PG     The quality rating for this care home is:   three star excellent 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: Stephen Webb     Date: 2 7 0 5 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. that people have said are important to them: They reflect the things 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 30 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Beacher Hall Nursing Centre 42 Bath Road Reading Berkshire RG1 6PG 01189530600 01189596213 whitmoch@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (ANS) Ltd care home 70 Number of places (if applicable): Under 65 Over 65 70 0 old age, not falling within any other category physical disability Additional conditions: 0 70 The maximum number of service users to be accommodated is 70 The registered person may provide the following category of service: 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 category : Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Beacher Hall Nursing Centre opened in 1997 following a period of extensive building and renovation. The main entrance to the Centre and original part of the house is a listed building. It is set back from the road and surrounded by mature protected trees, and is on one of the main routes into Reading, about one mile from the centre of the town and the Oracle shopping complex. The Centre has 70 registered beds on three floors. There are 68 single and one double room: all have en-suite toilet and washbasins and are equipped with nurse call system, television and telephone points. There are 3 assisted bathrooms on each floor and a Care Homes for Older People Page 4 of 30 Brief description of the care home total of 7 shower facilities. Three lounges, 3 dining rooms and 2 quiet lounges provide a range of communal areas for residents to use. The second floor of the home is dedicated to the care of 20 more active younger disabled residents and the accommodation and facilities have been adapted to meet the varying needs of this client group. There is a large attractive enclosed courtyard garden with good access for residents to enjoy outside activities and functions. The current range of fees is between five hundred and twenty-eight and two thousand one hundred and ninety pounds per week. Care Homes for Older People Page 5 of 30 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: three star excellent 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 included an unannounced site visit from 9.45am until 5.30pm on the 27th of May 2009. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager, and briefly with some of the staff members on duty during the day, as well as some verbal feedback from residents. The inspector also observed the interactions between residents and staff at various points during the inspection. Inspection surveys were also completed and returned by a sample of seven of the residents. The inspector examined the majority of the premises, including some of the bedrooms. Care Homes for Older People Page 6 of 30 Feedback from the residents was broadly positive, with comments including that you are treated as an individual; staff are very kind; and activities are much improved since November 08 with the arrival of the two excellent organisers. One resident raised some criticisms, which were fed back to the manager for consideration. 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. Care Homes for Older People Page 8 of 30 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 10 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with comprehensive information about the home to inform their decision regarding its suitability. Residents are thoroughly assessed prior to admission to establish their needs and whether the home can meet them. Once admitted a further assessment format is completed to gather the detailed information on needs and wishes which is used to develop their initial care plan. Evidence: The home has a combined Statement of Purpose and Service User Guide format which is given to prospective residents/their relatives, together with a copy of the most recent Inspection report on the home, the most recent customer satisfaction survey report and a copy of the homes regular newsletter. Copies of these documents are also available in the homes reception and a copy of the Service User Guide is also placed in each bedroom within the information file supplied. Existing residents have also been Care Homes for Older People Page 11 of 30 Evidence: asked and have taken part in showing prospective residents and their families around the home. Examination of a sample of five case files indicated that each contained a completed pre-admission assessment format containing good detail about the identified needs and wishes of the resident.The most recent pre-admission assessment format, entitled the Quest Individual Assessment, is a comprehensive document which is first completed prior to admission, then the post admission section is also completed soon after admission and this informs the care plan which is then developed as a living document which is amended as relevant new information is gathered, and regularly reviewed thereafter. The format gathers useful information on all aspects of an individuals support needs as well as on any personal preferences about how any support is offered. Care Homes for Older People Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents health and social care needs are documented within their care plan together with details of their individual wishes and preferences and other information to enable staff to support their individuality and dignity. Appropriate medication management systems are in place to manage the medication on behalf of residents. Evidence: As noted above, the completed Quest Individual Assessment provides the information for the initial care plan to be devised. The format is comprehensive and includes information on all aspects of physical and emotional care needs as well as identifying individual preferences about how support is provided. The lifestyle and activities profiles provide useful information on preferred daily routines, employment and life history, their hobbies and important contacts, as well as any spiritual support needs. It was positive to note that the residents religion was identified in all of the five files sampled together with reference to whether there were current spiritual support needs. The manager indicated that a number of residents do still attend places of Care Homes for Older People Page 13 of 30 Evidence: worship and that representatives of relevant faiths also visit the home to support those unable to attend places of worship. The plan also identifies the key staff responsible for maintaining and reviewing the documents, which are seen as ongoing working documents to be amended whenever useful new information is gathered. Details of aspects of self-care and where only minimal support or encouragement are required, are also provided to support the staff to respect residents dignity and enable them to retain their skills wherever possible. In one file the residents preferred name was recorded as this was different to that on his records, which also shows respect for his dignity. The plans contain a lot of information for staff on how to meet the needs identified. There is also a section on individual end-of-life wishes, which is completed as and when the resident or their next of kin is ready to discuss this, which again helps the home to respect the dignity of the individual. The home has implemented the Liverpool Care Pathways system for end of life care. The residents care plans also include details of healthcare needs and of any healthcare appointments, and the sample examined indicated appropriate responses to healthcare needs where specialist external healthcare support was needed. It was positive to note references to actively working towards improving aspects of individuals health, where possible, not just seeking to maintaining this. Indeed the home has rehabilitated some residents to be able to return home or to alternative forms of support. Appropriate records were seen of the management of skin pressure areas, together with detailed support guidance. Nutritional screening is routinely undertaken on admission as part of the nutritional risk assessment and records are kept. Where necessary daily food diaries are maintained. The manager has also established a health bulletin board where notices are provided on health-related issues. There was evidence of the effective use of risk assessments across the range of identified social, emotional and healthcare support needs, including nutrition, isolation, personal care, falls, skin integrity etc. Where a risk assessment has been completed on the use of bed-rails this is reviewed on a monthly basis on the attached review form. Where their use is indicated, a copy of the specific guidance on their use is included in the plan. The home has an appropriate system in place for managing the medication on behalf of residents. Medication records include a photograph of the resident and details of any allergies alongside their current medication adminsitration record (MAR) sheets. The MAR sheets provide the necessary audit trail for medication as they include confirmation of the quantities of medication received and administered, and the distruction record details any disposals. Controlled drugs are checked at each shift-change and all MAR sheets are checked monthly as part of the medication audit system. Care Homes for Older People Page 14 of 30 Evidence: Medication is only administered by the nursing staff who receive an in-house medication training/assessment. Some carers do undertake medication training as part of their NVQ. The homes medication systems were inspected by the pharmacist in June 2008. Care Homes for Older People Page 15 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have excellent opportunities to engage in a varied and fulfilling lifestyle within the home and through the outings provided. Contact with family is supported and encouraged and relatives and residents are consulted for their views and kept informed of events in the home. Residents are supported to make day-to-day choices and decisions and to express their views on the service provided. They are provided with a varied menu about which they are consulted, and which provides choices at every meal as well as snacks available out of hours. Evidence: The resident assessment and care planning documents include an activities profile to record the hobbies etc. in which residents express an interest. The residents religion is also recorded together with their wishes as regards active participation in worship. Visiting clergy provide various worship opportunities within the home as none of the current residents regularly attend external worship. The home presents a varied and vibrant range of activities and events for residents. The activities coordinators provide a weekly activities planner, posted around the Care Homes for Older People Page 16 of 30 Evidence: home, which includes a mix of regular and one-off events and activities. Examples include quizes and games, visiting aromatherapists, an art class, church services, hairdresser visits, indoor curling, current affairs discussions, bingo, gardening club, a smoothie tasting session, wine/ale tasting and sports viewing events on the largescreen TV. Within the home a Royal Ascot event is also planned in June as is an armchair world cruise during July, with appropriate weekly themed events, food and entertainment to be provided. In so doing, the home reflects and celebrates the diversity within both its resident and staff groups. The activities coordinators also maintain a record of the participation of individual residents in the activities provided by them. It would also be beneficial to record the involvement of care staff in activities-related contact with residents. The home is also part of a local church shoebox appeal which provides items for children in the 3rd world. Recently the home borrowed a games console from Age Concern as part of their Fit as a Fiddle campaign and residents played a range of sports and games including tennis, bowling and golf. Although the console has since been returned, the manager is considering purchasing one for the home as it proved popular and provided good opportunities for exercise. A visiting artist runs a weekly art class for residents and there are plans for the art class to paint murals in two of the bathrooms and on the staircase; and also to produce a sculptural piece for the homes garden. The home has also joined Living Paintings an organisation providing copies of pictures in relief, together with descriptions on cassette, for use by residents with visual impairment. The home is also part of a BUPA initiative regarding sustainable crops, with a project on growing vegetables within the homes garden with the involvement of interested residents and volunteers from Reading University. The advice of Thrive an organisation involved in gardening projects for people with learning disabilities, was sought about the project and the design of the raised planting beds. A pair of guinea-pigs were recently obtained from an animal rescue centre and were named following a competition among the the residents and staff. They provide opportunities for petting by residents and spend some time in an around the home and also within a run which has been established in the garden. The home also has a cat. One of the residents is an accomplished photographer and a number of his photos are framed and displayed on the corridor walls of the top floor. Monthly outings to the theatre are now being provided for small groups of residents at a time and various cultural and other events are celebrated within the home. Recent examples included a St Patricks day party, an easter egg hunt, a valentines supper, a traditional sweet stall and a garden tea-party. The residents newsletter refers to these events and to those planned in the future. The home also uses reminiscence packs provided by the Reading museum and is collecting its own reminiscence items. Eight or nine residents are able to go out independently or with family to external clubs, hydrotherapy and on visits to the family home. A small number have been away on holidays with family. Family contact varies from regular involvement in the home to no visiting family for a small number. One Care Homes for Older People Page 17 of 30 Evidence: resident was recently supported by staff to attend their mothers funeral. One resident has been involved in the regular checking of fire doors and fire drills as representative of the resident group. Residents each have their own bedroom within which they can see visitors in private, and there is also a quiet lounge available for use. Bedrooms are personalised with residents own belongings to varying degrees according to personal preferences. Residents and staff are consulted on menus and the chef devises a four weekly, nutritionall balanced menu which is then passed back to residents for their views. The final menus are sent to head office. The Spring newsletter refers to some dissatisfactions with the food service which emerged from the most recect customer satisfaction survey, and also detailed some of the action taken to address the issues raised, which demonstrated a positive response to resident feedback and led to further consultation. The chef uses a monthly feedback questionnaire with residents, and a specific format for use with one resident who has previously been unhappy about the food. The final menu is displayed about the home, and includes reference to the availability of alternatives, including a vegetarian option and the chef will also try to meet individual wishes. One resident also has their own specific dietary wishes provided for and the home will also meet health-related or cultural needs. The provider has also introuced the Nite Bite menu available to all residents during the evenings and night-times. The manager plans to have clear lists of condiments and accompaniments to various meals available to staff in each servery area to ensure that all staff are aware of appropriate combinations. The home was rated as five star - excellent at the last environmental health inspection. Care Homes for Older People Page 18 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives have access to an appropriate complaints procedure and are consulted in other ways about the operation of the home. The home has systems and procedures in place to safeguard residents. Evidence: The home has an appropriate complaints procedure in place which is displayed in reception, referred to within the homes Statement of Purpose and included within the Welcome pack given to each resident. The complaints records contained seven new complaints since the 1st of January 2009, which had been investigated appropriately. The complaints log has monthly separators to assist with monitoring and complaints are regularly monitored by head office. Residents are also consulted about the operation of the home via regular residents meetings, the minutes of which are posted on the notice board, and annually via a customer satisfaction survey; as well as at other times by the chef, activities coordinators or care staff. The home also has an appropriate procedure in place to safeguard vulnerable residents. One safeguarding issue had emerged over the past year which was not related to the care provided by the home, but the home took appropriate action to safeguard the resident. Care Homes for Older People Page 19 of 30 Evidence: Staff have received recent training on the Mental Capacity Act and other legislation relating to safeguarding. As noted already, wherever a potential need for such items as bed-rails or lap-belts is identified, their use is subject to risk assessment and regular review to safeguard residents. Care Homes for Older People Page 20 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, homely environment for residents, which has adaptations available to meet the range of presenting needs. Standards of hygiene were good and the home had appropriate laundry facilities to meet its needs. Evidence: The home provides light and spacious accommodation over three floors, each with its own lounge and dining facilities, though residents can use the facilities on any floor if they wish. There is also a further quiet lounge which can be used for meetings, seeing visitors or just where peace and quiet are desired. Corridors are wide and well lit, with pictures and photographs to maximise homeliness. Standards of decor are generally good apart from some wear and tear and areas of damage to doors and frames due to wheelchairs. Bedrooms are all single occupancy and have en suite toilets and adjustable beds. The rooms are personalised with varying amounts of residents own furniture, ornaments etc. which they are encouraged to bring with them. Some of the bedrooms would benefit from refurbishment, some new furnishings and curtains, and there are plans for some to be redecorated this year included in the homes development plan. There are three bathrooms on each floor plus an additional shower on the first and Care Homes for Older People Page 21 of 30 Evidence: second floors, providing a mixture of standard and adapted facilities, plus a number of toilets in addition to the en suite facilities in each bedroom. A storage shed is being constructed in the garden to store any hoist equipment not actively in use, but one of the bathrooms, which is no longer used, is used as a store for those hoists that are in daily use and have to be readily available. One new storage cupboards has also been provided for these and the manager is exploring the possibility of providing additional storage cupboards for such equipment in the stairwell. The toilets and bathrooms have appropriate locks and now also have an in use notice on the doors to improve residents privacy and dignity. The home has an attractive enclosed courtyard garden, which provides a secure area for residents to sit or to walk or wheel their wheelchairs, using the level paths and seating provided. There is also a gazebo to provide some shelter and this was seen to be used even during light rain, on the day of inspection. The garden is decorated with an interesting and varied mixture of art projects and sculptures, some of which have been produced by members of the homes art class, and some raised planting beds had been provided for the community crops project. The home has appropriate laundry facilities to meet its needs and standards of hygiene were very good aside from a slight odour in one area. The manager was in the process of arranging for the replacement of the flooring in one of the bedrooms to address this issue. Care Homes for Older People Page 22 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of residents are met by sufficient numbers of staff with an appropriate mix of nursing and care staff, amongst whom levels of of NVQ attainment are improving. Recruitment practice provides safeguards to residents, and staff training is provided on a rolling programme to equip staff with the necessary knowledge of current good practice. Evidence: The home employs about fourty-nine permanent nursing and care staff and staff recruitment and retention have improved, with only one part-time RGN vacancy at the time of inspection, for which interviews had already taken place. This has reduced the level of hours worked by staff which was raised as a concern at the last inspection. Staff are encouraged to come up with ideas about how to improve the operation of the home through the BUPA One Life awards scheme, and motivated to achieve excellence in their day-to-day work through the Personal Best scheme. The provider is also accredited by Investors In People and the manager reported they are due for reassessment this year. Some progress has been made on improving the level of NVQ attainment with nine staff now having attained NVQ level two and a further eight currently undertaking this, Care Homes for Older People Page 23 of 30 Evidence: with five more due to start in May and a further three who will be starting in July. At present the levels of NVQ attainment remain below Government guidelines. Examination of a sample of three recent recruitment records indicates that an appropriately rigorous recruitment and selection process is in place and appropriate records of the process are maintained. Where staff come from overseas, appropriate checks have been made on their eligibility to work. The reference and interview processes include checks on interpersonal communication skills with colleagues and residents to ensure the applicant will be able to communicate effectively with residents and staff and maintain the necessary recording systems. To date there has been no resident involvement in the recruitment of new staff but following the success of resident involvement in the show-rounds of visiting prospective residents, the manager is considering how they might involve some residents in the staff interview process in the future. The training records supplied did not provide the dates when each staff member last attended the mandatory training courses but this information is available within other formats and systems within the home. The records provided for the training to date this year indicate that most staff received training in manual handling, fire awareness, safeguarding and the Mental Capacity Act, and other records provided indicated that a wide range of other training is scheduled within 2009. This included a wide range of inhouse (within Beacher Hall itself), courses as well as those provided by BUPA. In addition several courses were also scheduled from external trainers. A record of recent updates to mandatory training was also provided indicating a rolling programme throughout early 2009, in many of these areas. Until recently first aid training was not provided to all staff, but the availability of this training has been improved and the manager is seeking to get all staff on this training on a rolling programme. This is best practice to maximise the chance of an appropriate first response to any incident or accident. In line with recent government guidance the training should include input on the appropriate response to a choking situation. The home has made links with a local college and has provided mentors for local university students undertaking their nursing degree/diploma. The manager is also planning a display on staff training for the home to demonstrate the range of training provided and celebrate staff training achievements. Care Homes for Older People Page 24 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is appropriately qualified and experienced to run the home in the best interests of the residents. Residents and their relatives are consulted via customer satisfaction surveys, about their experience within the home and their views are listened to in deciding how the home is run. The home has appropriate systems in place to safeguard residents funds, where they manage these on their behalf. The health, safety and welfare of residents is promoted and protected by the systems in place within the home. Evidence: The manager is appropriately qualified and experienced to manage the home effectively to meet the needs of residents. She is an RGN and has attained her NVQ level 4 and Registered Managers Award, and is an NVQ assessor. She also has an ENB 941 qualification in elderly care and a health and safety qualification. The manager has Care Homes for Older People Page 25 of 30 Evidence: managed the home since January 2000, having started working at the home as a nurse in 1986. She attends ongoing training to maintain her current knowledge and has recently attended courses on the Mental Capacity Act, the Liverpool Care Pathway, Supporting Excellence (a 1 year course), and other management training. The provider has a quality assurance system in place and residents and relatives were last surveyed in October 2008. The resulting summary report was made available to survey participants and within the home, and was discussed at a subsequent residents meeting. The manager had been disappointed by some of the scores on this occasion, but it had not proved possible in dscussion with residents to identify any particular reasons for these. Previous issues raised about meals had been addressed through improved resident choice and consultation on the menus; and about activities had been addressed by the recruitment of two new activities coordinators and development of the programme. The manager had produced an annual development plan for the home, though this may be subject to revision in line with new longer term planning. BUPA also undertake their own internal audit system of management monitoring on a monthly basis, and the home was audited the day before this inspection. At the March audit the home achieved a high level of compliance with the providers criteria, of between ninety-six and one hundred percent. The provider undertakes monthly Regulation 26 monitoring visits alongside their monthly audit system, which had recently been revised. The new Regualtion 26 format contains very limited space for comment on any feedback obtained from residents, relatives or staff, which are two of the key purposes of the visits. It is suggested that this format be looked at again to encourage and facilitate feedback from residents, relatives and staff to be recorded in a useful and meaningful form. The recent monitoring visit forms examined contained limited reference to these aspects. The provider has an appropriate system for managing residents funds on their behalf where they are unable or do not wish to do so themselves. At present the home manages the funds on behalf of the majority of residents. Residents/their representatives are asked at admission, to select the additional services, (such as hairdressing, newspapers, private chiropody etc.), to which they wish to subscribe, via a written form. Surplus funds are kept in a collective interest-bearing account but individual records are maintained of monies in and out and the ongoing balance. Individual printouts are available and receipts are retained for any expenditure of residents funds. Monthly accounts are provided to the resident or their representative. The manager undertakes monthly audits on medication, pressure sores, personal plans and complaints, all of which are submitted to BUPA head office together with quarterly accident returns. The records of the management of residents funds are also cheked monthly. Care Homes for Older People Page 26 of 30 Evidence: Examination of a sample of health and safety-related service certification indicates appropriate cycles of servicing and maintenance in key areas. The fire risk assessment had been commissioned from an external company and the manager was unsure about some of the expectations raised therein, and was planning to explore these with the fire officer. Some of the resulting action plan had been addressed and other aspects were still pending. The home uses the required tear-off accident record system plus an additional inhouse record form, which is due to be phased out to avoid duplication. A follow-up form has been devised by the manager to ensure that post-accident welfare is also checked and recorded. The forms are signed off by the manager. If a resident has two falls within a month, a falls diary is set up to log instances and a falls risk assessment and a review of the individuals care plan are undertaken. At present copies of accident forms are held collectively separated by month, to enable overall monitoring. It is suggested that copies of accident forms should also be filed on the relevant residents file as part of their care history. Care Homes for Older People Page 27 of 30 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 28 of 30 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 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 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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