Care Home: Beacon Edge Nursing Home

What the care home does well Most of the people that contributed to our inspection told us that they had received enough information about the home to help them make their decisions to move there. They told us that they had been given a contract by the provider, telling them of the terms and conditions of residency at Beacon Edge. This helps to ensure that people understand what the service can offer and that it will be able to meet their needs and expectations. In addition to providing appropriate information to people thinking of using this service, the manager at Beacon Edge carries out or obtains pre-admission assessments for each potential resident. This process also helps to ensure that the home will suitable and capable of meeting people`s health and social care needs. The service employs two activities co-ordinators. Some of the people that live at Beacon Edge told us that there are usually things for them to take part in if they wish. There is a programme of events organised and residents are told of them regularly. We found that the home is generally clean and tidy, providing a warm and comfortable environment for the people that live there. Communal areas are clearly marked to help people identify bathrooms, toilets and sitting rooms. Corridors around the home are decorated with photographs of old film stars and front pages of old national newspapers reporting significant historical events. These help to provide discussion points for some of the people living at Beacon Edge. People are helped to identify their own personal rooms by the use of `memory boxes` outside the door. The boxes contain old photographs and mementos from their life to help people recognise their individual bedrooms. What has improved since the last inspection? People who have lived at the home for some time have had their care needs assessments reviewed. Some of this information has been used to update their care plans. We found that where people need specialist support, the acting manager has contacted appropriate health and social care professionals to help manage their care needs. Some improvements to the way in which medicines are managed were noted, particularly where `when required` medicines are in use. There are still areas that need attention to ensure medicines are consistently managed safely. The home employs a team of housekeepers to help make sure the home is kept in a clean and hygienic condition. We spoke to the team during our visit. They told us that they had recently completed training suitable to their job role and that cleaning routines had been reviewed and changed, particularly for bathrooms and toilets. They agreed that it has been a change for the better as they are able to `keep on top of things better now.` The acting manager has started to produce newsletters about the home and planned events. Resident and relative forums are being set up to help keep people updated with matters relating to life at Beacon Edge. What the care home could do better: Although more detailed care plans are in place and are reviewed monthly, we saw that there are still gaps in the information recorded. This potentially means that staff do not always know what level of care they should be providing and compromises the health and well being of some of the people using this service. We found that there are gaps in the medication recording processes and this means the medications are not consistently or properly accounted for. People thought the home could improve by having more activities and staff on duty. One person said; `I would like to go for walks and spend more time outside but sometimes there is not enough staff.` Another person told us; `They could have more care and activities staff. More one to one time, staff always seem busy.` Staff and residents indicate that there may not always be a sufficient number of staff on duty. Staff told us about the use of agency staff and how this impacted on both staff and residents because of the `lack of continuity` for both staff and residents. One person told us; `It can be difficult because agency staff don`t know the people and don`t get the chance to develop relationships. There are sometimes issues with communication and some staff come with no experience - these things also cause problems at times.` Although the provider has started to make improvements to training, staff would benefit from further training to help them understand and deal with challenging behaviour better. This would help make sure that staff act appropriately towards people who may be challenging and protect both themselves and other residents from the risks of harm or injury. Staffing levels and skill mix are areas that require further review to ensure they reflect the complex needs and demands of many of the people using this service. The provider needs to review and update their complaint process and ensure that everyone has access to this. Some of the people who returned surveys to us said that staff do not always `listen and act` upon what it said to them. Additionally, not everyone is aware of the formal complaint process that exists at the home. The home does not have a manager that is registered with the Care Quality Commission, as required. This is an area that the provider needs to concentrate on to help ensure the home is managed and operated in the best interests of the people that live there and by a competent person. Following our last inspection of the service, the provider submitted an improvement plan detailing how the statutory requirements we had made would be met. We have found at this latest visit to the service that not all of the requirements have been met. As a result of this inspection we have made 8 statutory requirements, 5 of which are repeated from our last inspection in November 2009 as the provider has not complied and 8 good practice recommendations. Key inspection report Care homes for older people Name: Address: Beacon Edge Nursing Home Beacon Edge Penrith Cumbria CA11 8BN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Jinks     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Beacon Edge Nursing Home Beacon Edge Penrith Cumbria CA11 8BN 01768866885 01768210758 stokesw@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr William Stokes Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following category: Dementia Code DE. The maximum number of service users who can be accommodated is: 41. Date of last inspection Brief description of the care home Care First Care Homes Limited, a subsidiary of BUPA, owns and runs Beacon Edge Nursing Home. Beacon Edge was originally a private house that has been altered and adapted for its current use and provides nursing care for 41 residents with dementia and 5 of these may be under 65 years of age. The home is on the outskirts of the market town of Penrith close to residential areas and overlooks the town; it is on local bus routes and is within a mile of local amenities. The residents bedrooms and communal areas are on the first and ground floors that residents can reach using a passenger lift. The home Care Homes for Older People Page 4 of 38 0 9 1 1 2 0 0 9 41 Over 65 0 Brief description of the care home has three lounges/ dining areas, a conservatory for residents and a quieter area. The home has a kitchen on site and the homes laundry goes to another nearby BUPA home to be done. Outside, the home has two small car parks for visitors and staff and well kept gardens. There is a sensory garden for residents. Fees payable are variable and are subject to the care needs assessment. There are additional charges for hairdressing, chiropody, newspapers and magazines and personal toiletries. The home makes information about its services available through its service user guide, welcome pack and statement of purpose. These documents and CQC inspection reports, are available in the home. Care Homes for Older People Page 5 of 38 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: The inspection of this service takes into account all of the information we have received since our last visit in November 2009. We sent surveys to some of the people that live and work at the home in order to obtain their views on life at Beacon Edge. Some of the residents asked their relatives to complete surveys on their behalf. We spoke to some of the people that live and work at the home, including the acting manager. We also had telephone contact with some of the staff and relatives that had asked us to contact them. Our inspection was completed by two inspectors, one of whom is a pharmacist. They assessed and checked the medication arrangements in place at the home. We also looked at a variety of records that the home is required to maintain, including resident Care Homes for Older People Page 6 of 38 care records and staffing records. We looked around the home to assess the environment and accommodation provided to people who use this service. Following our inspection November 2009, we asked the provider to develop and implement an improvement plan for the service. We took this information into account as part of our inspection process. The acting manager completed an up dated annual quality assurance assessment (AQAA) and returned it to us. The AQAA contained brief information about the service and helped us to plan and target our visit to the home. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? People who have lived at the home for some time have had their care needs assessments reviewed. Some of this information has been used to update their care plans. We found that where people need specialist support, the acting manager has contacted appropriate health and social care professionals to help manage their care needs. Some improvements to the way in which medicines are managed were noted, particularly where when required medicines are in use. There are still areas that need attention to ensure medicines are consistently managed safely. The home employs a team of housekeepers to help make sure the home is kept in a clean and hygienic condition. We spoke to the team during our visit. They told us that they had recently completed training suitable to their job role and that cleaning routines had been reviewed and changed, particularly for bathrooms and toilets. They agreed that it has been a change for the better as they are able to keep on top of things better now. The acting manager has started to produce newsletters about the home and planned events. Resident and relative forums are being set up to help keep people updated with Care Homes for Older People Page 8 of 38 matters relating to life at Beacon Edge. What they could do better: Although more detailed care plans are in place and are reviewed monthly, we saw that there are still gaps in the information recorded. This potentially means that staff do not always know what level of care they should be providing and compromises the health and well being of some of the people using this service. We found that there are gaps in the medication recording processes and this means the medications are not consistently or properly accounted for. People thought the home could improve by having more activities and staff on duty. One person said; I would like to go for walks and spend more time outside but sometimes there is not enough staff. Another person told us; They could have more care and activities staff. More one to one time, staff always seem busy. Staff and residents indicate that there may not always be a sufficient number of staff on duty. Staff told us about the use of agency staff and how this impacted on both staff and residents because of the lack of continuity for both staff and residents. One person told us; It can be difficult because agency staff dont know the people and dont get the chance to develop relationships. There are sometimes issues with communication and some staff come with no experience - these things also cause problems at times. Although the provider has started to make improvements to training, staff would benefit from further training to help them understand and deal with challenging behaviour better. This would help make sure that staff act appropriately towards people who may be challenging and protect both themselves and other residents from the risks of harm or injury. Staffing levels and skill mix are areas that require further review to ensure they reflect the complex needs and demands of many of the people using this service. The provider needs to review and update their complaint process and ensure that everyone has access to this. Some of the people who returned surveys to us said that staff do not always listen and act upon what it said to them. Additionally, not everyone is aware of the formal complaint process that exists at the home. The home does not have a manager that is registered with the Care Quality Commission, as required. This is an area that the provider needs to concentrate on to help ensure the home is managed and operated in the best interests of the people that live there and by a competent person. Following our last inspection of the service, the provider submitted an improvement plan detailing how the statutory requirements we had made would be met. We have found at this latest visit to the service that not all of the requirements have been met. As a result of this inspection we have made 8 statutory requirements, 5 of which are repeated from our last inspection in November 2009 as the provider has not complied and 8 good practice recommendations. Care Homes for Older People Page 9 of 38 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 38 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 11 of 38 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 using this service have their care and support needs assessed prior to admission. They are provided with information about the home. These things help to ensure that the home will be suitable and able to meet their needs and expectations. Evidence: The people that contributed to this assessment of the service told us they had received enough information about Beacon Edge to help them make their decisions to live there. These people also told us that they had a copy of their terms and conditions of residency, which also informs them of the service they can expect to receive whilst living at the home. The provider told us that the service user guide and statement of purpose documents have been updated. We found that copies of these information documents are available in the home and in the bedrooms of residents. Some work has been done to update them, but there are some areas that need further attention to ensure people Care Homes for Older People Page 12 of 38 Evidence: are provided with current information in relation to the manager at the home and of the addresses of other organisations that may be contacted for advice or assistance. These documents are available in one written format only and may not meet the communication needs and understanding of some of the people that use this service. During our visit to the home we looked at a selection of care records. We found that people living at Beacon Edge had their care and support needs assessed, prior to living at the home. Assessments are usually carried out by their social worker or healthcare professional and by a senior person at the home. Pre-admission assessments help to identify the needs and expectations of prospective residents. They help the manager to decide whether the home and the staff employed there will be able to meet the needs of each individual. Since our last inspection of this service, the provider and acting manager have started to carry out reviews to help ensure adequate staffing levels are maintained and that staff have appropriate skills and knowledge to meet the needs of the people using this service. Care Homes for Older People Page 13 of 38 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. People using this service have plans of their care and support needs, which generally provide an indication of how those needs will be met. There are gaps in the care planning and medication systems which mean that the health and well being of people living at Beacon Edge, may not always be promoted consistently and may at times be compromised. Evidence: At our last inspection of this service we told the provider that people must have complete and up to date plans of how their care and support needs would be met. We also told the provider that people must have access to specialist healthcare professionals when necessary, to help ensure their health and welfare are promoted and protected. The provider told us that a full review of care plans and risk assessments would be carried out and that some staff would have further training on the subject of care planning. During this visit to the home, we looked at a sample of the care records relating to Care Homes for Older People Page 14 of 38 Evidence: some of the people that live at Beacon Edge. We received comments back from residents and staff either via surveys or by speaking to them. The people using this service who returned surveys to us, said that they usually receive the support and care they need from the staff. People also said that the staff usually treat them well, but do not always listen and act upon what is said to them. The comments we received from relatives were varied. One relative we spoke to said; It was unbelievable when you (the inspector) were there, staff are not normally so attentive or even around in the lounges. It goes to show that staff do know what they should be doing. Whilst another relative told us; my relative is well looked after and the carers are very good. They have to deal with some very difficult situations at times. We found that some improvements have been made and that people have received pre-admission assessments. Since our last visit these assessments have been reviewed and updated where care and support needs have changed. There is evidence to demonstrate that the home has sought the involvement of health care professionals and social workers to help manage people who may have poor appetite, behavioural issues or general medical conditions. We found that staff have discussed a variety of matters with residents and/or their families where appropriate. Map of Life records have been completed and include information about individuals previous lifestyle, for example; previous employment, interests, family life, likes/dislikes and usual or preferred daily routines.This helps to ensure peoples needs and requirements are properly understood by staff supporting them. Care plans generally include assessments and plans relating to nutrition, skin care, the risk of developing pressure ulcers, personal care and contain an element of risk assessment, particularly where people may have behaviour that can be challenging at times or those at risk from falling. End of life arrangements have been discussed with residents and their family and records of peoples wishes and beliefs have been kept. This will help ensure staff at the home respect peoples preferences and know who to contact in the event of a death. Although more detailed care plans are in place and are reviewed monthly, we saw that there are still gaps in the information recorded. This potentially means that staff do not always know what level of care they should be providing and compromises the health and well being of some of the people using this service. For example, one persons records indicate that they have developed continence Care Homes for Older People Page 15 of 38 Evidence: problems and although their care plan records have recently been reviewed there is no mention of this matter. Another persons relative had to request that staff carry out a personal care task, which should be done at least daily anyway. This persons care plan was not updated for some days after the request was made and records show that a few weeks later further issues were identified. Another example of poor recording and communication was seen in the care plan of someone who has been identified as having lost weight. Their weight, food and fluid intake was being monitored and the dietitian had been consulted for help and advice. A dietary supplement is recorded as being prescribed and there is a note for staff to chase up the prescription for this. However, there is no record on the care plan of this being received nor are there any instructions for its use. One of the care plans we looked at recorded the person has developed a small sore or pressure ulcer. A wound assessment and body map have been completed but their assessment relating to the risk of pressure ulcers has not been reviewed nor has their skin care plan. This lack of information means that staff may not provide the right type of care to manage the wound and promote the recovery of the resident. Poor recording procedures and the lack of clear information for staff mean that people may not always receive the care and support they need. This places them at risk of harm or suffering. The pharmacist inspector examined the handling of medication by looking at relevant documents, storage and meeting with the acting manager and other staff. The inspection took approximately six and a quarter hours. Feedback was given at the end of the inspection to the manager. Overall we found that the manager has improved the way medicines were managed though there are still areas that require attention in order to fully protect the people who live there. We looked at records for receipt, administration and disposal of medication. Overall these are better though we did note occasional disposal records that are incomplete so the medication cannot be accounted for. Although the records for administration of medication have improved we saw fourteen medications that had not been signed for administration at 10pm on 11 March 2010. We did not know if these had been administered or not. Staff must make sure that records are made at the same time that medicines are given. A requirement that all administration records are free from errors was made at the last pharmacy inspection on 10 November 2009. Whilst this requirement has not been met there has been much progress towards improving the accuracy of these records. Care Homes for Older People Page 16 of 38 Evidence: We counted a sample of medicines and compared them with records to check if they added up, therefore given in the correct dosage and accounted for. Whilst most are in order there are occasional discrepancies showing that there are errors in record keeping or administration. Since the inspection of this service we have received a report from the home about medicines that have gone missing and can not be accounted for. We looked at the administration of when required medication and in particular sedatives to check that they are given appropriately. The manager has introduced new protocols for administration of these medicines and each time they are given the staff write down the reasons why they were needed. We also looked at a number of changes to medication and residents records clearly show when and why these changes were made with good records of input from health care professionals such as GPs. We saw a small number of medicines that had been recorded as out-of-stock for a few doses. However, other records show that in each case the home had received further supplies before they ran out but the staff had failed to administer them. We also noted that one resident who was prescribed a pain-killer patch that needed to be replaced every seven days did not have have it replaced until the eighth day on three occasions this year. This means that on the eighth day they would have insufficient pain relief. We checked medicines liable to misuse called controlled drugs. A stock check was in order. Overall, storage of medication was satisfactory. We were told that staff were undergoing a compulsory training package in the safe management of medication with ongoing assessment of competence. The manager has also introduced a more thorough audit process in order to monitor how medicines are managed and to allow prompt correction of errors to protect the people who live there. Care Homes for Older People Page 17 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service receive some support and encouragement to make positive choices about their daily life and how they spend their time at the home. There may be times when this is limited, particularly for people who may have dementia or other cognitive impairments. Evidence: The home employs two activities co-ordinators who provide a variety of activities at various times of day throughout the week. We saw a programme of formal activities that were planned for the coming month. This included musical evenings and afternoons, baking, looking at photo albums, games, singing, helping with cleaning, washing up, walks, outings and a monthly church service. One of the activities co-ordinators was on duty during our visit. We observed that she played games with some of the residents in the home, encouraging them to join in but respecting their choice if they did not want to. One lady was baking in the kitchen under the supervision of the cook. She said this was an activity she enjoyed very much as she used to do a lot of cooking. We observed some staff spending time with some of the residents looking at photographs of popular places in the Lake District. Care Homes for Older People Page 18 of 38 Evidence: This activity stimulated interest and conversation. The television was on in one of the lounges and music was playing in various parts of the home. Some people had their own paper and were sat in one of the lounges reading. One of the lounges has extensive views across the fells of the Lake District and provides a pleasant place for people to sit. We observed that many people were sitting around, dozing or wandering around the home. The acting manager has started to produce a Newsletter for residents and their relatives and events and activities are also advertised in this. The acting manager has said that she plans to develop resident and relative forums, which will help to provide another opportunity for people to voice their opinions, ideas or concerns. We saw that people are generally able to get up or go to bed when they please. At the time of our arrival in the home, people were still in the process of getting up and having breakfast at their own pace. During the day we saw coffee and tea being given out to residents and their visitors. Fresh fruit, cakes and biscuits were also available at this time. We saw the menu for the day outside the dining room describing the choices and alternatives available to residents. The acting manager told us that this has been based around resident choice and preference. She also told us that menus were available in an alternative picture format, which would be a more suitable format for most of the people that live at Beacon Edge, but we found that these are not yet in use at the home and the menu is produced only in written format. During our time in the home we made a short visit to the kitchen. This was clean, tidy and well organised. We spoke to the cook. She is aware of peoples dietary needs, for example low or high protein diets, diabetic diets, pureed meals, likes and dislikes. The cook has developed a checklist of all this information to help ensure she provides a suitable diet. One resident told us; I am a vegetarian with many food dislikes, but am well catered for with consultation. The care records we looked at show that people have their nutritional needs assessed and monitored. We saw that professional advice has been sought although this is not always properly recorded or followed consistently. The acting manager has introduced protected mealtimes. This helps to reduce or prevent any interruptions for residents who are eating or staff who may be assisting them. Care Homes for Older People Page 19 of 38 Evidence: During the assessment of this service we received comments from relatives, staff and residents, either by speaking to them directly or by surveys. Some visitors told us that they are always made welcome at the home and are offered light refreshments. Some of the comments from staff included; The home provides lots of entertainment and activities. We work very hard in trying to make residents happy and content and Staff could improve and do some activities with residents when the activities staff are not in. Staff could spend more time with residents. Most of the residents that returned surveys told us that there are usually activities for them to take part in but some said there were never activities that they were interested in. People thought the home could improve by having more activities. One person said; I would like to go for walks and spend more time outside but sometimes there is not enough staff. Another person told us; They could have more care and activities staff. More one to one time, staff always seem busy. Care Homes for Older People Page 20 of 38 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 using this service are generally protected from the risks of harm or abuse. There are some gaps in some of the processes, which may at times affect the best interests of people living at Beacon Edge. Evidence: At our last visit to this service we found that the home had poor processes in place to help protect people from the risks of harm or abuse. We told the provider that this matter had to be addressed quickly, to make sure residents lived in a safe environment. At this visit we found that the staff have received up to date training regarding the safeguarding of vulnerable adults. The acting manager has also obtained copies of the local authoritys guidance on reporting allegations or suspicions of abuse. This guidance is readily available to staff at the home. The acting manager and the head of care at the home, both understand the importance of reporting allegations or suspicions of abuse and are now aware of the processes for notifying social workers and the Care Quality Commission as required. We have received notice of five safeguarding referrals made by the home to social workers for further investigation. These actions help to make sure people living at Beacon Edge are safe and protected from harm. Care Homes for Older People Page 21 of 38 Evidence: We noted that staff at the home have received training in the safeguarding of vulnerable adults. This helps them to understand what abuse is and how to report and deal with it properly. Some of the staff we spoke to told us that this training had been very useful and highlighted areas that they may not previously thought of as safeguarding or abuse issues. There is a complaint process in place at the home. This needs reviewing and updating to ensure it reflects accurate information and contact details of other services and organisations to whom people may also voice their concerns. People participating in this inspection told us they know who to speak to if they are not happy about something, however, some of the people who returned surveys to us said that staff do not always listen and act upon what it said to them. Additionally, not everyone is aware of the formal complaint process that exists at the home and the provider needs to address these matters. One of the relatives we spoke to said; I know who to speak to if I am unhappy about anything. I am confident that it will be dealt with properly. I have had issues in the past, but these have been resolved to my satisfaction. However, another relative was not so confident with the complaint process. Some people who live at Beacon Edge, may at time display behaviour that may be aggressive or challenging. We saw that risk assessments had been completed for people who may display this type of behaviour. There are some instructions for staff to follow, which are intended to help staff deal with situations appropriately and safely. The instructions say that staff will undergo annual training in health and safety and the management of aggression. The provider told us that staff training in dementia care and challenging behaviour would be reviewed and completed. The staff training matrix and the staff we spoke to do not confirm that training with regards challenging behaviour has been completed. One member of staff told us about the repeat training the staff have had to do. She thought that staff would benefit from further training to help them understand and deal with challenging behaviour better. This would help make sure that staff act appropriately towards people who may be challenging and protect both themselves and other residents from the risks of harm or injury. Care Homes for Older People Page 22 of 38 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. Beacon Edge generally provides a warm, safe and comfortable environment for the people that live there. Evidence: During our visit to the Beacon Edge we looked at the general standards of the environment at the home. The home underwent some refurbishment in 2009, particularly to the decor and furnishings. We found that the home was generally clean, tidy and well maintained, although we did note some unpleasant odours in the reception area and main corridor on the ground floor. At our visit to the home in November 2009, we found that bathrooms and toilets did not have locks on the doors and this compromised peoples privacy. There were also issues with the disposal of soiled waste and the safe storage of toiletries. During this recent visit we noted that doors have now been fitted with suitable locks. There are cleaning check lists in place in the bathrooms and toilets and special waste bins have been provided. Staff check these areas regularly to help ensure they are always clean. Care Homes for Older People Page 23 of 38 Evidence: Improvements to the lighting in the dining room have also been made since our last visit and the rooms are now bright and cheery. There are some issues with some of the dining tables, they are unstable and need urgent repair or replacement to help reduce the risks of accidents occurring. We looked in several of the bedrooms at the home. Residents have personalised their own room according to their tastes or needs including personal TVs, radios, pictures, ornaments and photographs. One person had a list of things they like to watch on TV kept in their room for staff to be aware of and help them with. Some people need specialist equipment such as bedrails or pressure mattresses and these have been provided. Communal areas are clearly marked to help people identify bathrooms, toilets and sitting rooms. Corridors around the home are decorated with photographs of old film stars, old front pages of national newspapers proclaiming significant events. These help to provide discussion points for people living at Beacon Edge. People are helped to identify their own personal rooms by the use of memory boxes outside the door. They contain old photographs and significant mementos to help people recognise their individual bedrooms. There are pieces of furniture in the communal areas of the home where people are able to rummage through drawers, cupboards and boxes if they wish. We looked in some of these, there were balls of wool but in one drawer someone had left shaving equipment including a razor and gel. These items could pose a risk to some of the people that live at Beacon Edge. Some of the communal areas have limited space. This causes some difficulties for staff trying to use handling equipment and wheelchairs in confined spaces. The home employs a team of housekeepers to help make sure the home is kept in a clean and hygienic condition. We spoke to the team during our visit. They told us that they had recently completed refresher training in a variety of topics including safeguarding adults, dementia care and infection control. They told us that cleaning routines had been reviewed and changed, particularly for bathrooms and toilets. They agreed that it has been a change for the better as they are able to keep on top of things better now. They also told us that they are provided with adequate amounts of cleaning equipment and protective clothing such as rubber gloves and aprons. These measures help to reduce the risks associated with cross infection. Care Homes for Older People Page 24 of 38 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. Staffing levels and skill mix may not always be sufficient to consistently meet the needs of the people using this service. Evidence: The staff team at the home includes care assistants and qualified nurses. The provider tells us that Beacon Edge provides specialist care for people who may have dementia related illnesses, but this is not generally reflected in the specialist skills of the qualified nurses or care staff employed at the home. There is one nurse at the home who has, and continues to undertake further training in dementia care. Some of this training has been approved nationally, by the Alzheimers Society. The acting manager told us that all of the residents at the home have some degree of dementia illness. Most people need help with daily activities such as washing and dressing and a third of the residents need two staff to help them with these activities. On the day of our visit there appeared to be a sufficient number of staff on duty to meet the needs of the people that use this service, although they were kept very busy for most of the day. The surveys we received from staff and residents indicate that there may not always be a sufficient number of staff on duty. Staff told us about the use of agency staff and Care Homes for Older People Page 25 of 38 Evidence: how this impacted on both staff and residents because of the lack of continuity for both staff and residents. One person told us; It can be difficult because agency staff dont know the people and dont get the chance to develop relationships. There are sometimes issues with communication and some staff come with no experience these things also cause problems at times. Many of the comments made by relatives or residents said the home could do better by having more care and activities staff and more one to one time staff always seem busy. We also looked at the staff rota. We noted that there was one occasion where the home is recorded as being understaffed during a night duty and another occasion where a nurse did not get a sufficient amount of time away from work between shifts. Managers and staff told us that the home frequently uses agency nurses to help ensure adequate staffing levels. We discussed this with the acting manager and the provider. We were told that the home has experienced a high level of staff sickness and that the acting manager now plans to address this matter. The provider told us that the home is currently staffed to the level it would be if the home had no vacancies, so in effect it is overstaffed. Staffing levels and skill mix are areas that require further review to ensure they reflect the complex needs and demands of many of the people using this service. We looked at the homes staff recruitment processes. The acting manager told us that there are robust procedures in place and these are produced by the organisation. We looked at a sample of recruitment records for two staff that had recently been employed by the home. We found that prospective employees are required to complete application forms, although there are some inconsistencies with the way in which this is done. People are also required to attend the home for interviews and this part of the recruitment process involves some input from residents too. Although people are generally recruited properly with criminal record bureau checks and safeguarding checks being made prior to their employment, we did find some gaps in the process that could compromise the safety and well being of people using this service. One person did not have a reference from their last employer, nor did they have any previous experience of care work. Another person had gaps in their employment history that had not been accounted for. Care Homes for Older People Page 26 of 38 Evidence: Staff told us that they had received a variety of training sessions since our last visit including, health and safety, manual handling, food hygiene, the Mental Capacity Act and safeguarding adults. Some people have completed basic dementia training and five staff have completed advanced dementia training. Much of the training is carried out in-house and staff complete BUPA work books, which are then evaluated to check their knowledge of the subject. Some of the staff were quite cross that they had needed to complete training again, because previous training records had not been adequately maintained. We found that records have improved and that staff, although upset about the training issues, had found the refresher training of benefit and that it was useful. Some people said that the training had raised their awareness of issues they had not previously considered. Care Homes for Older People Page 27 of 38 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. Some improvements have been made to the service, but there are still gaps in the records and management processes, which indicate that people may not always receive consistent service, care and support. Evidence: The provider notified us, the Care Quality Commission, of a change in manager at Beacon Edge Care Home in February 2010 and told us that an application for their registration was in progress. We have not yet received an application to register this manager, despite making a requirement at our last inspection of this service. The acting manager is experienced in the management of care homes and staff tell us that they usually feel supported by her. The acting manager is supported in her role at the home by the head of care, a regional manager and by an organisational, national team of Quality Consultants. Their role includes supporting quality issues within the home, auditing and providing guidance on policies, procedures and practice. Care Homes for Older People Page 28 of 38 Evidence: The acting manager returned a completed AQAA to us. The information helped us to gather information about the home and the management of Beacon Edge. There are areas in the document where more supporting evidence would have been useful to illustrate what the service has done to bring about improvements and their plans to ensure continuing improvement. We looked at some of the records kept at the home, including the records relating to the supervision of staff. We found that staff are regularly supervised by their manager either on a one to one basis or by group/team supervisions and team meetings are held regularly. Ancillary staff are included in the training and supervision plan at the home. Staff are able to use these opportunities to feedback to the management about improvements, ideas or issues they may have. Staff supervision helps to make sure that staff are working safely and in line with the aims and objectives of the home. It also helps to identify staff training and development needs, which ultimately helps staff to meet the changing needs of people using this service. We looked at a selection of records kept at the home during our visit including care records, staff records and accident records. The provider is required to formally notify us of certain events that occur at the home, which affect the health and welfare of people living there. The records show that we are notified of some events but this is not done with any consistency. We discussed this matter with the provider at our last inspection of this service as improvements to this process were needed. We looked at staff training records, particularly in relation to health and safety and protection. The records show that staff have updated their skills in health and safety matters, manual handling and infection control. Most staff, including night staff have completed fire safety training. We suggested that the acting manager checks with the fire and rescue authority to ensure that this type of training is carried out at the recommended intervals. The provider has some training in first aid scheduled for some of the staff that work at the home. With regard to other health and safety matters, we noted that some of the care plans we looked at contain an element of risk assessment and include plans and strategies to help people who may be at risk from falling or who may have aggressive behaviour at times. We also noted that cleaning schedules have been introduced into the home to help ensure the environment is maintained in a clean and hygienic condition. Care Homes for Older People Page 29 of 38 Evidence: The organisation has provided a wide range of policies and procedures to help ensure the home is operated safely and in the best interests of the people that live there. From the information supplied in the AQAA it is evident that these documents have not been reviewed or up dated for some time. It is good practice to review such documents frequently to ensure they meet the requirements of any new legislation and are consistent with current good practice guidelines. Care Homes for Older People Page 30 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 People using this service 31/01/2010 must have complete and up to date plans for all of their care and support needs. Clear instructions must be recorded of how those needs will be met. Care plans provide staff with the information they need to ensure people using this service receive the right care and support and are treated with respect and dignity at all times. 2 9 13 All records for administration 15/12/2009 of medication must be free from errors. This will help to protect residents from mistakes that could cause harm to their health and well-being. 3 27 18 There must be a sufficient number of experienced and suitably skilled staff working at the home at all times. Staffing levels must reflect the needs of the people using this service and take into account the aims and objectives of the home. 31/12/2009 4 31 9 The service must be run and 31/01/2010 managed by a qualified, Page 31 of 38 Care Homes for Older People 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 competent and experienced person who is registered with the CQC. People using this service must live in a home that is run in their best interests and by a suitably registered manager. 5 38 37 You must make sure that the 14/12/2009 Care Quality Commission are notified of any event that adversely affects the wellbeing or safety of any person using this service. The Care Homes Regulations require you to do this. This information helps us to judge the quality of the service provided and of the homes ability to ensure people using this service are safe and protected. Care Homes for Older People Page 32 of 38 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 7 15 People using this service 31/05/2010 must have complete and up to date plans for all their care and support needs. Clear instructions must be recorded of how those needs will be met. Care plans provide staff with the information they need to ensure people using this service receive the right care and support and are treated with respect and dignity at all times. 2 8 13 People using this service 14/05/2010 must have access to specialist healthcare professionals. Advice and guidance from such professionals must be clearly recorded in care plans and acted upon consistently. Care Homes for Older People Page 33 of 38 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 It is important that the health and well being of people using this service is promoted and maintained. 3 9 13 Medication must be 01/05/2010 administered as prescribed. This will ensure that residents receive the correct treatment to keep them well. All records for administration 01/05/2010 of medication must be free from errors. This will help to protect residents from mistakes that could cause harm to their health and well-being. There must be a sufficient number of experienced and suitably skilled staff working at the home at all times. Staffing levels must reflect the needs of the people using this service and take into account the aims and objectives of the home. 6 29 19 Robust recruitment processes must be followed to ensure appropriate staff are appointed and thoroughly vetted prior to commencing work in the home. 31/05/2010 31/05/2010 4 9 13 5 27 18 Care Homes for Older People Page 34 of 38 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 Staff must be properly checked out and have the skills and experience appropriate for the work they are to perform. This will help ensure that people using this service are supported by appropriate staff. 7 31 9 The service must be run and 30/06/2010 managed by a qualified, competent and experienced person who is registered with the CQC. People using this service must live in a home that is operated in their best interests and by a suitably registered manager. 8 38 37 You must make sure that 14/05/2010 the Care Quality Commission are notified of any event that adversely affects the well being or safety of any person using this service. The Care Homes Regulations require you to do this. This helps us to judge the quality of the service provided and the homes ability to ensure people using this service are safe and protected. Care Homes for Older People Page 35 of 38 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 1 1 The Statement of Purpose and Service User Guide should be reviewed to ensure they contain up to date and accurate details about the managers and responsible persons qualifications, skills and experience. Where the details for contacting other relevant organisations are listed, contact details should be updated and accurate. Consideration should be given to producing this information in alternative formats to help meet the communication needs of the people this service is aimed at. Staff training and development plans should continue to be implemented to help ensure staff have the skills and knowledge to meet the needs of the people they support. Where special therapeutic diets and/or supplements have been advised or prescribed, clear instructions for their correct use should be recorded in care records. Catering and care staff should be informed and knowledgeable about their use to help ensure people consistently receive the nutritional support they need. The complaint process in place at the home should be reviewed and updated to ensure it contains up to date and accurate contact information of the other agencies people may direct their concerns or complaints to. Staff should be made aware of the importance of listening to and responding to peoples queries and concerns appropriately. Risk assessments make reference to staff receiving training to help them deal with challenging behaviour. Serious consideration should be given to ensuring staff understand the special needs of and are trained to deal appropriately with residents who may display challenging or aggressive behaviour. Dining tables at the home should be checked for suitability and safety. Any defects should be repaired or replaced without delay. This will help reduce the risk of any accidents or injuries to people using this service. The training and development programme should continue to be developed and implemented. This will help ensure staff understand the aims of the home and are able to competently meet the changing or specialist needs of the people using this service. 2 4 3 15 4 16 5 17 6 19 7 30 Care Homes for Older People Page 36 of 38 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 8 33 Policies, procedures and practices should be regularly reviewed to ensure they reflect current legislation and good practice advice. Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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