Care Home: Beaumont Lodge Nursing and Residential Home Limited

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What the care home does well We were told by the service users that their right to privacy is maintained at all times and the support they receive from care workers is given in a way that maintains their dignity. They told us the home is responsive to their culture, religion, race, age, disability, gender and sexual orientation. They informed us management and staff are competent and knowledgeable about the health care needs of older people including health and safety and that their practise routinely protects and promotes the safety of all who uses the home. There are policies and procedures in language staff and service users can understand, to ensure excellent standards of care is achieved in all areas of practise. The home values the opinions of service users and staff and meetings are held regularly, minuted and outcomes actioned in a timely fashion to ensure the health and safety are maintained and seamless care experienced by service users. Service Users meet together monthly to discuss and debate life at Beaumont Lodge and meet formally with the managers (who are responsible for the smooth running of the home) quarterly to express their wishes and opinions about the service. Bi-annual questionnaires are also sent out and results collated and circulated. No requirement or recommendations of good practise was made on this visit. What has improved since the last inspection? The home has improved on the service users` participation in decision making on matters of significance to them by involving them in the selection process of new care workers after suitable briefing and up to date information sharing. They have also recruited a new deputy manager which allows the registered manager to have managerial support and provides the home with a solid team of management for service users, relatives and staff to access. The Home has ensured that they complied with the requirements and recommendations of good practise made on the last key inspection visit. The home continues to be proactive in meeting the needs of the service users, ensuring suitable and up to date training is available and undertaken by care staff to ensure seamless care is provided and delivered to the people living at this home. The home has purchased fifteen new electrical profiling beds, they have replaced two old sluice machines with new ones, new carpets have been fitted to all upstairs bedrooms and corridor, new flooring to sluices and bathrooms, they have purchased three new potable hoists, new dishwasher and toaster. They have constructed a new sensory garden for the use of service users. What the care home could do better: The home continues to provide excellent service to the people using the service. They are continually exploring ways in which they can improve their service, and listen and act on suggestions from service users and staff. Key inspection report Care homes for older people Name: Address: Beaumont Lodge Nursing and Residential Home Limited 19-21 Heatherley Road Camberley Surrey GU15 3LX     The quality rating for this care home is:   three star excellent 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: Mavis Clahar     Date: 2 0 0 8 2 0 0 9 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 30 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Beaumont Lodge Nursing and Residential Home Limited 19-21 Heatherley Road Camberley Surrey GU15 3LX 0127623758 01276709030 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Beaumont Lodge Ltd care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 43 The registered person may provide th following category of service: Care home iwth Nursing (N) to service users of the following gender: Either whose primary care needs on admisison to the home are within the following category : Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Beaumont Lodge is a large detached property situated in a quiet residential area of Camberley. The home can provide accommodation for up to 43 older people, any or all of whom, may require nursing care. Up to 12 older people who may have dementia and up to two people who may have a sensory impairment, may also be accommodated within the total number of 43 service users. Care Homes for Older People Page 4 of 30 Over 65 0 43 43 0 Brief description of the care home The majority of bedrooms are for single occupancy, although a small number of double rooms are available. There are spacious communal areas and a large garden, most of the garden being to the front of the property. Car parking is also available to the front of the property. Fees at this service range from £550.00 per week to £750.00 per week subject to the care needs and room requirements. This fee does not include personal toiletries, escort duties and transport expences. 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: The last Key Inspection on this service was carried out on 23rd August 2007. The service also received an Annual Service Review on 23rd August 2008. This unannounced site visit, which forms part of the key inspection to be undertaken by the Care Quality Commission, (CQC) was undertaken by Mrs. Mavis Clahar on the 20th August 2009 and lasted for seven hours; commencing at 09:20 hours and concluding at 16:20 hours. The registered manager of the home Mrs. Indira Roopun and the Responsible Individual (RI) assisted on this inspection. The CQC Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received by CQC (us) and is referred to throughout the report. The comments Care Homes for Older People Page 6 of 30 received via the pre inspection questionnaires sent to service users and members of staff are also included in this report. The majority of the service users spoken to were able to express their thoughts and feelings about the care they receive and the food served to them. The information contained in this report was gathered mainly from observation by the inspector, speaking with a number of service users, with the manager and with care staff. Further information was gathered from records kept at the home and from the pre inspection questionnaires returned to us. The first part of the inspection was spent discussing and agreeing the inspection process with the manager and RI, followed by a tour of the home, which included time spent in discussion with service users and care workers and relatives visiting the home. The manager and staff are aware of the Laws regarding equality and diversity and this was reflected in the staff mix. Service users in this home are a mixture of Caucasians service users from other ethnic minority groups and reflect the population of the area in which the home is situated. All records sampled were up to date with care plans being signed by the service users or by relatives. No requirements or recommendation of good practise was made on this visit. The final part of the inspection was spent giving feedback to the manager and RI about the findings of this visit. We would like to thank all the service users, visiting professional and care staff for taking time to complete and return the pre inspection questionnaires. Thanks also to the service users, relatives and staff who took time out of their busy schedule to speak with us and for making the visit so productive and pleasant on the day. Care Homes for Older People Page 7 of 30 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 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. The care needs of prospective service users are assessed prior to admission into the home. This enables the home and prospective service user to be sure that the diverse needs of the service user will be met. Evidence: The AQAA informs initial assessments are carried out, in accordance with Standard 3 of the National Minimum Standards, by the Manager or Deputy Manager. Further assessments are carried out by Registered Nurses. Prospective service users are invited to come to the home for visits if they are able to or for the relatives to visit and spend time in the home observing general care such as activities and staff and service users interactions. In discussion with service users relatives on the day of the site visit they confirmed they had visited the home prior to making a decision to allow their relative to become a resident. In discussion with service users they assured us they had viewed the home with their relative and were then able to make their decision about becoming a resident of the home. Care Homes for Older People Page 11 of 30 Evidence: The AQAA informs the assessment of service users is obtained by observation, sometimes by a joint discussion between other members of the multi disciplinary team but most importantly through the discussion with the prospective service user about the type of care and support they feel they need. The assessment covers the following needs: washing, including oral hygiene, dressing, continence, dietary-including enteral feeding, mobility, including falls, sleeping pattern, communication, hearing, eyesight, medication, skin integrity, clinical, pressure sores, including waterlow score, social, mental state, orientation, and memory. The assessment defines how funding will be arranged. The assessment form also requires a signature and date of when the assessment was carried out and by whom and also the signature of the service user or their relative if the service user is unable to sign. All potential service users have a health needs assessment completed. We were told the home finds this an excellent framework to assist the assessment process ensuring they are able to meet the potential service users individual needs before moving in. Service users, whose residential placement is arranged by social services also, have a health needs assessment carried out. The home encourages prospective service users to come and stay for meals or for the day so that they can meet with staff and other service users and have first hand experiences of what it is like to live at Beaumont Lodge. Prior to any admission to Beaumont Lodge, the home ensures that Service Users individual needs can be met and any specific equipment or aids are in place. Intermediate care is not provided at this home. Five completed service users pre inspection questionnaires were returned. Four said they received enough information to help them decide if this home was the right place for them and they were given written information about the homes terms and condition before deciding to move into this home. One said they did not know if they had received this information. Two completed pre inspection questionnaires received from visiting health and social care personnel. One said service users assessments always ensure that accurate information is gathered and that the right service is planned for people at the home. The other one said usually this is done. 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. Detailed care plans are available to guide staff to the care and support needs of the service users and medication is administered, stored and disposed of appropriately. Ensuring service users health care needs are well met. Evidence: The AQAA informs the home involve service users and their relatives as appropriate in devising their individual care plans which are then updated and reviewed at least monthly or as individual needs change. Review of the care plans on the day of the site visit revealed the care plans consider all needs specific to the individual including the following, Communication, eyesight, hearing, personal care to include bathing and washing, dressing, choosing own clothing, oral hygiene, medication administration, memory and mental awareness, mobility, skin care, including waterlow score, elimination, hobbies, social, family and work histories, activities within the home, eating and drinking including likes, dislikes, special needs and any adaptations necessary, and likes and needs of the service user during the day and at night. We observed that Death and dying is also discussed on admission and funeral preferences were also documented. The plan focuses on independence and strives to encourage Care Homes for Older People Page 13 of 30 Evidence: service users to optimise their abilities to reach their full potential. The AQAA informs service users rights, responsibilities, dignity and privacy are respected in accordance with the homes philosophy of care and we observed that service users received care based on a positive approach to equality and diversity and human rights at the centre of service delivery. We observed from the randomly selected service users care plans reviewed that each service user has a Local Community Record within their care plan which details their life experiences including family, travel, work, childhood memories, dreams, school and hobbies. These are completed on or soon after admission if the service user agrees, and give the care staff an insight into the past life of a service user to better facilitate individualised care. The AQAA informs and we also observed documentation within service users file that the home operates by the gold standards for palliative care which encourages service users to discuss their end of life care and think about advance directives. We also observed the home utilises the Mental Capacity Assessments (Knowing you Knowing Me) and we were told this type of care plan helps the staff to continue to offer seamless care to the service user, in the event of a service user becoming mentally incapable of making certain decisions such as specific clothes they like, hobbies, activities they like to do, places they like to visit. If the service user is incapable of completing this plan information is sourced from family and friends, to build up a comprehensive picture of what the service user would actually want. The care plans are kept in a personal file, which is kept under lock and key to ensure privacy. We were told Service users are able to access their plan at any time, and in discussion with service users they confirmed this and told us their relatives are also able to have access based on the service user giving permission. Registered nurses and senior care workers with NVQ L3 have received training in writing care plans. All care staff are encouraged to read the care plans to ensure the care they are giving is person centred. Staff are trained through induction on how to deliver individualised care and treat all service users with respect. Staff are able to extend their supernumerary period if they feel they need more training. Referrals are made wherever needed to members of the multidisciplinary team e.g., speech and language therapist, dentist and hygienist, physiotherapist, dietitian, diabetic nurse, Parkinsons nurse, occupational therapist, wheelchair services. We were told the home has a retained GP who visits weekly. However service users can remain with their own doctor if they prefer. Within the Service users personal file there are risk assessments which cover the following, falls, nutrition, mobility and manual handling, wandering, level of awareness, medication risk, hazards in rooms, use of side rails. Service users also have risk assessments that are specific to them. All service users risk assessments are reviewed at least monthly or more often if required. Side rails are checked more often to ensure they are in full working order. The home has found the use of specific individual risk assessments an excellent way of empowering service Care Homes for Older People Page 14 of 30 Evidence: users to live their life as they wish. There are also risk assessments for equipment, health and safety general environment and first aid. Review of randomly selected service users medication administration records demonstrated good records are kept. The amount of current Control Drugs in the home matched the records kept by the home. In discussion with a registered nurse we were told and shown the records kept of medication entering and leaving the home for which a signature of the receiving person is obtained. We were also told service users who are assessed as capable are encouraged and enabled to self administer their medication. We reviewed the homes policy and procedure for this action which were in good order having being recently updated. In discussion with service users they told us they were happy in their home and that the staff were lovely and treated them with respect. When we asked them what is the best thing in the home they responded everything. Staff ensures care is service user led; personal support is flexible, consistent, and is able to meet the changing needs of the service users. Staff respects service users preferences and have expert knowledge about individual personal needs when providing support, including intimate care. The staff response appropriately and sensitively in all situations involving personal care, ensuring that it is conducted in private and at a time and place directed by the person receiving the care. Five completed pre inspection questionnaires were returned to us. Five said they always receive the care and support they need. Three said the home usually makes sure they receive the medical care they need and two said the home always did this. 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. The home has sought the views of the service users and considered their varied interests when planning the routines of daily living and arranging activities both in the home and in the community. Routines are very flexible and service users can make choices in major areas of their lives. Evidence: The home employs an Activities Co-ordinator who is responsible for the planning and organisation of activities for people living at the home. There are also another two members of staff who have undertaken training successfully to manage service users activities. We were told there are a variety of activities within the home including scrabble, bingo, musical bingo, music and movement, listening to music. We observed activities taking place in service users dinning and living rooms on the day of the visit. In discussion with service users they told us they are very involved in the planning of the activities and enjoys them very much. We were told service users have been on a number of outings and one outing they particularly liked was going to the seaside and having fish and chips. We saw photographic evidence of this visit. The home also has a Sensory garden with fibre optics, project images and calming scented plants such as calamine, various thymes and jasmine for service users who may have dementia or some agitation. Service users can use this facility for short sessions with the activity Care Homes for Older People Page 16 of 30 Evidence: co-ordinator or for longer periods on their own to help them feel calm. We were told by service users they enjoy Themed Lunches, tea parties and suppers, celebrating special days such as St Patricks, St Georges, Halloween, Easter parties with an Easter bonnet parade. The AQAA informs the home provides summer fetes, Christmas fairs, performances from the local school, musical concerts, which are held in the lounge for all service users together. The service users meet on a monthly basis to discuss what they want to do for the next month. At this meeting the manager is then able to keep everyone informed of news, the forthcoming events and to give feedback from the previous meeting. These meetings are minuted and every service user receives a copy. Service users, unable to attend, are consulted prior to the meeting to see if they have anything they wish to bring up. Following the meeting they are given verbal feedback until the minutes are ready. The Cook regularly attends these meetings alongside the activities co-ordinator. We were told there is no restriction made by the home on visiting time. Service users can have visitors any time it is convenient to them. Visitors to the home on the day of the visit told us they are always made welcome and offered refreshments or meals at no charge. There are areas around the home which are available for service users to meet their visitors in private, to play cards, games, sit quietly and read. Service Users are encouraged to maintain links with the local community. Beaumont Lodge encourages service users to become involved in activities and learn new skills should they wish to do so, for example, use of computers, mobile telephones, cookery or gardening. Service users are encouraged to manage their finances independently in accordance with the homes policies. Service users who require contact with external agencies e.g. advocates further information is provided in homes information leaflets. Safes are provided for all service users who request one. Service users continue to be involved in devising menus with the Cook based on their favourite choices. There is also an extensive off menu choice. At lunchtime this includes a fish option, salad, omelet, baked potato and plough mans lunch. These are in addition to their two main choices. Specialist diets( ethnic minority and diabetic) are catered for when required and details are recorded in individual care plans. Hot and cold drinks and snacks are offered and available on request at all times. Risk assessments are put in place if service users wish to make their own drinks or snacks. Mealtimes are as flexible as practicable. Meals can be taken in service users rooms or in the dining rooms. Meals are promoted as social occasions and service users are encouraged to join each other for meals where they can chat and enquire after each other and staff ensures that mealtimes are unhurried. Staff assists service users discreetly and sensitively with Care Homes for Older People Page 17 of 30 Evidence: eating their meals and promotes independence for as long as possible. Five completed pre inspection questionnaires received from people living at the home. Five said the home arrange activities that they can take part in if they want. Three said they always like the meals provided and two said they usually like the meals. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safeguarding issues in the home are given high priority and discussed at staff and service users meetings. Staff are trained in Safeguarding matters to ensure the welfare and safety of service users are protected and maintained. Evidence: We observed information leaflets in Mental Capacity, Safeguarding Adults and Complaints procedure are available in the home to staff, service users and all visitors. We saw evidence where Staff have undertaken an accredited level 2 course in the Control of Infection and Contamination to ensure service users are protected. The AQAA informs Key discussion sessions have been implemented in addition to care plan review at staff meetings. These discussions enable topics covering all aspects of life at Beaumont Lodge to be discussed, which may not necessarily involve direct care delivery. They have found this provides an excellent forum for service users to discuss any issues or put forward ideas and suggestions on how the home can improve their service. Both key discussion and care plan review sessions enable service users to verbally comment on any issue they feel needs addressing. This statement was verified during discussion with a number of service users in an individual situation. The Home continues to promote a transparent service and have clear complaints procedure, which is contained in the Service users guide, contract of residency and statement of purpose. A complaints leaflet has also been formulated to give to service users and relatives on admission, and a copy is also displayed on all notice boards. We Care Homes for Older People Page 19 of 30 Evidence: observed copies in reception available in large print and we were told arrangements are available to have this document printed in other version or language if needed. A record is kept of all complaints made, and the details of what has been done about it. We were told by service users the home has Complaints policy and service users, relatives, and visitors to the home are free to lodge complaints if they wish. We observed details of CQC is also contained in the Complaints procedure. We were also told complaints procedure can be made available in audio and large print and other format such as different languages or Braille has been sourced and can be accessed when or if required. The AQAA informs prompt response to any complaints, concerns and issues and are the managers first priority. Any service user or relative who feels their complaint has not been dealt with effectively can appeal to the General Manager. The manager told us she pro-actively deals with complaints when they are made and will ensure any disciplinary action is taken if required after the appropriate investigations and discussions have taken place and she would keep the complainant informed at each stage of the complaint investigation. All allegations or incidents of abuse are dealt with immediately in accordance with the Surrey Multi agency procedures. Safeguarding adult referrals are made appropriately. We observed the home had thirteen complaints since the last Key inspection. All of which were dealt with to the satisfaction of the service users. CQC has not received any complaints about this home. Five completed service users pre inspection questionnaires were received by us. Five said they knew who to speak to if they were not happy. Four said they knew how to make a formal complaint. One said they did not know because they havent needed to know. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout of the home enables service users to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: The home has a well-maintained environment, and service users are encouraged and enabled to personalise their bedrooms. The home presents as a safe place to live with bedrooms that meet the National Minimum Standards for Older People. The management has a good infection control policy: they seek advice from external specialists, e.g. infection control, and encourage their own staff to work to the homes policy and procedures to reduce the risks of infection. It was noted in care workers file that they attend regular training sessions on Health and Safety issues. Care workers spoken to were knowledgeable about suitable storage and disposal of waste, and the need to keep all dangerous substances in a locked cupboard to prevent risk of harm to service users. The home presents as comfortable with large kitchen, living room and dining room. All service users have their own bedroom, most with en-suite facilities. There is a large garden, part of which has been turned into a sensory garden whilst the rest is laid mainly to lawn. On the day of the visit we saw garden furniture stacked and on enquiry we were told normally these would be strategically placed for the use of the service users but the home is planning to replace and enlarge the garden shed so they have stacked the furniture to protect service users safety. The atmosphere in the home on the day of the visit was friendly with service users, visitors and staff Care Homes for Older People Page 21 of 30 Evidence: interacting in a positive way. We were told the building has been inspected by the Environment Health Agency and Fire Brigade and the home has complied with suggestions made. There were no requirements made for these visits. We observed all bedroom doors had fire guards fitted and keys to doors are available for those service users who wish to have a key. Each room is en-suite and complies with relevant guidance regarding door widths to enable wheelchair use and floor space. The manager informs the home employs a full time handyman and gardener, who is responsible for the grounds and for minor odd jobs within the house. The home has rolling programme for upgrading and decorating and so far they have replaced all carpets in the upstairs bedrooms and corridor. The Business and operational plans incorporate the maintenance programme and a schedule of planned maintenance has been developed for the next 5 years. The home encourage Service Users to bring in their own furniture and personal belongings e.g pictures, photos, ornaments, cushions etc. The home has purchased fifteen new electrical profile beds where the height can be adjusted to aid care staff with bed making and delivery of care to service users in bed. Prospective service users can choose the bedroom wall colour and carpets if they need replacing before moving in. Handrails are fitted throughout the home and are regularly monitored for damage. Grab rails are fitted in service users en-suites and can be fitted in their rooms if they require them. There is call bell system in all rooms, toilets, bathrooms and shower rooms and service users can have a personal pendant if preferred. We observed the staff adhered to their clinical waste policy. Five completed service users pre inspection questionnaires were returned to us. Five said the home is always fresh and clean. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a highly developed recruitment procedure that has the needs of the service users at its core. The recruitment of good quality carers is seen as integral to the delivery of an excellent service. The service is highly selective, with the recruitment of the right person for the job being more important than the filling of a vacancy. People who use the service are involved in the recruitment of staff and receive training and support to do this. Evidence: The staff rota demonstrated the number and grade of staff on duty to provide care and attention to service users for any twenty-four period was good to meet the assessed care needs of the service users. The home has a programme of planned training in place and all members of staff have an individual training record. 72 of care workers have attained the National Vocation Qualification at Level 2 Level 3 and above (NVQ L2 ; NVQ L3). Care workers are encouraged and enabled to undertake developmental training as well as the mandatory training. . All newly appointed staff undertakes an induction programme. The home ensures that staff undertakes the mandatory training with yearly updates as necessary to maintain their competency to fulfil their duties. This was evidenced through discussion with the manager and care workers and from review of care workers training records and the training grid which at a glance one can see the training staff have completed (these are signed off by staff member) and those planned for the year. Care Homes for Older People Page 23 of 30 Evidence: The AQAA informs that staff turnover at the home is relatively low. We were told all care workers are Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checked and two written references are obtained prior to commencing employment plus any gaps in their employment history is explained. They are also in receipt of terms and conditions of employment as evidenced in their randomly selected files. The manager informed us that supervision records were up to date and this was verified during random sampling of care workers files. The manager had shown us her planned programme of improvements and supervision of staff was high on her agenda. In discussion with service users we were told they are involved in the formal interview process of all new staff. One identified capable service user sits on the interview panel and small group interview is carried out by service users having tea and biscuits with the intended care worker in a social informal way. All permanent staff receives a Contract of employment. They also receive the Policy and Procedures Manual and sign to say they will read it and seek help for anything they do not understand. This is monitored through support and supervision. Induction Period is six weeks, during this period all new staff receive two weeks of being supernumerary and work along side other members of staff. This supernumerary period can be extended dependent on the needs of the individual staff member. The induction process incorporates the six common induction standards. All Staff have a copy of the GSCC code of practises. The manager was knowledgeable about equality and diversity and equal opportunities and how this relates to employment and retention of staff. We evidenced staff have had Equality and diversity training and access to a copy of the GSCC code of practises. The manager was knowledgeable about equality and diversity and equal opportunities and how this relates to employment and retention of staff. We evidenced staff have had Equality and diversity training. Five completed service users pre inspection surveys were returned to us. Three said staff are always available when they needed them. Two said staff were usually available when they needed them. Five said staff always listen and act on what the service users wanted. Some comments made by service users about the staff include the following. The staff are interested in you. The staff make my relatives feel very welcome. Im quite happy here thank you. I feel Im looked after very well. Im genuinely happy with all care and support. 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 able to describe a clear vision of the home based on the Societys value and corporate priorities. She communicates a clear sense of direction, is able to evidence a sound understanding and application of best practise operational systems, particularly in relation to continuous improvement, customer satisfaction and quality assurance ensuring the home is run in the best interests of the service users. Evidence: The manager has demonstrated that she has kept herself updated on issues relating to care of the service users and staff in her charge. She has attained the Registered Managers Award. In discussion with the manager it was evident she was knowledgeable about the care needs of the service users and the training needs of the care workers to meet these identified needs. She continues to strive to meet the aims and objectives of the Society and is committed to providing service users with an excellent quality of service which meets their needs. She ensures equality and diversity; human rights and person centred care are an every day occurrence within the home through various avenues such as, Staff meetings, support and supervision Care Homes for Older People Page 25 of 30 Evidence: sessions, appraisals, staff questionnaires and her open door style of management, and by actively promoting and seeking the views of all staff. Service User meetings, care plan reviews, key discussion meetings, service user questionnaires, best interest records ensure the views of service users and their sponsors are actively sought and all these contributed to the development of the homes business and its operational plans. The AQAA informs the home provides suitable and up to date equipment to ensure a high standard of work is carried out by staff and service users can experience a high level of comfort and safety at Beaumont lodge. They have purchased fifteen electrical profiling beds, replaced two sluice and disinfection machines with new ones, they have purchased three new ski pads to aid service users evacuation in case of emergency. They have also two new hoists, laid non slip flooring in one bathroom and two sluice rooms. We were told the senior management of the home believes that effective clinical leadership has a determining influence on the care delivered to service users. Consequently, the management structure of the home has been organised in such a manner as to promote and support a high quality of clinical leadership. An example of this is a deputy manager has been appointed and registered nurses are responsible for maintaining areas of the National Minimum Standards to include regular evaluation on how well the home is meeting these standards. In discussion with staff we were told that this practise makes them more responsible and accountable for their actions and also more competitive as no one want to see their area of responsibility evaluated as not meeting the standard. We were told Quality Assurance questionnaires are carried out to establish feedback from service users and their sponsors, which are evaluated and any areas are actioned by the manager as appropriate. The results of these questionnaires are collated, published, distributed and displayed in all areas of the home. There are clear lines of accountability within the home, each member of staff spoken to on the day of inspection aware of their role and responsibilities. Equality and Diversity, human rights and person centred thinking are given priority by the manager who is able to demonstrate a high level of understanding and demonstrate best practise in these areas. The way the home is run shows an understanding of peoples needs in respect of the six strands of diversity; gender, including gender identity, age, sexual orientation, race, religion or belief and disability. Included is a sample of comments made by visitors on the day of the visit and also by staff working at the home. Beaumont Lodge cares very much for all the service users Care Homes for Older People Page 26 of 30 Evidence: and staff. They have high standard of care and cleanliness we never experience the smell of urine here and they must have people who are incontinent. I have worked at Beaumont for a number of years and it is the happiest, warmest and loving place I have ever worked. I have always felt appreciated and relied on and love coming to work. Its nice to go to work where I feel I am at my second home. Working here has made me more caring and mellow and to treat people as I would like to be treated. As much as I give to the job I get back, not just meeting with residents but with staff of different nationality. Our children mix well and this is good cultural development for them. The Manager and General Manager are both very supportive to all the staff. 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 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) Care Quality Commission (CQC). 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