Care Home: The Epsom Beaumont

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What the care home does well All people that wish to use service benefit from a thorough pre-admission assessment and the care plans are then generated from this initial assessment. The pre-admission assessment is kept in the persons individual care plan folder. Care plans and risk assessments contained enough information about the people using the service that allowed staff to care for them appropriately. The plans were observed to be person centred where this was appropriate but had clear instructions for staff regarding skin integrity and wound care. Regular training takes place and this includes the NVQ (National Vocational Qualification) which all staff have access to. The deputy manager demonstrated a clear understanding of safeguarding policies and procedures. Documentation evidenced that complaints that are received by the manager are investigated appropriately within the timescales set by Barchester. There are clear lines of managerial responsibility and the deputy told us she has good support from her registered manager and operations manager. What has improved since the last inspection? Following the inspection in January 2009 four requirements were made. These requirements have now been met. All staff now receive safeguarding vulnerable adult training and are now aware of how to report an incident if required to do so. Staff numbers at the home have been reviewed and this ensures there are adequate staff on duty to meet the needs of the people who use the service. The employment folders have been reviewed to ensure that staff are fit to work at the care home. Since the last inspection the home has appointed a new manager who is now registered with CQC and she is supported by a newly appointed deputy manager. This ensures that there is always a suitably competent and experienced person on duty at all times. What the care home could do better: No requirements were made following this key inspection. Key inspection report Care homes for older people Name: Address: The Epsom Beaumont 20-22 Church Street Epsom Surrey KT17 4QB     The quality rating for this care home is:   two star good 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: Lesley Garrett     Date: 1 3 0 1 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 27 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 27 Information about the care home Name of care home: Address: The Epsom Beaumont 20-22 Church Street Epsom Surrey KT17 4QB 01372747999 01372739335 epsom@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Barbara Carter Type of registration: Number of places registered: care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 55. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The Epsom Beaumont is situated on a main road in a residential area near to the centre of Epsom. There is limited car parking space to the front of the property. The home provides care and accomodation for fifty-five older persons. Accomodation is provided in single bedrooms with en-suite facilities which is situated on the ground and first floors of the building. There is a passenger lift giving access to the first floor. Care Homes for Older People Page 4 of 27 Over 65 55 0 1 3 0 1 2 0 0 9 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector, carried out the inspection and the registered manager represented the service. We arrived at the service at 11:00 and were in the home for five hours. It was a thorough look at how well the home is performing. It took into account information provided by the home and any information that the Care Quality Commission (CQC) has received about the service. The registered manager for the service supplied CQC with an AQAA (Annual Quality Assurance Assessment) and this document was used to assist with the inspection. We also spent time talking with and observing some of the people using the service and staff members. We looked at how well the service was meeting the key national minimum standards and complying with the regulations and has in this report made judgements about the Care Homes for Older People Page 5 of 27 standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, staff files, training records, and the homes safeguarding and complaints policies and procedures. From the evidence seen by us and comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 6 of 27 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. 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 Care Homes for Older People Page 7 of 27 order line 0870 240 7535. Care Homes for Older People Page 8 of 27 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 9 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service benefit from a pre-admission assessment from a suitably trained person to ensure that the home can meet their needs. Evidence: We looked at the service user guide and statement of purpose. They contained all the information required to enable people who wished to use the service to make an informed choice about living at the home. All people who wish to use the service benefit from a pre-admission assessment. This assessment is carried out by the deputy manager. The assessments that were sampled on the day were thorough and takes into account all activities of daily living together with some social history and details of relatives and friends important to that person. The deputy told us that if an assessment is required for a prospective person wishing to use the service who does not live in the area another manager from a Barchester home in their area carries out the assessment. The two mangers then Care Homes for Older People Page 10 of 27 Evidence: liaise to ensure that the home can still meet their needs. As these assessments are so thorough it enables the nurses at the home to begin to generate care plans for the person. The AQAA told us that all rooms are prepared to high standard prior to admission with all equipment that is required in place prior to their admission. On the day of inspection one relative told us that their family member had settled in well following their admission as every thing was in place prior to the admission. It therefore made it easier to settle in. The home does not offer intermediate care. Care Homes for Older People Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were well written with enough information available to allow staff to care appropriately for the people using the service. They are written in a person centred style with evidence that people using the service have agreed them. Evidence: The care plans contained detailed risk assessments for example the skin integrity of the people using the service, nutrition and the use of bed rails. All were reviewed monthly. Equipment that includes hoists and height adjustable beds are provided to encourage independence for the people using the service. There are specialist mattresses available for those people who are at risk from pressure sores. For one person using the service we observed detailed information of how to use a piece of specialised equipment. Pictures were on the bedroom wall and available to staff. The relative told us that she believed the staff were continuing to use the equipment to benefit the person using the service. The deputy manager said that people who use the service are registered with three GPs. One surgery, where the majority of people are registered, visit every week and Care Homes for Older People Page 12 of 27 Evidence: the other GPs will visit when requested to do so by the home. People using the service can retain their own GP if the surgery agree and they are in the catchment area. The deputy manager also said that the home has support from other health care professionals and they include chiropodist, optician and physiotherapist. All people who use the service have access to their local hospital and NHS services. People using the service are supported by the staff to attend any out patient appointment and specialist clinics. The deputy manager told us that a large chain pharmacy is used for the supply of medications to the home and they are delivered in blister packs. The homes policy and procedures for the safe handling of medicines was sampled and staff have access to this documentation. The AQAA states that medication administration is safe as the nurses that administer are assessed for competency at the end of their induction period and then annually. The deputy told us that she audits the medication procedures regularly. Those medicines that cannot be placed into blister packs are counted each time a tablet is administered. During a tour of the building it was observed that staff were speaking appropriately to the people using the service by their preferred name which had been documented in their care plan. All people were dressed in clothes appropriate for the weather with hair well groomed and nails clean. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in social religious and recreational activities and are able to exercise choice in their daily lives. The standard and quality of the meals are good which means nutritional needs should be met. Evidence: The manager employs two activity organisers who between them organise the social programme Monday to Friday. It was observed that the home has a varied programme of activities and social preferences are documented in their individual care plans.On the day of the visit people who use the service, who had chosen to, were gathering in the downstairs lounge to attend the church service. Prior to lunch sherry is served and another activity was due to take place in the afternoon. A variety of activities are available including group meetings and one to one interaction. The home has their own minibus so trips outside of the home are also available. One person spoken to on the day said how much they had enjoyed the garden party in the summer. Another person told us the home is well run with plenty of activities available. One person using the service who completed a survey for us, when asked, what does the home do well the reply was activities - I like music, crosswords, outings and sherry mornings. Care Homes for Older People Page 14 of 27 Evidence: The deputy told us that visitors are welcome in the home at any time and the home promotes open visiting. On the day of inspection it was observed that people using the service had visitors during the day in individual bedrooms and in the communal areas. It was observed that in the care plans it was clearly documented the preferences of the people using the service. It stated preferences for getting up in the morning and going to bed. It is also documented those people who prefer an early morning cup of tea. People using the service can also choose daily newspapers that are delivered to their bedroom. All people using the service have access to a telephone and post is always delivered to their bedroom unopened. The deputy told us that since the last inspection the quality and presentation of the meals has improved. A new chef has been employed who is assisted by a second chef. Between them they cover the week which includes breakfast and supper service. There is also a kitchen assistant so carers do not have to help in the kitchen during their shift. The deputy also told us that the chef had recently won chef of the year which is a competition held within Barchester. Part of the lunchtime service was observed and it was noted that staff were available to help those people using the service that required this. Tables were laid with tablecloths and napkins and drinks available. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listened to and that they should be protected from abuse as the staff team have received training in safeguarding adults. Evidence: The deputy manager said that during the last year they had received eleven complaints that had now been resolved. The complaints log was seen and the concerns had been appropriately investigated with timescales met. The home welcomes feedback from the people who use the service and their relatives or representatives and there is also a record of compliments received. The home has a clear complaints policy and this is available to all people in their bedroom and is clearly displayed on the homes wall. Since the last inspection there has been two safeguarding alerts which had been referred to the local authority for investigation. These are both now resolved and there is one safeguarding alert which is ongoing. This alert was referred to the local authority prior to the last inspection in December 2008. We had been made aware of the investigations and actions by Regulation 37 notifications. Documents sampled during the day demonstrated that safeguarding training has taken place for all staff. The staff that we spoke to on the day had knowledge of the Care Homes for Older People Page 16 of 27 Evidence: procedures followed in the home. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe, well maintained, comfortable environment. Evidence: During the tour of the building it was observed that people using the service benefit from a well maintained and decorated environment. The interior and exterior of the home is good. On the day of the visit the reception area had begun a programme of refurbishment so the receptionist had moved into the downstairs lounge which is still close to the front door.All bedrooms are single and have en-suite facilities. It was observed that the bedrooms had been personalised and the AQAA states that the management of the home encourages people to bring in their personal belongings. There are plenty of communal facilities which include lounges and dining rooms. The bedrooms benefit from adjustable beds, bed-rails, (if required), and plenty of equipment to aid manual handling which includes hoists. The gardens are large and well maintained and some rooms on the ground floor have patio doors which open into the garden. The AQAA told us that the homes gardener was a finalist in Barchester in Bloom competition held in the summer. The home has a housekeeping team who work every day to ensure the home is clean and free from offensive odours. Standards of cleanliness within the home was Care Homes for Older People Page 18 of 27 Evidence: observed to be high with evidence seen that the staff are working to COSHH (control of substances hazard to health) guidelines. Soap dispensers and paper towels were available in the communal areas which assist with infection control within the home. Records showed that staff have also received infection control training. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers at the home on the day of inspection were sufficient to meet the assessed needs of the people using the service. NVQ training for the care staff continues to ensure a good skill mix of staff on duty. Evidence: The deputy manager told us that she is responsible for organising and writing the staff rota for the nurses and care staff. We were told that numbers had increased in the home of people who use the service so staff numbers had also increased. Dependency levels are completed for people using the service and staff numbers can also be increased depending on these figures. On the day of inspection it had been snowing. The deputy told us that all staff had arrived for their shift. During the bad weather we were told that staff had been very supportive and loyal. Some staff members had arrived on duty prepared to stay overnight due to the snow. The activity organisers came in on their days off to support the staff team in case they were short of staff and the maintenance person went in his car to collect staff from various locations. The deputy told us that the staff team had been very good during the bad weather so the home continued to run smoothly. Care Homes for Older People Page 20 of 27 Evidence: People who use the service who spoke to us told us the staff are really good nothing is too much trouble. Another told us we had a very good Christmas here the staff made it very special for us. Staff have access to National Vocational Qualification (NVQ) training. The deputy told us that most staff have achieved this qualification and the training is on going for all new staff following an induction programme. The induction for all new staff is linked to skills for care a national programme of induction. The deputy told us that she is responsible for delivering this training and all staff are supernumerary during their induction period. Three staff employment folders were sampled and were found to have the necessary paper work to enable the home to employ those people safely. This ensures that the people who use the service are protected by the homes recruitment procedures. The deputy is also responsible for ensuring that all training necessary for staff takes place. Individual training files for the staff were viewed. This showed us that staff at the home have access to a variety of training to meet the needs of the people using the service. Mandatory training by the home is carried out yearly or when the certificate has expired. This includes safeguarding adults, moving and handling, fire awareness, infection control and food hygiene. The deputy told us that specialist training is also available depending on the needs of the people using the service. Some staff had recently completed a tissue viability training course and this will be repeated to ensure all staff have the benefit of this training. Care Homes for Older People Page 21 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home ensures the staff team is adequately supported and there are clear lines of managerial accountability. Quality assurance systems are in place which improve the quality of care offered to the people who use the service. Evidence: The registered manager for the home was away on a training course the day of inspection. The deputy manager was in charge. It had snowed during the morning but the deputy told us all staff had arrived on duty. The manager is not a registered nurse so the deputy is the clinical lead. She is responsible for all aspects of the care delivered to the people using the service and the supervision of the nurses and carers. The deputy ensures that care is delivered according to their assessed needs. The deputy told us there are clear lines of mangerial responsibility. She has good support from her manager and they work together well as a team. The manager is good at Care Homes for Older People Page 22 of 27 Evidence: keeping CQC informed of any events in the home and Regulation 37 notifications are sent to us promptly. Staff that completed surveys and spoken to on the day confirmed to us that management at the home had improved during the last year. One staff member told us I like working in Epsom Beaumont as the management team is working very hard. The deputy told us that since the last inspection in January 2009 the home has been regularly audited and the management team well supported. This ensures that the manager and deputy can raise the standard of care delivered to the people using the service. A recent incident at the home highlighted to the manager that staff needed extra training in skin integrity and this has been put into place. Staff have either attended the training or will attend this year. People using the service and relatives spoken to on the day of the visit were aware who the manager and deputy were and knew they could approach them if they had concerns. The managers office had been moved to the middle of the home and she is now very visible. The deputy told us that both she and the manager have an open door policy which allows family and friends to speak to a person in charge the day they visit if the wish. The deputy told us of various quality audit systems that were in place at the home. This ensures that people using the service, relatives and staff have the opportunity to air their views. Annual surveys are sent to all people using the service, relatives and health care professionals. The results of the surveys are sent to head office and then to the manager to devise an action plan for any short falls identified. Survey results had recently been received by the home which were very positive and mostly complimentary about the service provided. Regulation 26 visits take place every month and the reports are held at the home and available for inspection. The deputy told us that Barchester had recently appointed a compliance officer and visits to the home have taken regularly to undertake audits which are in line with CQCs minimum standards and regulations. The home has the assistance of a full time business administrator who assists with the paper work for finances and recruitment. The home does not handle any personal allowance money for people living at the home. The home will produce invoices for any money spent during the month. People using the service either manager their own finances or relatives act on their behalf. People without family or friends can arrange an advocate as the home has details of a local organisation. The home employs a full time maintenance person who has some health and safety responsibilities. An external body is also employed to carry out health and safety Care Homes for Older People Page 23 of 27 Evidence: audits. No health and safety issues were identified during this inspection and records confirmed that the appropriate certificates were in place and current. Health and safety in the home is promoted and the AQAA advises that there are generic risk assessments in place to promote safe working practises.The AQAA also showed us that the maintenance of equipment and services is up to date Care Homes for Older People Page 24 of 27 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 25 of 27 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 26 of 27 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). 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. 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