Inspection on 22/04/08 for Buchan House

This inspection was carried out on 22nd April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Buchan House 09/05/06

Buchan House 20/09/05

Buchan House 11/05/05

Buchan House 03/12/04

Buchan House 08/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Buchan House Buchan Street Kings Hedges Road Cambridge CB4 2XF Lead Inspector Janie Buchanan Unannounced Inspection 22nd April 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Buchan House Address Buchan Street Kings Hedges Road Cambridge CB4 2XF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01223 712111 01223 712113 sue.carter@excelcareholdings.com Buchan Healthcare Ltd Suzanne Carol Carter Care Home 66 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (65), of places Physical disability (1) Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user with category PD under the age of 65, to be accommodated for the duration of their residency. 27th April 2007 Date of last inspection Brief Description of the Service: Buchan House is a purpose built home for the elderly, built on two floors and is registered to accommodate up to 66 persons. The home was previously owned and operated by the Local Authority until Excelcare Holdings purchased the home in 2001 when they and also purchased a number of other care homes from Cambridgeshire County Council. The home has since been extended and increased the number of places for residents. The home is divided into three units, Snowdrop Sunflower and Iris. Snowdrop and Sunflower are on the ground floor and respectively accommodate 18 and 33 people. Sunflower is the part of the home where residents with dementia care related need are looked after. Iris is located on the upper floor and is a smaller area for 13 people. All rooms are single occupancy and all have ensuite facilities of toilet and washing facilities. Stairs and a passenger lift provide access to the upper floor. The home has two enclosed gardens and a visitors car park, and offers a dedicated and safe facility for residents with dementia. The home is located close to the King Hedges residential area of Cambridge on the outskirts of north side of Cambridge City. The home is accessible by car from the A14 Histon turnoff and can be reached by a city bus service. At the time of the inspection the fees charged ranged from £365 to £550 per person per week. 44 of the places are advance block purchased arrangements by Cambridgeshire County Council, whereby numbers of guaranteed places are commissioned and arranged through Cambridgeshire County Council for residents who they part fund. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. For this inspection we (The Commission for Social Care Inspection) looked at all the information that we have received. This included the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. We also received 21 surveys from people living in the home and from other people with an interest in the home. We spoke with five residents, four members of staff, one visiting district nurse and the manager, and looked at a range of policies and documents. We undertook a brief tour of the home to check the environment and health and safety matters. What the service does well: What has improved since the last inspection? The implementation of a cooked breakfast is a welcome one, offering residents genuine choice in what they eat each morning and maintaining their weight. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 6 The broken lock on the fridge in which medication is stored has been fixed, ensuring its safety. What they could do better: • Residents must be actively involved in planning their care and ways must be sought to enable residents to participate and communicate their views to the development and review of their care plan. Food and fluid charts must be more detailed so there is an accurate record of how much someone has drunk. The recording of medication needs to be tighter to ensure there is an accurate record of what medicines someone has, or has not, received, and who has administered them. Some parts of the home smelled strongly of urine and more must be done to ensure that residents live in a pleasant environment. Staff morale appeared rather low, with many of them complaining of low pay and high turnover. This should be addressed before more staff choose to leave and the continuity of care for residents is compromised. References for prospective employees must be checked more rigorously so that residents are fully protected. Staff must receive supervision so their working practices can be discussed and their training needs identified. This requirement is outstanding from the previous inspection and failure to comply with the requirements may lead to the CSCI taking enforcement action. Fire doors must not be wedged open, thereby preventing them closing in the event of a fire and putting residents at unnecessary risk. • • • • • • • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good. Residents receive good information about the home before they move in so they can decide if it is where they want to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has put together a welcome pack with excellent information about its services and facilities. Included is the home’s Statement of Purpose, Service User Guide, a copy of the latest CSCI inspection report, residents’ views of where they live and advice leaflets from Help the Aged. The entranceway to the home also gives residents and their visitors additional information including how to complain, protecting vulnerable adults, a range of information on benefits and financial matters as well as fact sheets on healthy eating, keeping fit and Alzheimer’s disease. There are also pictures of staff with their title and job role in the home. We checked the files of two recently admitted residents and each contained good evidence that their needs had been assessed thoroughly before moving into the home. Also each resident is issued with a contract that clearly states the terms and conditions of their stay at Buchan house, and the fees payable. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 9 Visits to the home to assess its facilities are encouraged and one resident told us she had visited for a day before moving in, and that her son had received a brochure about the home. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. Residents’ health needs are well monitored at the home, although more could be done to actively involve them in planning their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We checked the care plans for three residents and these were very generally very detailed, accurately reflecting residents’ needs and giving staff good guidance as to how to meet them. One plan for a resident in the dementia unit gave excellent information on how to deal with this person’s challenging behaviour. However, there was little evidence in the plans that residents had seen them or had been actively involved in planning and reviewing their care, and the plans were not really in a format accessible to many residents. We showed one resident her plan and although perfectly able to understand and read it, she told us she had never seen or signed it, despite being asked by the home to sign other documents. We also looked at a fluid chart for someone who was at risk of dehydration. This chart was very basic and did not give enough information as to the actual amount of fluid being given, also this resident’s fluid intake was not monitored daily to determine if she was actually receiving enough. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 11 Residents health needs are monitored at the home and their weights, risk of falls, dependency levels and Waterlow scores are checked regularly. Residents who completed the surveys told us that they received the medical support they needed and one commented: ‘there is no hesitation in calling doctor/nurse when necessary’. One relative told us: ‘as regards our mother Buchan House does very well and caters well for her psychological and physical needs. We know she can be difficult and demanding and have been agreeably surprised by their ability to cope with this’. A range of health care professionals visits the home frequently to support residents. We checked a sample of residents’ medical administration records in one unit. These showed that carers administering creams in residents’ bedrooms did not sign the MAR sheets as required; that there was no detailed explanation as to why one resident went without fortisip for a period of 4 consecutive days; that some staff did not record whether they had given one or two tablets of variable dose medication; and that codes used to determine why someone had not received their medication were not explained adequately enough. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. Activities and meals are well managed at the home, providing residents with stimulation and a nutritious and varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents told us that there were activities arranged by the home that they could take part in. On the day we visited we saw a number of residents on the dementia care unit enjoying a game of ludo. The staff member organising this was excellent: taking her time to explain the rules of the game repeatedly and slowly, and encouraging the residents gently to take a turn. We then saw her later in the day, in another unit, undertaking sensory work with different residents. One resident told us: ‘there is a good social programme and special lady who is responsible for arranging this, she is excellent’. Family and friends are made welcome and there are regular meetings held to include them as well as residents. Relatives who completed the surveys told us they were ‘usually’ kept up to date with important issues affecting residents, although one relative felt the home should be more ‘pro-active’ about this. Residents have genuine choice in what they eat, and on the day of inspection we saw residents enjoying a range of food for their lunch including braising beef, Shepherd’s Pie, poached fish or vegetable curry. All residents told us that they enjoyed the food although one resident told us that they would like Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 13 thinner custard. The home has recently introduced a cooked breakfast five days a week and this is clearly enjoyed by residents who are also reported to have put on weight as a result. We talked to the home’s cook who was enthusiastic and very aware of residents’ individual food likes and dislikes. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good. The home’s complaints procedure is well-publicised ensuring residents and their relatives have easy access to it. The home responds well to issues raised, and takes concerns seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about how to complain is publicised widely around the home: in the entranceway, in residents’ bedrooms and in the home’s service users’ guide. We also viewed minutes of a recent (25/04/08) relative’s meeting, where relatives were reminded of the home’s complaints procedure and some chose this opportunity to raise minor concerns. There is also a complaints/suggestions box in the entranceway to the home with slips of paper easily available to encourage visitors to air their views. Although not all residents we spoke to were aware of this procedure most were able to identify someone in the home they could speak to if they were not happy. Relatives told us that the home responds appropriately if they raise concerns. One commented: ‘any queries we have had have always been dealt with and answers given or arrangements made’. We looked at how the home had dealt with 3 recent complaints concerning a resident’s bedroom door being locked, how a resident’s laundry was handled and one concerning the quality of care. The manager had provided written responses to all three complainants within appropriate timescales. All matters had been resolved. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 15 There is good information in the home of a number of advocacy agencies for residents to access including Age Concern and Help the Aged, and three residents have already been referred to Age Concern for support. Staff have received training in protecting vulnerable adults and the home has been prompt in reporting adult protection concerns. There have been a number of concerns about the quality of care raised by local social services teams in the last year but none of these have been found proven. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25,26 Quality in this outcome area is adequate. Residents live in a comfortable environment with appropriate aids to keep them independent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We undertook a brief tour of the premises and found them clean and comfortably furnished. Although the dementia unit is rather large (accommodating 33 residents), there are good orientation aids to help residents find their way about and large signage reminding them of the day, date, month and season. One resident was clearly enjoying talking to the budgie that is kept in the corridor. However there was a strong smell of urine in parts of this unit, making it very unpleasant to be in. The home was generally well maintained although one relative stated: ‘better cleaning is needed in bathroom and ensuite- cold tap has been dripping since my mother’s arrival, 6 plus weeks ago. Lime scale shows it has been going on a long time’. We checked this particular resident’s bedroom and the tap was indeed dripping, and had been for some time. Another raised concern about poor plumbing in the building and the manager confirmed there had been an Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 17 on-going problem with an air lock in the central heating system. That was taking a very long time to resolve. Alcohol hand sanitizer is readily available around the home to reduce the risk infection and the housekeeper showed good knowledge about the extra precautions needed to deal with residents who have MRSA. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. Residents receive their care from well trained staff, although recruitment procedures need to be tighter so that only the right people look after them This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents who completed the surveys told us that there were staff around when needed and staff told us there was ‘usually’ enough staff to meet the individual needs of residents. One relative commented: ‘Staff are very good although language is a problem with some’. Almost all the staff who completed surveys complained about the low pay they received. Comments made included: ‘ the pay is very poor and for that reason lots of the staff are leaving to better paid jobs’; ‘the pay isn’t very good’ and ‘we want appropriate wages according to our work’. The manger told us that 7 staff have left since Christmas. Staff told us that they received good training relevant to their role and files that we viewed showed that they had received a range of up to date training specific to the needs of older people. More than 50 of staff have an NVQ care qualification which is above the recommended amount. We checked the personnel files for two recently employed members of staff. One file was good and contained all the evidence needed to show that appropriate references and CRB checks had been undertaken by the home before the person started working. However the two references for the second employee were exactly the same, had not been dated and were not on headed Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 19 notepaper, despite being form a hospital where the person had previously worked. These references had both come from the employee’s work colleagues rather than their manager or supervisor. These references are not sufficient to protect residents. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38. Quality in this outcome area is good. Leadership of the home is good, ensuring residents live in a well run home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of Buchan House is a registered nurse and has previous experience of running care homes. She has worked hard at raising standards at the home and is respected by staff. One member of staff commented; ‘my manager she is very supportive and very understanding always there to support and help in any way possible’. Others told us told that: ‘she mucks in and gets things done’ and ‘we have a good management team’. The home has well developed ways of seeking the views of residents and their families, and satisfaction questionnaires are regularly sent out to ascertain their views as to the quality of the service. However these questionnaires were last sent out over a year ago and should be sent out again. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 21 The home holds cash of up to £50 for some residents. We checked a sample of three residents’ monies sheets and these were in good order having been checked regularly and with receipts available for all monies spent. Staff told us they did feel well supported although it was worrying to note that one member of staff had not received any formal supervision since she had started work at the home, seven years previously. Other staff had received supervision but some not as frequently as recommended by the standards: two members of night staff had not received any supervision since July 2007. We viewed files that showed electrical appliances, fire systems, and lifts were regularly checked and serviced. However, a gas safety check was slightly overdue and we noted that a bedroom door (room 6) on the dementia unit had been pinned back with an armchair, thereby preventing it from closing in the event of a fire. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 x x x x 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 2 x 3 Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Residents must be actively involved in planning their care and developing their care plan where possible. All records of medication administered (or not administered) to residents must be accurate and up to date so it is clear what they have received. All parts of the home must be kept free from offensive smells so that residents live in a pleasant environment. Staff must not be allowed to work at the home until two suitable references have been received so that residents are protected All staff must be appropriately supervised to ensure they support people living in the home in an acceptable manner. This requirement had a timescale of 31/08/07, which has not been met. Enforcement action may now be considered. Fire doors must not be wedged DS0000015236.V363044.R01.S.doc Timescale for action 01/06/08 2 OP9 17 (1)(a) 01/06/08 3 OP26 16(2)(k) 01/06/08 4 OP29 7,9,19 01/06/08 5. OP36 18(2) 22/04/08 6 OP38 23(4) 01/05/08 Page 24 Buchan House Version 5.2 open so they can close freely in the event of a fire RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP27 OP33 Good Practice Recommendations Low staff morale should be addressed and methods to improve it implemented. The home should seek the views of residents and relatives as to the quality of the service provided. Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Buchan House DS0000015236.V363044.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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