Inspection on 01/06/05 for Burford House

This inspection was carried out on 1st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Burford House 18/06/08

Burford House 11/04/07

Burford House 12/10/06

Burford House 14/08/06

Burford House 02/06/06

Burford House 24/11/05

Burford House 30/11/04

Burford House 25/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Burford House Rickmansworth Road Chorleywood Hertfordshire WD3 5SQ Lead Inspector Angela Dalton Unannounced 1 June 2005 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 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. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Burford House Address Rickmansworth Road, Chorleywood, Hertfordshire, WD3 5SQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01923 282818 01923 286008 Westgate Healthcare Limited Elizabeth Elaine Ferguson CRH Care Home with Nursing 30 Category(ies) of OP-30 registration, with number of places Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate 28 older people who require personal care. Date implemented 29 June 2004. 2. This home may accommodate 30 older people who require nursing care. Date implemented 29 June 2004. Date of last inspection 30 November 2004 Brief Description of the Service: Burford House is a care home with nursing, registered for both nursing and residential service users. The home is situated in Chorleywood, close to a junction of the M25 Motorway and to both Rickmansworth and Chorleywood rail stations. The building is a period house with modern additions. There are 27 single bedrooms and three double bedrooms, let as single rooms or to couples (by arrangement). There are four day rooms available on the ground floor, including a television lounge and a library. The attractive landscaped rear garden is accessible to the service users. Many of the bedrooms overlook the gardens and service users enjoy the seasonal changes if they are too unwell to leave the house. Staff however make a concerted effort to assist people to enjoy the garden, even if just for a short space of time. There are parking facilities to the front of the home. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors on 1st June 2005 between 10.15 am and 5.45pm. Service users were generally well presented and their clothes are laundered to a high standard. There were several issues raised within the inspection which require addressing and are explained further in the report. Overall, this was a disappointing inspection and the home manager and proprietors must make concerted efforts to improve adult protection awareness and adherence to local policies. What the service does well: What has improved since the last inspection? What they could do better: Service users are not currently protected by adult protection procedures within the home. Recruitment records were incomplete. Two episodes of theft had not been investigated appropriately or referred to the required organizations i.e. Social Services, Police or Commission for Social Care Inspection. Allegations of neglect have not been appropriately referred. An enforcement notice has been served. A quality assurance system has yet to be fully implemented to voice any issues they may have. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 6 Some issues were identified regarding the environment – including the kitchen still requiring a steam claean, radiators not having low surface temperatures and inappropriate storage of soiled laundry. 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. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5, Service users do not have access to the necessary information to inform them about the home. Support is inadequate for service users with sensory impairments. EVIDENCE: An up to date Statement of Purpose is not available within the home to inform service users or visitors about the home and its ethos. Service users have a copy of their contract and can refer to it as required. The manager is available to assist with any related enquires relating to a contract. The home does not provide intermediate care. Assessments take place and form the basis for the care plan. Care plans did not expand upon how to meet the needs of one service user who was blind. It was both observed and reported that staff were ill equipped to provide a specialist service. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Care plans do not adequately reflect how individual needs will be met. Dignity of service users is not consistently observed. The systems for administering and recording of medication needs addressing in some areas. EVIDENCE: Care plans have deteriorated since the previous inspection. Needs are identified but the management and review of individual needs is not always recorded e.g. sensory impairment, pressure sores, falls. Risk assessments are completed but may be better served in being stored within the care plan. A requirement has again been made regarding medication although there has been some improvement since the previous inspection. Medication is not always dated on opening. Amounts are not carried forward so reconciliation would prove difficult. Staff signatures were not clear. Where service users choose to wear ankle socks with a dress or skirt this preference is to be recorded in the care plan as it is not age appropriate. Mealtimes require attention, as service users who require one to one assistance were not given this until some way into lunch. One service user was observed to have several staff pass by, each feeding a spoonful of food but not sitting down and providing undivided attention. When a staff member arrived to assist with lunch the interaction was positive but they did not sit along side the service Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 10 user. A requirement has again been made to observe privacy and dignity. Individual funeral wishes should be recorded and where information is not forthcoming then this is to be recorded. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Service users do not appear to be assissted to exercise choice and control over their lives. The new chef needs to ensure service users are involved in the menu planning. EVIDENCE: Some service users stated that they were not given a choice in the clothes that they wore whilst others were given the opportunity to state their preference. It appears that staff are inconsistent in their practise. The chef is new in post but would find an audit of service users likes and dislikes valuable. Some service users are storing food in their bedroom to ensure that their personal tastes are catered for. A menu is not on display to provide daily choices available. Currently a high number of omelettes are being consumed as an alternative to the main meal of the day. A gap of over twelve hours is in place between the evening meal and breakfast. This is too long and must be reviewed. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Complaints are not always as recorded and are inadequate. Service users are not adequately protected from the risk of abuse. Adult protection procedures are not adhered to. EVIDENCE: Complaints that are made are not always recorded and therefore are not able to be tracked. When complaints are recorded there is no evidence of how they are investigated and the outcome. Poor adherence to the Hertfordshire County Council’s Adult Protection Policy has resulted in allegations of theft and neglect not being investigated by the appropriate parties. Allegations that have been made are not validated by the response of the manager and owners which demonstrate that service users are not valued. Several issues have been reforced to Hertfordshire Adult Care Services by the Commission following this inspection. An enforcement notice has been served on the providers so that an improvement is sought in the important area of adult protection. An enforcement notice has been served on the manager to ensure that the Commission is notified of incidents of concern. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24 The environment is suitable and meets service users needs. However, there are some issues that compromises the health and safety of both service users and staff. EVIDENCE: The gardener was visiting on the day of inspection and planting summer flowers. Locks have been purchased ready to fit to service users bedroom doors. The size of the laundry compromises storage so infected items are stored outside until the last laundry cycle of the day. An appropriate storage facility must be explored to further observe infection control as the dissolvable alginate bags were in the rain on the day of inspection. It is recommended that an additional tumble drier is purchased to assist in the backlog of washing. Although the kitchen is in a better condition than at the previous inspection a thorough clean as identified in the previous inspection report remains necessary. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The hours that staff work compromises their ability to provide a high standard of care. Recruitment records were icomplete indicating that the homes recruitment practises do not protect service users. EVIDENCE: Staff work a large number of hours as long days feature as part of the shift pattern (12 hour shifts). There is a high risk of staff becoming tired and not providing good quality care if they are working up to sixty hours each week. This will impact upon service users. There are vacancies for a deputy manager and an administrator within the home. The manager spends much of her time providing hands on care as opposed to being office based. A balance must be achieved if the requirements made during the inspection are to be met. Although mandatory training is scheduled as stated earlier training specific to service users needs is necessary. Recruitment records were incomplete and this does not adequately protect service users. Comprehensive recruitment checks were not evident on the day of inspection. The application form has not been reviewed and this fails to identify adequate information about members of staff. References are not authenticated and the required number references were not in place. Service users protection from abuse is therefore not assured. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37,38 The home is not run in the best interests of service users. A formal quality assurance programme has not yet been completed. The health and safety of service users and staff is compromised. EVIDENCE: The manager has an incomplete management team and therefore has to complete additional tasks. The vacancy has been advertised and the proprietors are aware that the posts need to be filled urgently and are taking steps to ensure that this occurs. The new owners have owned the home for almost twelve months and are in the process of surveying service user views. A requirement has been made to inform the Commission of the outcome of this quality assurance exercise. Door wedges are being used in the home and this practise must cease as it compromises service users’ safety in the event of a fire. Radiators around the home are not all covered and could scald a service Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 16 user if they fell against them. This issure remains outstanding from the previous inspection report. Enforcement action may be considered if this is not addressed. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 3 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 3 3 3 3 3 3 2 2 Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 18 yes Are there any outstanding requirements from the last inspection? 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 OP4 Regulation 12(3) Requirement Timescale for action 30/06/06 2. OP9 13(2) 3. OP26 13(3) 23(2)(d) 4. OP38 13(4)(a) The proprietor and manager must ensure that the assessed needs of service users are met in an adequate and consistent manner. Service users feelings must be considered. This requirement was made at the previous inspection. Medication must be dated on 30/06/05 opening (Made at previous inspection) Medication amounts must be carried forward onto Medication Administration Record Sheets to enable reconcilliation to take place. Staff signatures should be clearly identifiable as there is currently confusion between a member of staffs signature and the symbol for refused medication. The kitchen must be thoroughly 30/06/05 cleaned (preferably a steam clean). An action plan for the date that this is scheduled is required. This requirement was made at the previous inspection. A requirement has again been 31/07/05 made to submit an audit of radiators that still require covers Version 1.30 Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Page 19 5. 6. OP1 OP4 OP7 4(2) 12(3) 15(1) 7. OP10 12(3) 12(4)(a) 8. OP15 16(2)(i) 9. OP16 22(3) 22(8) 13(6) 13(3) 23(2)(1) 17(1)(a) 19(1)(b) Schedule 2&4 18(1)(c)(i ) 24 10. 11. 12. OP18 OP26 OP29 13. 14. OP30 OP33 15. OP37 37 to ensure that they are low surface temperature. This requirement has been carried forward as it was not checked during this inspection. A current Statement of Purpose must be available in the home. Service users needs identified in assessments and care plans must be met. Identified needs e.g. sensory impairment, pressure care must be managed and monitored with records to evidence that this occurs Privacy, dignity and choice of service users must be observed e.g. assistance with mealtimes and age appropriate dress (ankle socks). Food must be available on request to service users in the period of time following supper at 5pm and breakfast at 7.30am. Complaints must be recorded and the outcome of any investigation recorded and available for inspection Service users must be protected from abuse. Appropriate procedures must be followed. Appropriate storage facilities must be available for infected and soiled laundry. Appropriate recruitment checks must be conducted prior to staff commencing employment. Records must be available for inspection. Training must be provided to enable staff to meet the needs of service users A quality assurance audit must be conducted. The outcome must be provided to the Commission for Social Care Inspection The Commission for Social Care Inspection must be notified of 30/06/05 30/06/05 30/06/05 30/06/05 30/06/05 30/06/05 31/07/05 30/06/05 31/07/05 31/08/05 30/06/05 Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 20 16. OP37 26 17. OP38 13(4)(c) any events relating to Regulation 37 of the Care Homes Regulations. The Commission must receive monthly reports from the Proprietor or their representative which focus on the welfare of service users. Door wedges must not be used and a safe alternative endorsed by the Community fire Safety Officer. 30/06/05 15/06/05 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 OP15 OP29 Good Practice Recommendations A daily menu should be on display to inform service users and staff of mealtime choices. The application form should be reviewed as discussed during the inspection. Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 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 Burford House I52 s60211 Burford House v230239 010605 Stage 4.doc Version 1.30 Page 22 - 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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