CARE HOMES FOR OLDER PEOPLE
Burford House Rickmansworth Road Chorleywood Hertfordshire WD3 5SQ Lead Inspector
Alison Butler Unannounced Inspection 11th April 2007 10:00 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 Burford House DS0000060211.V339903.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. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Burford House Address Rickmansworth Road Chorleywood Hertfordshire WD3 5SQ 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) 01923 282818 01923 282951 burford@westgatehc.co.uk www.westgatehealthcare.co.uk Westgate Healthcare Limited Manager post vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. This home may accommodate 28 older people who require personal care This home may accommodate 30 older people who require nursing care 25th January 2007 Date of last inspection Brief Description of the Service: Burford House is a care home with nursing, registered for both nursing and residential residents. The home is situated in Chorleywood, close to a junction of the M25 Motorway and to both Rickmansworth and Chorleywood rail stations. Information regarding the services provided is available in the Statement of Purpose and Service User Guide – this includes a copy of the last CSCI inspection report. Fees for the service range from £600-£700. For further information contact the home direct. 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 residents. Many of the bedrooms overlook the gardens and residents 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 DS0000060211.V339903.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors who spent time talking with those who use the service, the manager and staff on duty. Care records were also examined. This inspection report has been written with information known to the Commission, from the date of the last visit to the service in January and April 2007. Where information has remained the same this has been brought forward into this inspection report. What the service does well: What has improved since the last inspection?
Risk assessments have been undertaken, reviewed and updated in relation to those people who use wheelchairs, reclining chairs and bedsides. This ensures their protection and support needs are being met. Medication policies and procedures are being followed to ensure the people who use the service are protected. Following complaints the company has changed the supplier of meat to the home and the people who use the service stated that it is now a lot better and they can now eat it rather than leave it on their plates. A menu board has now been displayed to inform residents what the meal of the day is. People are not now spending all day in their wheelchairs unless it is their choice and details are contained within their care plan. An emergency evacuation plan has been written to ensure that a safe placement is provided in the event of an emergency. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Burford House DS0000060211.V339903.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 Burford House DS0000060211.V339903.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): 3 Standard 6 is not applicable to Burford House Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people have the information they need to make an informed choice about where to live. Assessments are carried out prior to admission. EVIDENCE: The statement of Purpose and Service User guide have been updated and are available to all prospective people who may wish to live at the home. From the files examined individuals have their needs assessed prior to admission. Where possible the people who use the service are involved in the process and give information about how their needs are to be met. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service have their personal and social care needs set out in the care plans although progress notes need some improvement in the recording to verify the care provided. People are treated with respect and their right to privacy is upheld. EVIDENCE: A previous visit to the home showed that risk assessments had been undertaken, reviewed and updated as appropriate especially in relation to those people who use wheelchairs and or reclining chairs and use bed sides to protect and support their care needs. Staff are provided with clear guidance on managing risks, these must be kept reviewed and changed and this will be monitored at future visits. Care plans examined showed clear action required by staff to meet the individual needs although progress notes are still not very detailed and do not provide an audit trail that needs are met. This was discussed with the manager at the time of the inspection.
Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 10 A requirement had been made at the October 2006 inspection in regards to the medication, a spot check was carried out during this inspection and the requirement had been met. Storage and administration records were well kept and dates of opening had been added to liquids and creams to monitor for disposal etc. Where one or two tablets were taken this is now recorded appropriately. The controlled drugs were well kept. Those spoke to during the inspection were very happy with the care and support they received, on asking one individual if they felt happy with the care they received at the home they stated “it’s ok, I have nothing to compare it to, as I have only ever been here”, others stated that “the staff are very nice, although can be busy at times making responses to our needs a little slow”. Staff were observed asking the people who receive care and support what their choices were in seating and what they would like for lunch etc. This outcome area has been judged as adequate, it is hoped that by the next inspection the evidence will show that they have managed to maintain care plans and improve the information recorded within the progress notes, and they have continued to review risk assessments. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service find the home provides some choice in their social and recreational interests. The food is of a satisfactory quality. EVIDENCE: An activities co-ordinator has been employed and is arranging activities in consultation with the people who use the service, those spoken to felt happy with what they are provided with and that they are asked if they would like to join in or not. Staff help those who require the support and encouragement to keep contact with family, friends and the community where appropriate. Visitors are able to visit at any reasonable time, visitors spoken to during the inspection confirmed this and stated they are always made to feel welcome and are offered hospitality. A local minister provides Holy Communion on a regular basis for those wishing to receive it. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 12 The food has improved since the last visit where the providers have sought a different supplier for their meat. An examination of the meat showed that it looked to be of a better quality and the people who use the service felt that the food had improved and they could now eat the meat, which is no longer tough or chewy. A menu board is now available detailing the meal of the day to allow those who are able to know what is the dish of the day. At a previous inspection it was noted that those using wheelchairs were spending a large amount of time sitting in them and were not offered a change of seating. This practise appears to have ceased and information is recorded within their care plans and alternatives are offered that are appropriate especially during meal times and after lunch where the resident may like a rest in their rooms. This outcome area has been judged as adequate but it is hoped that the improvements in practice for those using the service continues to be maintained, and activities options increase with choices being offered based on history. These areas will be inspected at the next inspection. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 13 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaints procedure is place, although those who live at the home are not fully protected from abuse, as the recruitment procedures are currently not being strictly followed. EVIDENCE: A new record has been developed to allow for the tracking of complaints, to look at the action taken and the outcome being recorded. As no complaints have been received it is not possible to test the system. Those living at the home are not fully protected from abuse due to not all paperwork being available prior for a member of staff commencing employment. See staffing section for further details. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 14 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not provide a well-maintained and homely environment. It is clean to a reasonable standard. EVIDENCE: At a visit carried out in January 2007 the proprietor had stated that the carpet fitter had brought the wrong order and that was the reason the requirement had not been met. On this inspection the manager stated they have applied for a grant and they are waiting to have this agreed before having the carpet fitted. The requirement remains unmet and must be addressed within the new timescales set as further legal action will be considered and this may include a Statutory Requirement Notice. The room carpet identified at the inspection in October 2006 had been cleaned and therefore that particular requirement has now been met.
Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 15 The water temperatures identified in the October 2006 inspection had been actioned and is being delivered within safe limits to protect service users from accidental scalding. The people who use the service are happy with the laundry service provider and they all look well kept on the day of the inspection. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. The people who use the service have their needs by adequate numbers of staff. However, robust recruitment procedures are not always being followed and therefore could put residents at risk. EVIDENCE: Examination of 2 staff records showed that whilst one had all the relevant paperwork in place the other contained no information that they are eligible to work in this country and did not have a work permit, the manager had spoken to the proprietor who had stated that one was not needed and a statement to this effect was held on the file. It was explained to the manager that if and when she became the registered manager it would be her responsibility to ensure all the documentation required is in place prior to staff commencing work. Details of somebody who could provide her with further information on recruiting people from abroad were given during the inspection. This must not happen in the future to ensure that the people who use the service are in safe hands as far as is practicable at all times. Staff were deployed in appropriate numbers to meet the needs of the people who use the service at the time of this inspection. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 17 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, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is yet to be registered with the Commission For Social Care Inspection. Health, safety and welfare of the people who use the service is promoted and protected (with the exception of the current recruitment procedures as discussed in other sections). EVIDENCE: The Commission For Social Care Inspection has still to receive a completed application from the manager to be able to commence the process for registration. A further letter was sent in April to ask for the resubmission of the application and correct fee to enable the process to commence.
Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 18 Staffing records must include all the documentation required under regulation 17 & 19 before commencing employment. The manager has introduced a supervision matrix although it is not fully operational and all staff has yet to receive formal supervision; this is difficult as there is not a deputy in post to take on some of the responsibilities. The proprietor should look at appointing a deputy to take on some responsibilities to enable the home to run more smoothly and action to be taken as required in meeting the national minimum standards. Care plan progress notes should be more detailed to ensure a full audit trial of the care provided and meets the needs of the individuals – as discussed in an earlier section. Previous inspections have shown that the financial interests of the people who use the service to be protected through a system of checks and good record keeping. A full emergency evacuation plan has been drawn up for the safe evacuation of all persons in the care home to provide a safe placement in the event of an evacuation. There is a full and up to date fire safety register to show which room is occupied by whom and also vacant rooms. All fire exits and pathways to these were clear from any obstruction. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 19 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 x 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 20 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 OP8 Regulation 15 Requirement The home must be able to demonstrate that the assessed needs of service users are fully met. Good progress notes that relate to the care plan and how the care was provided will assist in evidencing this. Timescale for action 31/05/07 This has been brought forward from the previous 2 inspection and a new timescale has been given further non-compliance may result in further legal action being taken. 2 OP18 OP28 OP29 OP38 OP19 17(2) & 19 (1)(b) 3 23(2)(d) All the required documentation must be in place prior to any member of staff commencing employment. An immediate requirement was made. Carpets as previously identified as needing replacing must be replaced. This has been brought 11/04/07 30/06/07 forward from the previous 2 inspection and a new timescale has been given further non-compliance will result in legal action being taken. 4 OP31 8(1) A fully completed application for registration of the manager must be received by the CSCI. This requirement has been brought forward (the application sent to the CSCI was returned to the
DS0000060211.V339903.R01.S.doc 30/06/07 Burford House Version 5.2 Page 21 manager as an incomplete application). This has been brought forward from the previous 2 inspection and a new timescale has been given further noncompliance may result in further legal action being taken. 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 Refer to Standard OP27 Good Practice Recommendations The appointment of a deputy manager remains strongly advised. Burford House DS0000060211.V339903.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area 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
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