Inspection on 18/06/08 for Burford House

This inspection was carried out on 18th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 01/06/05

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Burford House Rickmansworth Road Chorleywood Hertfordshire WD3 5SQ Lead Inspector Yoke-Lan Jackson Unannounced Inspection 18th June 2008 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 DS0000060211.V366808.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. DS0000060211.V366808.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 Miss Anna Marie Curran Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places DS0000060211.V366808.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 11th April 2007 Date of last inspection Brief Description of the Service: Burford House is a residential care home, provided by Westgate Healthcare Ltd. The home is registered for 30 people in the Old Age category and who may need nursing care. The home is situated in Chorleywood, close to the M25 motorway. Both Rickmansworth and Chorleywood railway stations are nearby. There is parking in front of the building. The building is a large period house with modern additions. The administrative office, kitchen and communal rooms, comprising a lounge/diner and a second lounge (with library and television) are all on the ground floor. Accommodation is on two floors served by a lift. There are 24 single bedrooms and three double bedrooms. The double bedrooms are used as single bedrooms or for couples who wish to share a room. To the rear of the building is a large and attractive landscaped garden with a fish pond stocked with koi fish. The patio has garden furniture and seating for residents. The garden is accessible to wheelchairs. The home charges £650 to £750 per week. Information about the home and the service it offers is contained in the Statement of Purpose and the Service Users Guide. A copy of these and the most recent CSCI inspection report are available in the home. DS0000060211.V366808.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 one star. This means the people who use the service experience adequate quality outcomes. The unannounced inspection was carried out on 18/06/08. The new Acting Home Manager and the new Operations Manager were both present. The home has 26 residents. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents. Staff and residents were interviewed and documents were examined. Survey questionnaires were sent to the residents and their responses and other information received by us were reviewed. This included the Annual Quality Assurance Assessment (AQAA) form which providers of registered services are required to complete. The AQAA focuses on how the outcomes are being met for the people using the service. What the service does well: The residents appeared content and well cared for. Those residents interviewed gave the following complimentary remarks: “Staff are very nice.” “All the staff are very kind and gentle.” “They don’t rush me. They have a chat with me.” “I get good and wholesome food.” “I have a nice bedroom. The lady cleans it everyday.” “The chef is very good and we have a choice of dishes.” In a recent CSCI survey the following comments were received: “Burford House is a very friendly home and the staff work hard to make us all comfortable.” “I am very content with the home.” “Most of the time the staff listen to my requests.” “Generally happy in the home.” “The care and attention is first class.” “The kitchen staff are very helpful and always offer an alternative to what is on the menu.” DS0000060211.V366808.R01.S.doc Version 5.2 Page 6 Members of staff interacted well with the residents and readily assisted those residents who needed help during lunchtime. The mealtime was unhurried and the majority of the residents seemed quite satisfied with the meals provided. The home is under new management. Members of staff interviewed felt very encouraged by the positive changes that are taking place in the home. Residents and their family have been reassured through meetings held with them by the Operations Manager and the Acting Manager. When interviewed, a resident said, “ The new person goes round to make sure we are alright and she speaks to us every day.” What has improved since the last inspection? What they could do better: The new management have identified a number of deficiencies and have taken remedial steps to improve the service. Work is in progress to improve all written care plans and to convert them to person-centred format. There were no records of review of care needs and it was not clear if any reviews had been carried out before 01/04/2008. The Acting Manager has since organised appointments with the next of kin and some reviews have taken place with the residents and their relatives. Proper documentation is now in place. The new management has identified a need for the monthly audit of accidents and pressure sores and a system is now in place. The new management has identified the need for more formal training for nurses in Care Plans and in Wound Management. The general training programme for all staff has also been revised to include Mobility and Equality and Diversity. Prior to 01/04/2008, nurses were not playing a key role in care planning and in admission assessment. The Acting Manager recognises their potential as professionals and is now encouraging the nurses to maintain their nursing practice in line with the requirements of the registration body, the Nursing and Midwifery Council. They have been given roles and responsibilities that were DS0000060211.V366808.R01.S.doc Version 5.2 Page 7 not allocated to them before. They are now encouraged to develop their professional nursing skills. The new management has recognised the need to improve communication in the home to the benefit of the residents. In a recent CSCI survey the following comments were received from some residents: “I can’t always understand what the staff are saying.” “It is difficult to communicate with some of the staff because their English is poor.” 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. DS0000060211.V366808.R01.S.doc Version 5.2 Page 8 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 DS0000060211.V366808.R01.S.doc Version 5.2 Page 9 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): Standards 3 and 5. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective clients can be assured that a pre-admission assessment will be completed before they are admitted to ensure that the home can meet all their care needs. EVIDENCE: The Acting Home Manager carries out the pre-admission assessment before a person is admitted to the home. There is a trial period and a six weeks’ review to ensure that Burford House is suitable for the new client. The manager said that the home will only accept a person on a permanent basis when all their care needs can be met. Currently there is a new admission who is waiting to be transferred because the home cannot meet all their care needs. DS0000060211.V366808.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): Standards 7, 8, 9 and 10. 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 can expect to be treated with respect and they are protected by the home’s medication policy and procedures. However, not all their care needs are being met and not all the written care plans reflected the individual’s personal and healthcare needs. EVIDENCE: Each resident has a written care plan. The Acting Manager, (appointed on 01/04/08) said that she had reviewed all the written care plans and noted that they lacked individualised information. Prior to April 2008, practically all the written care plans were standardised and not individualised. The care plans lacked content and specific needs were not identified in some cases. There were no records kept of the six weeks’ reviews or annual reviews of care needs. However, since the appointment of the Acting Manager, all written care plans are being revised and some have been changed to a more personcentred format. DS0000060211.V366808.R01.S.doc Version 5.2 Page 11 All new admissions since 01/04/08 have been in the new format. The six weeks’ reviews and yearly reviews of care needs are being carried out with the involvement of the resident and relatives. Appropriate records are now being kept. The pre-admission assessment forms have also been revised to include sections on Religion and Belief and Dietary Needs and other relevant information. Residents have access to their own doctor and to specialist medical, nursing and other therapeutic services when required. A referral has been made for a resident who may need an electronic wheelchair. This need should have been identified sometime ago in view of their mobility problem. Similarly the Acting Manager identified two other residents who should have been encouraged to mobilise instead of being nursed in bed over the last few months. These residents are now up and about in their wheelchairs and their quality of life has improved. They were seen in the lounge enjoying their lunch with other residents during the site visit. Currently there is a resident with a pressure sore (grade one). The Acting Manager said that this condition has improved. There is a case of bilateral leg ulcers and the Acting Manager said that the condition is improving. However, there were no body charts to indicate the sites where the ulcers were and there was no evidence that a wound progress chart had been used. The resident is, however, attending the dermatology clinic in the local hospital. The Acting Manager confirmed that there have been no medication errors since she took over. A trained nurse administers medication. All controlled drugs are stored in a compact controlled drug cupboard, which is fixed within a drug cupboard in the medication storage room. Proper records are kept. All other medicines that are in use are stored in a drug trolley, which is attached to the wall in the medication storage room. The Medication Administration Record (MAR) charts examined were correctly signed following administration of medicines. However, there were handwritten notes that were not signed by the author. The Acting Manager said that this will be addressed immediately with the nurses. DS0000060211.V366808.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): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are assisted to exercise choice and control over their lives, and their preferences, including recreational interests, are respected. They receive a wholesome, appealing and balanced diet, which is beneficial to their general health and wellbeing. Residents have close links with their friends and family. EVIDENCE: Residents interviewed during the site visit were complimentary about the service and care given, including the friendly approach of the chef. A resident remarked, “I tell him if I don’t like what is given and he always gives me an alternative.” It was noted that lunchtime was unhurried. A number of residents needed assistance and members of staff were readily available to help them. The dishes were attractively presented and looked appetising. Some residents had sausages and mashed potatoes while others had fish in sauce. An additional dish of vegetables was on each table for the residents to help themselves. After lunch the chef was in the lounge/diner offering a selection of fresh fruits to the residents, including bananas and freshly cut pineapple and DS0000060211.V366808.R01.S.doc Version 5.2 Page 13 watermelons. There has been a change of supplier for fresh meat and the menu was revised and improved under the new management. The activity programme and photos of group activities were on display on the noticeboard. There are planned group activities and the activities on the day of the site visit included cake decorating by residents who wished to take part. A summer barbeque party has been planned. In a recent CSCI survey, a resident commented, “Some activities are interesting and well organised. I would like more activities in the future.” The home has an activity co-ordinator who works three days a week. An additional activity co-ordinator (part-time) commenced working in the home on 25/06/08. During the site visit, it was noted that there were a number of visitors present throughout the day. Those visitors interviewed gave positive remarks about the care and service provided. A resident commented, “They welcome all my visitors very well.” DS0000060211.V366808.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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that their legal rights will be protected and that they will be listened to and protected from harm. EVIDENCE: The management team investigates complaints or concerns that are raised by relatives and visitors. Immediate action is taken to resolve any issues, which are documented. Recently there was a written complaint that was resolved following a meeting with the complainant. Residents’ meeting and relatives’ meetings are held regularly. The last meeting with relatives was held on 20/05/2008. All members of staff have received training on the Protection of Vulnerable Adults. They are aware of the Whistle-Blowing Policy. The home follows the Adult Protection Procedure of Hertfordshire Social Services. DS0000060211.V366808.R01.S.doc Version 5.2 Page 15 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): Standards 19, 23, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a homely and safe environment that promotes independent living, with access to communal facilities. EVIDENCE: On the day of the site visit, the home appeared clean and tidy. The residents interviewed said that they are quite happy with their bedrooms, which have personal items and potted plants on display. The external environment is well maintained. The home has an attractive rear landscaped garden that is accessible to all residents including wheelchair users. Part of the attraction is the fish pond with a number of healthy-looking koi fish. DS0000060211.V366808.R01.S.doc Version 5.2 Page 16 The maintenance worker was on site. He confirmed that the hot water system in the home is thermostatically controlled and the temperature is within safe limits. The temperature is recorded regularly. The old carpets identified in previous inspections have all been replaced. Communal spaces are limited and management is hoping to rearrange the furniture in the lounges and dining room to provide more space for residents as the lounges seemed overcrowded with additional admissions in recent weeks. The Acting Manager confirmed that all equipment such as hoists and wheelchairs had been regularly serviced and is maintained in good working order. DS0000060211.V366808.R01.S.doc Version 5.2 Page 17 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): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them and can be confident that they are safeguarded by the home’s robust recruitment policy and procedures and the improved training programme for staff. EVIDENCE: Under the new management, all the staff records have been updated. New recruits have Criminal Record Bureau checks and Protection of Vulnerable adults (POVA) checks done. Usually new staff commence working after CRB clearance but recently one new member of staff commenced work with supervision following the POVA First check and clearance. The Acting Manager said that she has conducted staff supervision and this will be carried out six times a year. The Operations Manager said that the home has advertised for domestic workers, care workers and a nurse (RGN). As the deputy manager is retiring, the vacant position has also been advertised. The Acting Manager is currently assessing the training programme for all staff. She has identified the need for nurses to have refresher training and their training programme include Care Plans and Wound Management. She has also identified the need for nurses to be given administrative roles and DS0000060211.V366808.R01.S.doc Version 5.2 Page 18 additional responsibility in order to enhance their nursing skills and maintain their nursing practice in accordance with the requirements of the registration body, the Nursing and Midwifery Council. A member of nursing staff said that she was not given the task of writing care plans or admission assessment notes before April 2008. The Acting Manager said that the nurses have since been given responsibility for writing admission notes and care plans. The Acting Manager is personally supervising and encouraging the nurses. On the day of the site visit, the Acting Manager gave training on Care Plans to all the nurses, including those who were on night duty. Members of staff interviewed felt very encouraged by the positive changes that are taking place in the home. DS0000060211.V366808.R01.S.doc Version 5.2 Page 19 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): Standards 31, 33, 35, 37 and 38. 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 can be assured that the care and service provided will continue to improve under the new management. They can be assured that their health and safety are promoted and protected. EVIDENCE: The registered manager has been on long-term sick leave since 17/03/2008. However, temporary management arrangements are in place with the appointment of an Acting Manager on 01/04/2008. She is well supported by the new Operations Manager, who was appointed on 01/05/2008. Under the new management, there have been a number of positive changes. The care plans have been reviewed, revised and improved. Residents will now have their care needs reviewed regularly and documented. There is an DS0000060211.V366808.R01.S.doc Version 5.2 Page 20 improved system of record keeping and updates. There is now in place a monthly audit of accidents, falls and pressure sores. The new management has identified some policies and procedures that need to be updated and this will be carried out. The staffing level has been reviewed. The nursing staff is to increased from 3 to 4. The nursing staff are now given more roles and responsibilities. The provider carries out an annual quality assurance and monitoring survey. This includes written questionnaire feedback from residents, relatives and others. The new Operations Manager conducts a monthly visit as required by legislation and she has produced her first monthly report (under regulation 26), dated 20/05/2008 which was readily available for inspection. All previous reports were contracted out to an independent assessor. The home is not involved in the residents’ finances or personal allowances. All records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. The servicing records have been well maintained. The Annual Quality Assurance Assessment (AQAA) form issued by the Commission was revised and completed by one of the Directors on behalf of the registered manager and was received in time for this inspection. The information provided was included in this report. DS0000060211.V366808.R01.S.doc Version 5.2 Page 21 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 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 x 18 3 3 x x x 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x 2 3 DS0000060211.V366808.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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. 3. Refer to Standard OP7 OP8 OP8 Good Practice Recommendations It is recommended that all written care plans be revised and updated as soon as possible. It is recommended that a body chart be used in cases where there are multiple sores or ulcers. It is recommended that a wound progress chart be used for pressure sores and ulcers so that the conditions can be monitored closely. It is recommended that all handwritten notes on the Medication Administrative Chart be signed and dated by the author. It is recommended that the small controlled drug cupboard be replaced with a more suitable one for the amount of controlled drugs that are currently in use. DS0000060211.V366808.R01.S.doc Version 5.2 Page 23 4. OP9 5. OP9 6. OP32 OP37 It is recommended that the management ensures that all policies and procedures and all documents required by legislation be maintained and be updated as soon as possible. DS0000060211.V366808.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection 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 DS0000060211.V366808.R01.S.doc Version 5.2 Page 25 - 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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