CARE HOMES FOR OLDER PEOPLE
Burford House Rickmansworth Road Chorleywood Hertfordshire WD3 5SQ Lead Inspector
Hazel Wynn Key Unannounced Inspection 2nd June 2006 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.V297164.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.V297164.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 286008 Westgate Healthcare Limited Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Burford House DS0000060211.V297164.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 24th November 2005 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. 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. The fee range is £600 -£700. Burford House DS0000060211.V297164.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report contains the outcomes of the unannounced inspection carried out by two regulation inspectors on 2nd June 2006 using available evidence gathered since the last key inspection and during this visit including observation, discussion with residents, care staff and the manager and examination of records maintained in the home. All of the key standards were assessed during this inspection and the overall outcome was positive. Requirements were made in respect of registration of the manager, for the regular supervision of all staff, individual risk assessments in respect of falls and for risk assessments to be carried out in respect of individual use of bed rails and individulal use of electric chairs. All residents spoken to (overall) expressed satisfaction with the home, and the service provided. Medication, recruitment, care plans and health and safety records were inspected. Based on this inspection visit and information received since the last inspection visit, the overall quality of this service is adequate and improving. What the service does well: What has improved since the last inspection?
Medication was well managed and there were no gaps on the recording sheet; the requirement made at the last key inspection had been met. The identified needs of residents (as assessed) and recorded in the care plan were being met; this satisfies the requirement made at the last key inspection. The privacy, choice and dignity of residents were being observed and the requirement made at the last key inspection was being met. Action had been taken to eliminate/minimise any risk of a breach to dignity, respect and choice of the residents. The quality of the food has improved and meals are served hot. Problems associated with the flooring in room 10 have been eliminated. Risk assessments and agreements had been conducted for night staff and
Burford House DS0000060211.V297164.R01.S.doc Version 5.2 Page 6 copies forwarded to the CSCI. Action had been taken in the area of Health and Safety with heating regulated and the placement of bait reviewed. 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. Burford House DS0000060211.V297164.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.V297164.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to this home. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. Assessments are carried out prior to a prospective resident moving into the home and only where the meeting of needs can be assured is an offer of placement made. EVIDENCE: The admission assessments seen during this inspection visit were comprehensive and from observation and information obtained from records, needs were being met. Standard 6 does not apply to this home. Burford House DS0000060211.V297164.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Generally, care plans adequately reflected how individual needs will be met. Risk assessments in respect of bed rails and/or the use of electric chairs and a falls risk assessment need to be in place for some residents. A social history needs to be completed all residents, were possible. The system for administering and recording of medication offered safeguards to residents. Dignity respect and privacy is taken seriously. With regard to the lack of risk assessments, the quality in this outcome group is poor; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The care plans seen detailed the health, personal and social care needs of the individual residents and tracking of four service user found the needs were being met. The care plans seen did not contain a falls risk assessment and risk assessments were not in place for bed rails or electrically operated chairs (loungers) and requirements were made in respect of these. The proprietor stated that none of the residents living in the home have pressure sores. Protocols and procedures were in place for people who can self medicate. The Medication Administration Records were satisfactorily recorded and medication
Burford House DS0000060211.V297164.R01.S.doc Version 5.2 Page 10 was stored according to guidelines. Controlled medication was well managed and those checked were easily reconciled. Residents spoken to stated that they were treated with dignity and respect and that their right to privacy was upheld. Good practice was observed with staff supporting individual residents in a caring and gentle manner. See complaints section with regard to one resident’s comments. Burford House DS0000060211.V297164.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. Not all of the residents are satisfied that the lifestyle experienced in the home matched their expectations whilst others are satisfied; activities are provided at regular intervals. Contact with family, friends and community is supported. The quality of food is much improved, wholesome and provides for a well balanced diet. EVIDENCE: Activities are provided at regular intervals but some residents said they found these boring; this was fed back to the proprietor. Several residents were in their own rooms on the day of the visit; from discussions with residents, this was their preference. A recommendation was made that social history’s of residents, who did not already have one, be obtained. The social, religious and cultural needs of residents were included in the care plans seen. The residents stated that family, friends and contact with community is supported and visitors come and go as the individual residents wish. The visitors’ book showed a constant flow of individual visitors. Burford House DS0000060211.V297164.R01.S.doc Version 5.2 Page 12 A quality assurance system is in place and the views of the residents are obtained; this supports residents to have control and choice over their lives as action is taken where residents have indicated that improvement is needed in any particular area. A dementia-training course was planned on the training schedule for shortly after this inspection and the outcome of this should ensure that staff have an improved understanding of the needs of the residents, especially those who may have dementia care needs. One of the inspectors tasted the lunchtime meal and reported that this was tasty and hot. The menu reflected a varied and wholesome diet and the dining facilities are attractive and comfortable; advice from a dietician is sought. Burford House DS0000060211.V297164.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. Work needs to be done to support named individuals to feel confident about making a complaint but generally residents and their relatives and friends can be confident that their complaints will be listened to, taken seriously and acted upon. Residents legal rights are protected. Residents are protected from abuse. EVIDENCE: We discussed with the proprietor and the manager that a resident had disclosed that one of the night staff had not provided support in a manner acceptable to her and both she and her husband did not feel confident in raising this. The proprietor commenced an investigation during the inspection and post inspection confirmed that the member of staff had been identified and had left her employment in the week the issue had arose and that the resident had been reassured that any complaint should be raised with confidence and would be dealt with. The proprietor stated that residents or their representative manage their own legal affairs. Residents are invoiced for their costs and any personal expenditure; the home does not manage any personal finances. Residents can use their vote through the postal service or attend the polling station with support from relatives. Burford House DS0000060211.V297164.R01.S.doc Version 5.2 Page 14 Abuse awareness training is provided to all staff and policies and procedures are in place providing guidance to staff in the whistle blowing process. Burford House DS0000060211.V297164.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. The environment was well maintained with health and safety protocols in place. The home was clean and pleasant and hygienic. EVIDENCE: The inspectors carried out a tour of the home and observed that it was well maintained; an order was in place for the purchase of a new carpet to replace a carpet that had some staining. Fire safety protocols were in place; the fire safety records were examined during the inspection process and a maintenance man is employed to carry out audits and maintenance to the premises. The home was fresh and clean with no odours. Burford House DS0000060211.V297164.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 -30 The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. The home is adequately staffed and the staff members have a skill mix between them providing residents with a safe service. The residents are protected by the home’s recruitment policy and practices. The planned dementia training will further enhance staff competence to do their jobs. EVIDENCE: During the visit of 4th May 2006, it was observed that staffing levels had been increased to cope with changing needs and this had been maintained. The home’s rota was seen and copies were provided; the rotas showed that some of the staff work long hours and this was discussed. The manager stated that observation is maintained to ensure that staff do not become overtired. At the additional visit inspection on 4th May 2006, a requirement was made for dementia training to be provided for staff to ensure that staff were fully equipped to understand the needs of people who have dementia; during this inspection evidence was provided that several staff would be attending dementia training in the week post inspection. Burford House DS0000060211.V297164.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 The overall quality in this outcome group is adequate with some areas needing improvement; this judgement has been made using all available evidence including a visit to this service. The home currently does not have a registered manager; a new manager has been recruited and is in post. The home is run in the residents’ best interests and their financial interests are safeguarded. Formal supervision on a regular basis needs to be provided to all staff. The health, safety and welfare of residents and staff is promoted and protected. EVIDENCE: The proprietor is qualified and experienced and has made a judgement that the new manager is fit to be in charge of the home; as an outcome of this inspection visit, a requirement has been made for an application for registration of the manager to be made.
Burford House DS0000060211.V297164.R01.S.doc Version 5.2 Page 18 Evidence was provided that regular residents’ meetings are held to ensure that residents are involved in running the service in their best interests and a quality assurance survey is also carried out by the home. The residents spoken with stated that the chef obtains their views regarding the level of satisfaction with the food served and is happy to make alterations to suit preferences. Discussions with staff provided evidence that formal supervision was not provided to all staff on a regular basis and this needs to be in place at least every 8 weeks or 6 times per year in addition to the annual appraisal of all staff. Records were well maintained and staff training provided in the interests of health, safety and welfare of residents and staff (see other sections of this report regarding records seen). Burford House DS0000060211.V297164.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 1 8 3 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 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 1 X 3 Burford House DS0000060211.V297164.R01.S.doc Version 5.2 Page 20 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. 1 Standard OP7 Regulation 15 Requirement Timescale for action 16/07/06 2 3. OP31 OP36 8(1) 18(2) Care Plans must contain risk assessments as appropriate, including electric chairs/recliners, bed rails and falls and these must be kept reviewed. (An agreement was reached that risk assessments would be prioritised according to risk but all care plans will need to be reviewed within the time scales given in respect of risk assessments). An application for registration of 30/07/06 the manager must be received by the CSCI. All care staff must receive formal 30/07/06 supervision at least 6 times a year and records of supervision must be maintained. Burford House DS0000060211.V297164.R01.S.doc Version 5.2 Page 21 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 OP16 Good Practice Recommendations Continue to monitor and generate a culture of being at ease with making a complaint or raising an issue, especially with those residents who may be more anxious about raising concerns. Record efforts in this area. The appointment of a deputy manager remains strongly advised. 2. OP27 Burford House DS0000060211.V297164.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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