Inspection on 24/11/05 for Burford House

This inspection was carried out on 24th November 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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Burford House Rickmansworth Road Chorleywood Hertfordshire WD3 5SQ Lead Inspector Angela Dalton Unannounced Inspection 23rd November 2005 09:50 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.V267046.R01.S.doc Version 5.0 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.V267046.R01.S.doc Version 5.0 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 Frances Shaw Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Burford House DS0000060211.V267046.R01.S.doc Version 5.0 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 1st June 2005 Date of last inspection 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 DS0000060211.V267046.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two Inspectors on November 24th 2005 between 9.40am and 1.50pm. It follows an additional visit conducted on the 31st August 2005 also by two Inspectors. Requirements made at the additional visit in August were reviewed and some have been carried forward as they remain unmet. What the service does well: What has improved since the last inspection? What they could do better: Food is a focus for service users and continues to disappoint. The poor quality of the lunch served during the inspection was borne out as one Inspector sampled the meal which confirmed service users’ comments. Recruitment practises are still poor and inadequate documentation is in place to protect service users. The medication recording system has deteriorated since the previous inspection and this is disappointing but may be due to adjustment to the use of a new system. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 Page 6 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.V267046.R01.S.doc Version 5.0 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.V267046.R01.S.doc Version 5.0 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): 1 Service users have access to information to enable them to make an informed choice about the care home they reside in. EVIDENCE: Following previous requirements being made at several inspections a Statement of Purpose is now available. This document explains the facilities that the home offers with an overview of the ethos of the home and information regarding terms and conditions. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 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 Care plans do not adequately reflect how individual needs will be met. Dignity of service users is not consistently observed. The system for administering and recording of medication does not safeguard service users. EVIDENCE: Needs are identified but the management and review of individual needs is not always recorded e.g. sensory impairment, pressure sores, falls. Care plan document is being reviewed and risk assessments are being collated with the plan of care to ensure all information is kept together. The manager is aware of the developments needed and the requirement has been repeated. A requirement has again been made regarding medication. A new system has been recently introduced to the home which should improve safe handling in the future. This is the first month of the changeover and the following issues were identified: Medication is not always dated on opening. Amounts are not carried forward so reconciliation would prove difficult. When amounts of medication were checked they did not balance on each occasion. Service users who are taking Risperidone must have evidence from the G.P. in recognition of Department of Health guidelines. Labels are used on Medication Administration Recording sheets which is poor practice as they are liable to fall off. A label was missing from a bottle of medication that was being administered. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 Page 10 Temperatures were recorded which is good practice and excess stock is being reduced. A service user with a visual impairment reported that staff entered their room without prior introduction. They also rely on a sighted resident to request their food to be cut up at mealtimes and request for staff attention. This illustrates that staff require guidance from the care plan and training (which is being offered) to provide better care. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 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): 12,15 Activities are offered at frequent intervals. Food is unsatisfactory. EVIDENCE: Service users enjoy regular activities and a music and movement exercise session took place during the inspection. Relatives reported they had observed a flower arrangement session during a recent visit. Relatives commented they felt it would benefit the residents if the home had its own transport to enable more regular outings. Food continues to be an issue within the home. Service users stated that the food was ‘terrible’ and had really ‘gone down’. Complaints centred on the quality, presentation and heat of food when served. One service user said that they had been looking forward to lamb chops but when they arrived they had been boiled and had lots of fat on. One Inspector sampled the food and found the meat to be tough and chewy and the accompanying vegetables and Yorkshire pudding to be cold. Service users said they would like thinly sliced meat from a joint as opposed to one thick slice or lumps of meat. They also said food was tasteless and the chef needed a cookbook containing traditional English recipes. It is strongly recommended that a senior member of staff tastes the food each meal to ensure improvement occurs. Staff must be proactive and offer food between supper and breakfast to those service users who have difficulty in making their needs known. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 Page 12 The chef was aware of two service users with diabetes but no information is available in the kitchen to reflect details from the care plan e.g. low salt diet or restricted vegetables. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 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 A system for recording complaints is now in place. EVIDENCE: A system for effectively recording complaints has been introduced. The manager must link this process to concerns and complaints raised informally such as the quality of food which was raised in a residents’ meeting and at mealtimes. The complaints procedure is now available to service users with a visual impairment in the format of an audio tape. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Flooring was not in a service user’s bedroom. Unpleasant odours were present in parts of the home. EVIDENCE: Plans are in place to replace the carpet in a bedroom identified at the previous visit (August 31st 2005). This has been done in conjunction with the family but is taking longer than was expected. The lead Inspector was assured by the proprietor work would be completed in the next seven days. Decoration is to take place in communal areas and the manager is drawing up an action plan so disruption to service users is minimal. New domestic staff have been employed and aim to address the odours in some areas of the home. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 Page 15 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): 27,29,30 The hours that staff work compromises their ability to provide a high standard of care. Recruitment records were incomplete indicating that the homes recruitment practises do not protect service users. EVIDENCE: The manager is reviewing hours worked by staff following concerns raised at the previous visit where staff were identified as working up to sixty seven hours each week. A requirement has been made to send a copy of risk assessments and agreements signed by staff to the Commission. Concern relates to the ability of staff to provide good quality care to residents after working long hours. Recruitment records were again 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 photos are not in place. Work permits are not evidenced or authenticated. Service users protection from abuse is therefore not assured. Recruitment has been an ongoing issue within the home and an Enforcement notice was served at the previous visit. The CRB identified as missing on this occasion is still not in place. An action plan is in place for the member of staff but the situation is far from satisfactory. The manager had employed a member of staff without a Criminal Record Bureau check which is the same scenario as the previous inspection. Some training has been provided and it is hoped that this will be ongoing to ensure the competence of staff. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 Page 16 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): 38 The health and safety of service users is not assured. EVIDENCE: Rodent poison is evident within the home. The use of this must be risk assessed and the placement of the bait must be reviewed. Service users complained that the heating was erratic within the home and had become so since the boiler was serviced in the past week. Heating within the home must be regulated so it is neither too hot nor too cold. A copy of the Environmental Health Inspector’s report is required as this was not available on the day of inspection. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Burford House DS0000060211.V267046.R01.S.doc Version 5.0 Page 18 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 OP8OP7 Regulation 12(3)& 15(1) Requirement 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. This requirement remains unmet. Medication must be dated on opening (Made at previous inspection) Medication amounts must be carried forward onto Medication Administration Record (MAR) Sheets to enable reconcilliation to take place. Labels must not be used on MAR sheets. Medication must be appropriately labelled. This requirement remains unmet. Privacy, dignity and choice of service users must be observed e.g. staff must be mindful and aware of specific needs such as visual impairment. This requirement remains unmet. Food must be served hot. It must be tasty, edible and of good quality. This must be DS0000060211.V267046.R01.S.doc Timescale for action 31/12/05 2 OP9 13(2) 30/11/05 3 OP10 12(3) 12(4)(a) 30/11/05 4 OP15 16(2)(i) 30/11/05 Burford House Version 5.0 Page 19 5 6 7 OP19 OP26 OP27 16 16(2)(k) 18 8 OP29 17(1)(a) 19(1)(b)& (4) 9 OP38 13 (4) audited at each meal and steps taken to ensure improvement. Staff must be proactive and offer food between supper and breakfast to those service users who have difficulty in making their needs known. This requirement remains unmet. The flooring in bedroom 10 must be suitable for the needs of the occupant. The odour associated with urine in the home must be addressed. Risk assessments must be conducted for night staff and agreements must be in place for staff hours worked. Copies must be sent to the Commission. Appropriate recruitment checks must be conducted prior to staff commencing employment. Records must be available for inspection. THIS REQUIREMENT WAS MADE AT THE PREVIOUS INSPECTION. AN EFORCEMENT NOTICE WAS SERVED. Staff are working without clearance from the Criminal Records Bureau. Application forms remain inadequate to ensure comprehensive information is received. Inadequate references are in place and their validity is not checked. The health and safety of service users must be assured. Regulated heating must be provided. Rodent poison must be risk assessed and the placement of bait reviewed. A copy of the recent Environmental Health report must be sent to the Commission. 30/11/05 28/11/05 04/12/05 30/11/05 28/11/05 Burford House DS0000060211.V267046.R01.S.doc Version 5.0 Page 20 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 is again strongly advised. Burford House DS0000060211.V267046.R01.S.doc Version 5.0 Page 21 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 © 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 DS0000060211.V267046.R01.S.doc Version 5.0 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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