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Inspection on 04/12/08 for Burgess Park Nursing Home

Also see our care home review for Burgess Park Nursing Home for more information

This inspection was carried out on 4th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a very stable staff team. All of the nursing staff have worked at the home for some years. This means that they know the residents well, and are familiar to them. It also means that they are familiar with the policies and procedures of the managing organisation. The home is working towards to implementation of a model of good practise for end of life care. The staff have received training and when we discussed these issues with staff they were very sensitive and caring, both in talking about the resident and their families. The Registered Manager is well qualified and experienced for her role. She provides a good role model for her staff team. Some comments received from residents and relatives included: `The Manager, nurses and staff are marvellous at Burgess Park Nursing Home`. `the staff are always ready to listen to anything we ask them and are always ready to help`. `the staff treat [my relative] with care and kindness, we are very happy with her care.`

What has improved since the last inspection?

All of the requirements made at the last inspection have been met. This means that care plans now include all the details required to provide care which suits residents` needs, some redecoration has been done, and items which might be risky are stored safely. A particular improvement has been in relation to staffing, there are now more staff on duty to look after the residents well, and staff are not expected to work unreasonable hours. This has improved staff morale in the home.

What the care home could do better:

We have made one requirement and three recommendations. The requirement is that senior managers from the managing organisation must visit the home at least monthly as required by Regulation. The recommendations are - to consider increasing the number of options available at mealtimes on the alternative African and Caribbean and Italian menus. This will allow the residents to have more variety at meal-times. We also recommend that plans to replace some of the bathrooms with wet rooms are implemented. This will enable residents with mobility problems to use a shower. The final recommendation is that consideration be given to the redecoration and refurbishment of the smoking room so that the people who use it have a more pleasant environment.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Burgess Park Nursing Home Burgess Park Picton Street Camberwell London SE5 7QH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Pritchard     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Burgess Park Nursing Home Picton Street Burgess Park Camberwell London SE5 7QH 02077032112 02077014220 burgesspark@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Spiwe Ruth Rondozai Type of registration: Number of places registered: Exceler Healthcare Services Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Burgess Park Nursing Home is located in a residential area of Camberwell. The home is registered to provide care for sixty older people who have nursing needs. In December 2008 there were fifty five residents in the home. The facilities in the home are spread over three floors. There are lounges on the ground and first floors of the home and dining facilities are on the ground floor. Bedrooms are located on all three floors of the Care Homes for Older People Page 4 of 24 Over 65 60 0 Brief description of the care home home. There are two double bedrooms and the remainder are single. Twenty three of the bedrooms have en-suite facilities. There is a passenger lift allowing all residents to have access to all parts of the home. There is a garden to the front of the home and parking is available on the street as well as in a car park to the rear of the home. Information about the service is made available to potential service users in a number of ways including when telephone enquiries are made, during introductory visits to the home, through the homes brochure, statement of purpose and service user guide. The home ensures that copies of CSCI inspection reports are made available to potential service users by ensuring that a copy is located in the hallway for review, enquirers are directed to the CSCI website and the reports are discussed at relatives meetings and staff meetings. In December 2008 the range of fees charged was between £582 and £690 a week. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and carried out over two days in early December 2008, we spent a total of 16 hours at the home. The inspection methods included observation of care practise, discussion with residents, relatives and staff. We looked at a range of files, including residents files, staff recruitment records, financial details and health and safety records. We walked around the home and looked at communal areas, we also saw a selection of bedrooms and bathrooms. Residents, relatives, staff and involved professionals were sent survey forms so that they could contribute their views to the inspection. We received a lot of completed surveys and we are grateful to everyone who took the time to complete them. Care Homes for Older People Page 6 of 24 The CSCI receives information about certain events in the home about which they are obliged to inform us. We also have access to a document called an Annual Quality Assurance Assessment (AQAA) which was completed by the Registered Manager in advance of the inspection. It gives us statistical information about the home, and also details what they feel they have achieved and what they intend to do over the coming year. The Registered Manager and the staff at the home were very helpful and courteous during our visits to the home and we are grateful to them for their assistance. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents benefit from being provided with enough information about the home to be able to decide if it is suitable. Staff from the home assess potential residents needs to be sure that they can meet them. Evidence: People who live at the home told us that they, or their relatives, were able to visit before they made the decision to move there. Assessments were carried out by staff from the home and information gathered from professionals familiar with the persons needs. Each person moving to the home is provided with a contract, a resident confirmed that they had received the document. Some people move to the home for a short stay before making the decision to move there permanently. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from care which takes into account the full range of their needs. The home has good contact with the GP and other health care professionals involved with older people. Medication management is satisfactory and specialist advice is being implemented. Residents need for privacy is respected, as is their dignity. When appropriate, residents wishes about care at the end of their lives are sought, and efforts are made to observe them. Evidence: We looked at seven care plans, selected from all three floors of the home. Some of the care plans were for people on short term placements, others for permanent residents of the home. We found that the plans were comprehensive, detailed and had been reviewed each month. The Registered Manager carries out checks of care plans as part of her monitoring of the standards of care. The plans included information about residents social, cultural and emotional needs as well as their physical and medical care needs. This has addressed a requirement of the last inspection of the home when Care Homes for Older People Page 11 of 24 Evidence: we found that there was insufficient attention paid to needs which arise from residents religious and cultural backgrounds. The home has good relationships with a range of health care professionals and call on specialists for their advice as necessary. Some of the nursing staff take on responsibility for particular areas of health care - such as tissue viability and mental health. The GP visits the home each week and, as required, in between these visits. Information was on each files to show the contact details of health care professionals. There is appropriate monitoring of residents weights and action taken to address any significant changes. There is a monthly evaluation of any pressure sores and we found that appropriate action was taken in all of the cases. Medication arrangements were checked on two floors of the home. We looked at the arrangements for one person who looks after his own medication. We found that the assessment of his capability to deal with his medication was clear, involved the Registered Manager, has been agreed with the GP and is reviewed regularly. We looked at the medication storage arrangements on the first floor and found they were satisfactory and the member of staff responsible for dealing with the medication was clear and knowledgeable about the homes medication policy and procedures. We heard that sometimes there is an issue around the arrangements for the provision of prescriptions. The home is in discussion with the surgery about these matters to ensure good outcomes for residents. On the ground floor the home has received advice about the management of medication from specialists in the care of older people and is in the process of implementing the advice, in liaison with the GP. Training for nurses in the safe administration of medication has been arranged to take place at the end of January 2009. Residents confirmed that when they wish to spend time alone in their rooms this is respected by staff. All of the contact we saw between staff and residents was kind and respectful. All of the residents we saw were well dressed, with regard for their age and the weather. We saw, on some residents files, end of life care plans. These are being completed in accordance with good practice guidelines. Staff have received training and are developing their practice in this area. When we discussed these matters with a member of staff they showed sensitivity to the needs of service users and their families. The home has good links with the palliative care team and is able to call on their assistance as necessary. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As the post of Activity Co-ordinator is currently vacant the residents have missed the regular programme of activities previously provided. Recruitment to the vacant post is underway. Musical and theatre groups have come to the home and a number of activities are planned for Christmas. Representatives of local Churches visit the home and conduct services. Meals are satisfactory and reflect residents preferences and nutritional and cultural needs. Evidence: At the time of our visits the post of activity co-ordinator was vacant and recruitment was underway. This has limited the availability of activities in the home.This was reflected int he feedback received from residents, relatives and staff, many of whom felt that residents would gain more benefit from a regular activity programme. Despite the vacancy some activities have taken place. Visiting entertainers have included musicians and theatre groups. Some residents went to a local school to see a play there. Arrangements have been made for a Christmas party to which relatives and friends are invited, local school children are coming to the home to sing Carols and a childrens dance show is arranged. Some people attend day centres in the local Care Homes for Older People Page 13 of 24 Evidence: community. One person told us during the inspection how much she enjoys the pottery classes she attends at the day centre and we were pleased to see an example of her work. Representatives of local churches come to the home to conduct services, - visits are made from the Roman Catholic church every two weeks and representatives from the Anglican Church visit monthly. Residents family and friends visit freely. Some of the relatives attend a relatives groups so that their views can be taken into account in the running of the home. Those residents who wish to and are able to do so may look after their own financial matters. If this is not possible, in most cases a relative takes on this responsibility. There is a four week menu planned for the home, it includes a choice at each meal and fresh fruit and vegetables. There are two additional menus from which choices can be made - one featuring African and Caribbean dishes and the other has Italian meals on it. There are four options on each of these menus and one person commented that they would like more variety to be available. The cook receives information about residents preferences and their nutritional needs so these can be taken into account in menu planning. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are confident that if they had concerns they will be listened to and investigated. The procedures of the home contribute to the protection of service users. Evidence: The records showed that there had been four upheld complaints since April 2008. We judged that the complaints had been investigated properly and appropriate action had been taken in response,including apologising to the complainant. All of the feedback that we had from service users was that they knew who to talk to if they wished to make a complaint. They said that they were confident it would be dealt with. There are safe arrangements to deal with any money or other valuables that are kept on behalf of service users. Access to the valuables is limited and there are management checks and audits carried out regularly. Money held on behalf of residents earns interest and this is credited to the resident. The majority of the staff team have received training in safeguarding issues over the last year. Staff were clear about the action they would take in the event of a concern being raised with them. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have benefited from the programme of redecoration. There remain some areas that could be further improved - including the smoking room. Residents with mobility needs who cannot use the baths easily will benefit from a plan to change bathrooms into wet rooms. The building is clean and good attention is paid to infection control matters. Evidence: The home is situated on a residential street in Camberwell. There is on street parking available and there is a small car park to the rear of the home. Public transport routes and a range of facilities, shops, restaurants and pubs, are available in Camberwell. Most of the communal areas are on the ground floor and they are in good condition, clean, fresh and decorated in a homely way. There is also a garden to the front of the home for which good quality furniture has been bought. There is a smoking room on the first floor of the home, this is in a less good condition and would benefit from redecoration and refurbishment. There is a lift allowing access to the upper floors of the home. On the corridors there are handrails fitted and lighting is good. Bedrooms, all of which are single, have been redecorated as have some of the bathrooms. The Registered Manager hopes to be able to convert some of the bathrooms into wet rooms. This will benefit the residents as currently some of the bathrooms cannot accommodate hoists to assist residents. The home was free from offencive odours on Care Homes for Older People Page 16 of 24 Evidence: our visits and the laundry facilities are adequate for the needs of the home. on each floor of the home hand cleaning products are available for staff, residents and visitors. This is part of the homes infection control strategy. An audit of infection control matters in the home carried out was carried out by the PCT in January 2008. The home has put in place an action plan in response. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are trained staff in sufficient numbers available to meet the needs of the residents. Recruitment practise is safe and assists in the protection of residents. Evidence: There is a nurse on duty at all times of the day on each floor of the home. They are assisted by, on the first floor one member of care staff; on the first floor by five care staff in the morning and four in the evening. On the second floor the nurse is assisted by three carers. At night time there are two RGNs on duty and five care staff. These staffing levels have increased since our last visit to the home and the feedback we received from both residents and staff is that they are more appropriate for the needs and numbers of the residents. We were also pleased to hear that no staff are working excessively long shifts as was previously the case and overall the rota planning is now more effective. As a result of these improvements we were told that staff morale is now higher and there is a greater sense of teamwork, which will be beneficial for the residents. we were told by some of the nursing staff that the carers role is important and they are valued members of the staff team, one nurse described the care staff on her floor as very very good. This reflected our observations which were of staff, at all levels, Care Homes for Older People Page 18 of 24 Evidence: having warm supportive contact with the residents. Of the 28 care staff, 19 have achieved NVQ2, two have achieved NVQ 3 level of training. There are a further 13 staff who are registered to do NVQ 2 or 3, or are already studying. This represents 86 of the staff team which exceeds the minimum standard. A sample of recruitment records was checked. They were in good order and showed that the appropriate checks and references were taken up. This is an important element in the protection of residents. A training matrix is used to monitor staff training and this showed that the staff team have received training in a range of issues mandatory health and safety training and in safeguarding issues and nutrition. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are effective, open and have produced improvements in the home. Those residents who wish for the home to manage money on their behalf are protected by safe systems. Health and safety is managed well. Senior Managers from the managing organisation have not visited the home as frequently as required and reported on their findings. Evidence: The manager of the home has been registered under the Care Standards Act since 2005. She is well qualified and experienced for the role, and continues to update her learning. The Registered Manager is familiar to the residents and with their needs. She presents a good role model in her calm and kind manner with residents. There is effective quality monitoring at the home based on a system of regular audit. We found that visits on behalf of the managing organisation have been completed infrequently and there were reports of only three visits in 2008. There have been Care Homes for Older People Page 20 of 24 Evidence: several changes of personnel within the managing organisation and this has led to inconsistency in these visits. The current Operations Manager expressed her commitment to improving this area. We checks records of financial transactions carried out on behalf of residents. They were in good order and checking systems are built in so that residents interests are protected. Some people hold cash in a central account and they earn a small amount of interest on the money held on their behalf. Health and safety matters were in good order, we saw records that confirmed weekly checks of the fire and emergency lighting systems and a current fire risk assessment. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 26 The Registered Person must ensure that visits as required by Regulation are carried out each month and reports of the visits made. This will give residents and staff have the opportunity to raise issues with a representative of the managing organisation . 09/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 15 The Registered Manager should consider increasing the number of options available on the African and Caribbean and Italian menus. The smoking room should be included in the programme of redecoration and refurbishment so that the residents who use the room benefit from a better environment. The plan to refit some bathrooms as wet rooms should be implemented so that residents benefit from bathing facilities that more closely meet their needs. 2 20 3 21 Care Homes for Older People Page 23 of 24 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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