Random inspection report
Care homes for older people
Name: Address: Burgess Park Nursing Home Burgess Park Picton Street Camberwell London SE5 7QH two star good service 09/12/2008 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Alison Pritchard Date: 0 8 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Burgess Park Nursing Home Burgess Park Picton Street Camberwell London SE5 7QH 02077032112 02077014220 burgesspark@schealthcare.co.uk www.schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Exceler Healthcare Services Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 60 Number of places (if applicable): Under 65 Over 65 60 old age, not falling within any other category Conditions of registration: 0 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.
Care Homes for Older People Page 2 of 12 0 9 1 2 2 0 0 8 Brief description of the care 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 home. 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 and in a small car park to the side of the home. The current manager has been in post since early November 2009. Care Homes for Older People Page 3 of 12 What we found:
We carried out this random inspection so that we could look at how the home was meeting standards relating to care planning; medication; provision of meals; staffing and the environment. Other observations were made during our visits and these are recorded below. Two inspectors visited the home on 8th March and on 17th March a Pharmacy Inspector visited the home. During our visits we spoke to residents, relatives and staff. We also had contact, before and after our visits, with involved professionals from health and social services. On the first day of our visit we arrived at 9am and found that some of the people who live in the home were awaiting their breakfast in the small dining room off the hallway. Others were being assisted by staff in their rooms to get ready for the day. All of the residents looked well rested and everyone we had contact with was well dressed with their hair tended. Care staff were observed to be gentle and caring in approach and there was a calm atmosphere. Care planning We sampled care documentation on the first and second floors. We found many gaps and inconsistencies in recording. The care plan for one resident did not reflect all the changes that have taken place in the individuals condition in the last six months.Some areas of need were not reflected on a written care plan, for example the psychological needs of this resident were not addressed. Some of the assessments were undated and because they were not evaluated regularly did not reflect all of the changes that have taken place. This contrasted with another file we found that staff had responded appropriately to changes that arose in the persons condition and made appropriate records. For example when the resident had a fall, appropriate medical assistance was sought and the falls risk management document was updated on the same day. We looked at the records of residents about whom there was concern about low body weight and poor appetite. It was identified in each case that frequent nutritional screening was necessary. Appropriate assessment tools were introduced to monitor and support the individuals with nutrition but one of the care plans was unclear about this and we found that the tools were not used effectively. There was a lack of consistency in recording weights over recent months. This could lead to the failure to identify significant changes. In other cases the records of fluid intake were incomplete. On further exploring the care arrangements with staff and management we found that the weight records were held elsewhere and not cross referenced to individual care plans. Although the documentation was poor we found evidence that staff are providing the relevant care. For example we discussed the case of the person whose weights were not recorded with the Manager. He showed us the weekly audit records which showed that she is making steady progress. We found that there is a weakness in recording systems We did not find a care plan on the support a person needed with diabetes. We enquired about the blood sugar monitoring for this person to discover that the pharmacist advised for this to be done weekly rather than daily. The care plan did not have any record made of this, neither was there any reference to this in any of the records. Care Homes for Older People Page 4 of 12 In the case of a service user admitted two weeks prior to our visit we found that although an assessment of need had been made prior to admission there was no care plan in place. There was no reference to a named nurse or key worker who should be responsible for ensuring that appropriate care was provided. In another case a nurse told us of the persons needs, including that he has a sight impairment. When we reviewed the persons file this was not addressed through the care plans. Records are held of the consultations that take place with the visiting GP. We heard from the manager that this has become much more consistent in recent months as the GP spends a much longer period at the home. There was evidence that better communication with external professionals would benefit residents. See recommendation. These findings demonstrated the need for care planning and record keeping to be improved and for relevant supporting documentation and assessment tools to be used consistently. This will help to promote and make proper provision for the health and welfare of residents. See requirements. Meals We noticed on our visits and have heard from other visitors to the home that more people are currently eating together in the dining room, rather than separately in their own rooms. While it is important that residents have the choice of where to take their meals, communal meals allow social interaction between residents and staff. In the case of residents about whom there is concern for their nutritional status it is important that this is monitored. We received information before our visit that there were concerns about the meals provided at the home. The service has experienced changes of kitchen staff and a new cook was appointed four days before our visit. A comment that we received was the food is not as good as previously experienced and needs to be improved to give people more choice. One person told us that he missed the Caribbean food that the previous cook used to provide, he said he was happy to have had chicken at a recent Sunday lunch, although he said that it was a bit hard. We observed a lunch time at the home, it was served late and residents had to wait longer than usual for the meal. It was not entirely to the satisfaction of residents when served. The meal was beef casserole, boiled potatoes and cabbage. They said that the meal was not hot enough, and the meat was rather tough. Staff were present to assist with meals. See recommendation. Environment When we arrived at the home 8th March and 17th March 2010 we noted there was a lot of discarded furniture at the rear of the home, overflowing from a skip. The Manager said that old items had been removed from the building as part of the redecoration and refurbishment programme: he was waiting for the unwanted goods to be collected by the refuse collection service. Inside the building redecoration was underway on the ground floor. The hallway had been redecorated in bright colours, as had the Managers office. Work was in progress to prepare the dining room for redecoration and a communal room
Care Homes for Older People Page 5 of 12 at the back of the building is being converted to make a leisure room for residents. The Manager informed us that a programme of refurbishment was planned for the whole building. We noted that some of the bedrooms were in a poor state of decoration. On the first and second floors there are small kitchenettes off areas where residents records are held. The kitchenettes are in very poor condition with damaged cupboards and drawers. See requirement. In one bedroom the light fitting and the call bell is not operating. We checked with the maintenance person to find that this was repair request was reported. A repair person called some days ago but did not have replacement items with him. It is recommended that provision for repairs to call bells is reviewed to ensure a speedier response to repairs. The home was clean, the daily cleaning programme was in progress during our visit. We observed that the cleaning was not completed before lunch and many dustbins in residents bedrooms were not emptied at this time. We checked the start time, and were told that staff started work at 8am which should give sufficient time to prioritise bedooms. We recommend that the cleaning programme should ensure that residents bedrooms are cleaned within a reasonable time frame to avoid inconveniencing residents later in the day. See recommendation. At the last inspection in December 2008 we made recommendations about redecoration and refurbishment of the building. We noted the hopes expressed by the then Registered Manager to convert bathrooms into wet rooms. We recommended that this plan is implemented so that the bathing facilities more closely meets residents needs. We also recommended that the smoking room is included in the redecoration and refurbishment programme. Although we heard that the current Manager is keen for the wet rooms to be created, and that the smoking room is included on the refurbishment programme this work has not yet been undertaken. A garden is available at the front of the home, it is attractive and could be a good place for residents to sit in warmer weather. It is unfortunate that sometimes the garden is used as a short cut by people in the local community, thus intruding on the residents privacy. We recommend that this is addressed through appropriate fencing. Staffing There is evidence from a range of sources that staff shortages are experienced on occasions, both during the day and at night time. We heard that, as a result of falling resident numbers, staffing levels had been reduced. We were concerned about this as it meant that one nurse was covering residents on the ground and second floors. We consider that this is a difficult task, both because of the layout of the building, and because of the numbers and needs of the residents. Since the inspection we have been informed that and increased staffing level has been agreed so that three nurses are now to be on duty throughout the daytime shifts (from 8am until 8pm) . We have made a requirement that staffing levels are maintained and kept under review to ensure that they reflect the needs and numbers of residents. Management The recently appointed Manager has previously worked within Southern Cross as a Deputy Manager in a large nursing home and is a Registered General Nurse , he has also achieved the Registered Managers Award. The Manager has begun the process of application for registration under the Care Standards Act. The majority of residents and relatives that we spoke to were positive about the changes
Care Homes for Older People Page 6 of 12 introduced by the new manager and describe him as a person with enthusiasm and energy. Some say that staff practices are improving, they also feel the manager acts in the best interest of residents and has set about making improvements. Clinical supervision for trained nursing staff has begun. The action plans introduced by the Manager included areas of shortfall identified on this inspection. The Manager has taken a proactive approach to improving standards of care. Supervisions and staff meetings are now taking place more frequently.The Deputy Manager is currently unavailable for work but experienced nurses work as team leaders and provide management cover in the Managers absence. We looked at records of visits made under Regulation 26 of the Care Homes Regulations. These visits should be made monthly and were the subject of a requirement in the last key inspection report of December 2009. We found that the most recent visit was made two days before our inspection. No visits were made during January and February 2010, as this was early in the Managers employment at the home it was important that senior management support and direction was available to him. We are aware that senior staff were unavoidably unavailable for work during this time but this task should have been given to another senior manager. The previous requirement remains in place. What the care home does well: What they could do better:
Visits required to be made each month by a representative of the managing organisation have not been taking place often enough and were missed in January and February 2010. Care Homes for Older People Page 7 of 12 Care plans need to be in place for each resident, even if their placement at the home is short term. Care planning needs to be improved so that it addresses the whole range of residents needs, including medical needs and care needed as a result of sensory impairments. Staffing levels must be adequate to meets residents needs at all times and must be kept under review, taking into account needs and numbers of residents and the layout of the building. The menu should be reviewed in consultation with residents and relatives. The review must take into account the preferences, nutritional and cultural needs of the residents. We have also made recommendations and a requirement about the refurbishment programme.; about ensuring that residents rooms are cleaned in good time and recommend that fencing is fitted to ensure residents privacy n the garden. 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 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 33 26 The Registered Person must 09/02/2009 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 . Care Homes for Older People Page 9 of 12 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, 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 7 15 Each service user must have 19/04/2010 a care plan which details how their needs in respect of health and welfare are to be met. To ensure clarity about service users needs and how they will be met. 2 7 12 Record keeping must be improved with relevant supporting documentation and assessment tools used consistently. This will assist in the promotion of the health and welfare of residents. 19/04/2010 3 19 23 The refurbishment and 26/05/2010 redecoration programme must include the kitchenettes as they were noted to be in a poor state of repair. This will ensure that facilities are in good repair, clean and reasonably decorated. 4 27 18 There must be, at all times, 01/04/2010
Page 10 of 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 suitably qualified and experienced staff in sufficient numbers to meet the needs of the residents. To ensure that service users health and welfare needs are met. 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 8 It is recommended that meetings are held with health professionals involved in the care and treatment of residents so that communication is improved between the range of professionals involved in residents care. It is recommended that the menu is reviewed in consultation with residents and relatives. The menu should reflect residents preferences, nutritional and cultural needs. It is recommended that fencing is fitted to ensure that residents can use the gardens in privacy. 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. It is recommended that provision for repairs to call bells is reviewed to ensure a speedier response is achieved and residents are not left without means to summon assistance. It is recommended that the cleaning programme is reviewed to ensure that residents bedrooms are cleaned within a reasonable time frame to avoid inconveniencing residents later in the day 2 15 3 4 19 21 5 22 6 26 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
