CARE HOMES FOR OLDER PEOPLE
Burgh House High Road Burgh Castle Great Yarmouth NR31 9QL Lead Inspector
Hilda Stephenson Unannounced 11 July 2005 11.00am 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 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. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Burgh House Address High Road Burgh Castle Great Yarmouth NR31 9QL 01493 780366 01493 780366 info@burghhouse.co.uk Burgh House Residential Care Home Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Helen Harris Care Home 33 Category(ies) of Old Age (33) registration, with number of places Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Thirty-three (33) Older People may be accommodated. Date of last inspection 3 February 2005 Brief Description of the Service: Burgh House is a care home providing personal care and accommodation for 33 older people and is owned by Mrs Church-Greiner and Mr Greiner. The home is situated within the village of Burgh Castle on the outskirts of Great Yarmouth. The home was opened in 1987 and consists of a two-storey building. It has 29 single and two shared bedrooms with en-suite facilities, one of the single bedrooms is used for respite accommodation and has no ensuite. Access to the first floor is via a shaft lift. The premises consist of a two-storey building situated in large attractive grounds with ample parking at the front of the building. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit to Burgh House was undertaken as an unannounced inspection taking three hours during the lunch time period. A partial tour of the premises took place, staff records, care plans and required records were examined. Two of the five staff, eight of the thirty-one residents, one visitor and the proprietors was spoken to during the visit. The home was found to be clean, tidy with no unpleasant aroma. A small amount of construction work was being carried out at the front of the building. The manager is away for a period of time and the home is currently being managed between the deputy manager and the operational co-ordinator, with ongoing daily support provided by both proprietors. What the service does well:
The home is run as an efficient business offering services and facilities within the statement of purpose by both proprietors with evidence of development for the future. The home has a small loyal staff team who have worked at the home for some time. The manager is currently off for a short period of time and the home is currently being managed by the deputy manager and operational co-ordinator. Residents and visitors have been kept informed and knew who to speak to if they had any issues or concerns, while the manager is away. Both proprietors visit the home most days to offer support. The environment consists of two main lounges and one dining room with two other smaller areas for the residents to entertain visitors. The home was clean, tidy and free from odour and is cleaned on a daily basis. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 6 Burgh House is renowned for the organised activities during the week, with extra clothes parties, fetes and shopping events organised on an occasional basis. Residents wishes are respected for those who prefer not to take part. The care plans and records are well monitored and reviewed on a regular basis. There appeared to be sufficient numbers of staff to meet the residents’ needs during this busy lunch time period. What has improved since the last inspection? 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. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 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 standard(s) 3,5 Each resident has an assessment of his or her needs prior to admission for a trial period. Both residents and their relatives are encouraged to visit the home beforehand. EVIDENCE: Three care plans were seen and contained records of the assessment visits undertaken by the manager. The assessment records contained details of the needs of each individual. Each resident is invited to visit the home prior to admission, some stay for lunch. In some cases the relatives visit the home in place of the prospective resident to ensure that Burgh House would be right for there relative. One resident who has lived at the home for a year stated ‘I knew the home before I came here because I was a regular visitor, the staff are very friendly and look after me very well, and that helped me make up my mind to come to this home’. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 9 Several residents confirmed that they knew they would need a review meeting before making up their mind before staying at the home, with the majority having some input with their care plans. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Care plans and health needs of residents are identified, reviewed and are met, with knowledgeable staff having a good understanding of the residents’ needs. Further attention is required to sign all entries in the medication records sheets. EVIDENCE: Three care plans were seen; all of these contained personal, health and social care needs of the residents, although the risk assessments were stored in a separate folder. Care plans are kept in individual files with daily notes recorded to enable staff to follow the care needs of the residents. The care plans are written and reviewed by the key workers on a regular basis with the proprietor monitoring this. One resident stated ‘I ring for help when I want to get up and go to bed, but I can manage most other things during the day’. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 11 Evidence within the care plans of visits from other professionals such as the district nurse, GP and social worker were seen. It was obvious the home obtains advice from other professionals to continue and maintain care for the residents. The medicines are stored and administered by staff that has undergone the recent medications course provided through a local college although some gaps were seen within the medication records. This should be monitored by the deputy to ensure that all records are signed appropriately. The home has a medication policy and encourages residents to self medicate if appropriate with relevant risk assessments in place. Medication was stored in a secure locked cupboard. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Social activities are well managed with several group and individual interests for residents living in the home, with lunch and teatime included as a sociable event. EVIDENCE: The home is renowned for their organised daily activities from Monday to Friday with residents preferring a quieter weekend. Each afternoon the home has outside people visiting to arrange an activity for groups, with the home’s own staff arranging individual interests if they do not wish to take part. The week ends with ‘boozy bingo’ arranged by the proprietor with visitors regularly taking part as well. Occasionally, a clothes party, summer fete or special party is arranged throughout the year. This month a summer fete is being arranged by the proprietor with residents and visitors also being involved, which is very good practice. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 13 Visitors are welcomed into the home and it was observed that several visitors were seen during the inspection. One visitor stated ‘the staff are very friendly and welcoming, so I have no problem with popping in to see mum, and they ask mum’s views when they arrange parties, which is good’. The lunch was served to residents during this visit with the majority of residents going to the dining room. This was nicely laid out in tables to seat up to four people. Several residents confirmed that the cook asks them there preferences for meals and that plenty of snacks and drinks are served during the day. Any resident who requires a specialised diet can also be catered for. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has a satisfactory complaints system with evidence that residents’ views are listened to and acted upon. EVIDENCE: The home has a detailed complaints procedure and complaints are recorded with the necessary action taken. Residents and staff commented that they prefer to speak to the Proprietor or deputy manager if they had any concerns. No complaints were received during this inspection. A procedure for responding to allegations of abuse was in place. The proprietor has a adult protection booklet for all the staff to keep up to date on matters of abuse, and staff confirmed that they had received these and regularly kept up to date by attending adult protection workshops which is very good practice. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 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 standard(s) 19,25,26 The home is clean, tidy and provides a comfortable environment for residents to live. EVIDENCE: Burgh House is a detached two-storey property within the village of Burgh Castle. It is surrounded by well-maintained large gardens with a seating area and patio at the rear. The maintenance of a drain is currently being undertaken at the front of the building. The proprietors have plans in place for the following year and have recently upgraded four bedrooms since the previous inspection, as well as redecorating a hallway, laundry and replacing some windows on the first floor in line with the regulations. A partial tour was undertaken; the home was clean and tidy with two comfortable lounges and dining room. There are two smaller areas situated off the main corridors where residents can entertain visitors if they do not wish to go to their rooms.
Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Sufficient numbers of well-trained staff are on duty to meet residents’ needs, with extra staff brought in to cover busy periods. EVIDENCE: The home has a core team of staff with the majority having worked at the home for several years. During the morning three care staff and the deputy manager are on duty reducing to two care staff and one senior until the evening, reducing to two care staff overnight. The proprietor has introduced a system of ‘on call duties’ in the deputy manager or operational co-ordinators absence. The staff has increased the number of staff who have achieved or are undertaking the recommended NVQ training and should be praised for this. Staff confirmed that they feel well supported by the proprietors and operational co-ordinator regarding the amount of training they are offered. Staff training records identified areas of training that the majority of staff have recently undertaken including moving and handling, food hygiene, first aid, medication administration and infection control. Newly employed staff are monitored through the induction programme and are supervised by the deputy manager or senior staff. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The home has good health and safety procedures in place to ensure the safety of both residents and staff. EVIDENCE: The operational co-ordinator ensures the health and safety procedures are followed. The home has a regular fire procedure to follow with records in place to confirm this takes place. An accident policy has been adapted for audit purposes to reduce accidents where possible with relevant risk assessments in place. Individual risk assessments for residents should be kept within the care plans to enable them to be reviewed at the same time as the care plans. General risk assessments are stored in a file for staff to follow. These are regularly reviewed with staff during supervision.
Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 18 Training records for staff were seen with mandatory training being kept up to date. Samples of the required records such as the insurance, environmental health checks and registration certificate were also seen and had been kept up to date. Overall, the home has developed a good system for monitoring health and safety issues to provide a safe home to live and work in. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 4 x x x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? 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 9 Regulation 13 Requirement The medication records must be signed for each entry. Timescale for action Immediate and ongoing 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 38 Good Practice Recommendations Risk assessments for residents should be kept within their care plans so they can be regularly reviewed. Burgh House I55 S27440 Burgh House V236420 110705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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