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Inspection on 22/01/07 for Burkitt Nursing Home

Also see our care home review for Burkitt Nursing Home for more information

This inspection was carried out on 22nd January 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Service users needs are assessed prior to moving to the home and their changing needs reviewed and met. Service users health, personal and social care needs are set out in an individual plan of care. The care plans and risk assessments examined at the time of the inspection were clear, comprehensive and very well organised. The service users needs were assessed holistically and all identified needs are documented effectively in the care planning process. The pre admittance assessment allows for the identification of service users hobbies and interests and good records are kept of participation. An activities co-ordinator is also employed. Service users can take responsibility for their own medication and are protected by the homes policies and procedures for dealing with medicines. Service users say they are treated with respect and their right to privacy is upheld. Service users find the lifestyle in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and can maintain contact with family friends and the local community as they wish. Service users enjoy their meals. Service users and their relatives and friends are confident that their complaints will be listened to and taken seriously and acted upon. Service users live in a home, which is run and managed by a person who is fit to be in charge. Service users are supported and protected by the homes recruitment policy and practices. Staff are trained to do their jobs.

What has improved since the last inspection?

The home has been undergoing some refurbishment and has new soft furnishings carpets and been redecorated. The detail recorded in service users daily records has improved.

What the care home could do better:

Service users do not have the full information required to make an informed choice about where they live. There was evidence that individual service users dignity may be compromised due to staff not being on hand to give prompt assistance when needed. Some service users that cannot make an informed choice are expected to wait at the dining table for long periods before being served with their meal. Although service users said they feel safe in the home there are a number of identified issues, which indicate that service users are not fully safeguarded and which must be addressed to improve outcomes for them. Service users safety and comfort is compromised by a number of health, safety and environmental issues identified. There has been an ongoing problem with the plumbing and on the day of the inspection sewage was observed spilling from the drain to the front elevation and down a ramped pathway. Inside the home, in that particular area, the smell of sewage emanated into the corridors, which was unpleasant and affected the bedrooms around.An immediate requirement was issued for the Registered person to contact the Environmental Health officer for advice about the issue, which may present a health risk to service users, staff and visitors. There was no evidence that a system was in place for the prevention of legionella. The manager reported that contract quotes were being obtained currently. The home is currently not fully compliant with the Regulatory Reform [Fire Safety] Order 2005. Service users needs are not being fully met due to rotas not incorporating the level of dependency and design of the building. A review of the staffing levels is recommended. Service users are supported and protected by the homes recruitment policy and practices. Staff members are trained to do their jobs but outcomes for service users would be improved by staff training in Equality and Diversity and Dementia Care.

CARE HOMES FOR OLDER PEOPLE Burkitt Nursing Home Burkitt Care Home 41-47 Melton Road West Bridgford Nottingham NG2 7NE Lead Inspector Jayne Hilton Key Unannounced Inspection 22nd January 2007 10:15 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 Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burkitt Nursing Home Address Burkitt Care Home 41-47 Melton Road West Bridgford Nottingham NG2 7NE 0115 981 4046 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) Mr David Hetherington Messenger Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55) of places Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named service user shall be within Category PD Service user shall be within the Category OP Date of last inspection 7th November 2005 Brief Description of the Service: The Burkitt is a care home registered for 55 people, providing both nursing and personal care for older people. The home was first registered by the Nottingham Health Authority on 20th January 1986. The home is an older, converted and extended detached property, with bedrooms on the ground, first and second floor. There are 2 passenger lifts, which facilitate access to the upper floors. Handrails and adapted toilet and bathing facilities are available. There are 30 single bedrooms, 11 of which have en-suite facilities and 6 double bedrooms, none of which have en-suite facilities. There is a lounge and dining room on the first floor and a large lounge and small dining area on the ground floor. The home is situated on one of the main roads running through West Bridgford and is thus convenient for public transport. The centre of West Bridgford is also close by which offers facilities such as shops, cafes, a library and public houses. The home has an enclosed garden to the rear of the property. Information about the fees charged was not provided. Information within the Service user Guide indicates that fees charged are dependent on The type of facility required and the type of care package and needs of the individual service user. Information of what is not included within the fees charged is in the Service user guide and includes newspapers, personal toiletries and Chiropody. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 5 daytime hours. The main method of inspection used was called ‘case tracking.’ This involves selecting three residents and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading residents’ records and documents. The residents who were “case tracked” were not able to help by giving an opinion about the care provided. Due to time spent on some specific areas of concern two residents who could express an opinion was interviewed. No relatives were spoken with during the inspection but comments are included from ten service user/relative questionnaires Three members of staff and the manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. Information was also provided, by the manager in the pre-inspection questionnaire. What the service does well: Service users needs are assessed prior to moving to the home and their changing needs reviewed and met. Service users health, personal and social care needs are set out in an individual plan of care. The care plans and risk assessments examined at the time of the inspection were clear, comprehensive and very well organised. The service users needs were assessed holistically and all identified needs are documented effectively in the care planning Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 6 process. The pre admittance assessment allows for the identification of service users hobbies and interests and good records are kept of participation. An activities co-ordinator is also employed. Service users can take responsibility for their own medication and are protected by the homes policies and procedures for dealing with medicines. Service users say they are treated with respect and their right to privacy is upheld. Service users find the lifestyle in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and can maintain contact with family friends and the local community as they wish. Service users enjoy their meals. Service users and their relatives and friends are confident that their complaints will be listened to and taken seriously and acted upon. Service users live in a home, which is run and managed by a person who is fit to be in charge. Service users are supported and protected by the homes recruitment policy and practices. Staff are trained to do their jobs. What has improved since the last inspection? What they could do better: Service users do not have the full information required to make an informed choice about where they live. There was evidence that individual service users dignity may be compromised due to staff not being on hand to give prompt assistance when needed. Some service users that cannot make an informed choice are expected to wait at the dining table for long periods before being served with their meal. Although service users said they feel safe in the home there are a number of identified issues, which indicate that service users are not fully safeguarded and which must be addressed to improve outcomes for them. Service users safety and comfort is compromised by a number of health, safety and environmental issues identified. There has been an ongoing problem with the plumbing and on the day of the inspection sewage was observed spilling from the drain to the front elevation and down a ramped pathway. Inside the home, in that particular area, the smell of sewage emanated into the corridors, which was unpleasant and affected the bedrooms around. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 7 An immediate requirement was issued for the Registered person to contact the Environmental Health officer for advice about the issue, which may present a health risk to service users, staff and visitors. There was no evidence that a system was in place for the prevention of legionella. The manager reported that contract quotes were being obtained currently. The home is currently not fully compliant with the Regulatory Reform [Fire Safety] Order 2005. Service users needs are not being fully met due to rotas not incorporating the level of dependency and design of the building. A review of the staffing levels is recommended. Service users are supported and protected by the homes recruitment policy and practices. Staff members are trained to do their jobs but outcomes for service users would be improved by staff training in Equality and Diversity and Dementia Care. 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. The summary of this inspection report can be made available in other formats on request. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 8 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 Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users do not have the full information required to make an informed choice about where they live. Service users needs are assessed prior to moving to the home and their changing needs reviewed and met. The home does not provide an intermediate care service. EVIDENCE: The Statement of Purpose was not displayed in the home on the day of the inspection but copies of the Service User Guide were available on request and a copy of this was examined. The Service User Guide contains the contract but there were no copies of contracts seen on any of the service users records examined. One complaint made referred to there being no contract issued. There was no information posted to inform service users or their Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 10 representatives of how they can access a copy of the most recent inspection report and information about the actual fee amount charged were not detailed or provided in the re inspection information, where requested, neither was there any evidence on service users personal information that they had been informed about the fees or any changes to the fees. It is recommended that service users or their representative’s sign for receipt of the service user guide and a copy of the contract be kept on individual service users files. There was evidence that the diversity needs of service users is generally well promoted however staff need to have training to embrace the Equality and Diversity agenda further. The registered person also needs to address the capacity for consent within the assessment and review process. The registered manager stated that she had arranged for many of the service users to be re-assessed by nursing determination assessors or social workers as their needs and dependency levels have changed. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users health, personal and social care needs are set out in an individual plan of care. Service users can take responsibility for their own medication and are protected by the homes policies and procedures for dealing with medicines. Service users say they are treated with respect and their right to privacy is upheld however there was evidence that individual service users dignity may be compromised due to staff not being on hand to give prompt assistance when needed. EVIDENCE: The care plans and risk assessments examined at the time of the inspection were clear, comprehensive and very well organised. The service users needs were assessed holistically and all identified needs are documented effectively in the care planning process. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 12 The healthcare needs of service users and how these are met were well documented. A district nurse spoken with at the inspection reported that the district nurse team had no concerns about care provision at the home. Attention is needed to ensure that new care plans are implemented for newly identified pressure areas. Risk assessments should be implemented for denture soak tablets. Medication management was assessed and found to be satisfactory. At the time of the inspection no service users were responsible for the selfadministration of medicines. It was established that should a service user wish to be independent in the administration of medicines and has been assessed as being safe, self-medication would be facilitated however there was no documentation available for this such as an appropriate risk assessment and capacity for consent. It is also recommended that the storage temperatures of medication be monitored. Service user stated that the staff always respected their privacy and that all the staff within the home speak to them in a respectful manner. Within comments made by service users and staff it was raised that service users do have to wait longer than necessary for assistance to the toilet or for call alarms being answered on occasions due to staff being busy and not by deliberate neglect. It was also raised that there was also on occasions some expectation by night staff that service users be in bed by 8pm although service users said they did have a choice about their daily routines including getting up and bedtimes. Service users were also observed on the day of the inspection, to be sat at the dining table for a long period prior to lunch being served. The Registered Provider needs to address the issues raised within the staffing provision issues raised. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users find the lifestyle in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and can maintain contact with family friends and the local community as they wish. Service users enjoy their meals, however some service users that cannot make an informed choice are expected to wait at the dining table for long periods before being served with their meal. EVIDENCE: The pre admittance assessment allows for the identification of service users hobbies and interests and good records are kept of participation. An activities co-ordinator is employed. The activities coordinator, who is currently employed over four days, is responsible for the provision of varied and stimulating social activities such as knitting, bingo, guest entertainers, painting, colouring, film afternoons, glass painting, gardening and flower arranging, church service and monthly resident meetings. Activities in the wider community are provided for example football Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 14 matches, attending the local church of chosen faith, shopping trips, park and pub trips and various social clubs It was established that no restrictions are in place in relation to visiting times. Service users spoken with confirmed that the home operates an open policy in relation to visiting times and makes visitors welcome. Service users relatives are also encouraged to take resident out for day trips or to the church as they wish. Information about Advocacy services is posted in the home and personal possessions were seen in service users rooms. Service users confirmed that they made choices within their daily routines. The menu on offer appears appetising varied and nutritious and offers choice options. Where service users require assistance and soft diet this was assessed as satisfactory. Service users confirmed that drinks were provided when requested and regularly throughout the day. Opinions about the food were varied but most service users said the food was very nice. Service users who need assistance with eating receive their meal first and as there are many this takes up all of the staff on duty time and it was observed that some service users were sitting at the dining table for almost an hour before they were served their meal. Whilst it is recognised that those service users who require assistance were not rushed and were given individual attention the mealtime routine requires review to ensure that service users are not left sitting at the dining table for long periods before being served their meal. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends are confident that their complaints will be listened to and taken seriously and acted upon. Although service users said they feel safe in the home there are a number of identified issues, which indicate that service users are not fully safeguarded and which must be addressed to improve outcomes for them. EVIDENCE: A complaints procedure was displayed but was noted to be in very small print and was on the day of the inspection out of view to service users and visitors. It is recommended that a large print version be posted in an accessible position. The Service Users Guide informs service users how they can make a complaint and that this will be responded to within 21 days. On inspecting the records held in the home on the day of the inspection it was found that thirteen complaints had been documented and resolved or unsubstantiated. One complaint had been made to the Commission For Social Care Inspection and had been mostly resolved. Complaints appeared to be well responded to and service users said within the surveys and personally that they knew how to make a complaint and felt they would be listened to. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 16 There have been no Safeguarding Adults issues in the home and the registered manager confirmed that she is conversant with the Nottinghamshire Protocols and the home has a local policy in place. Evidence that training in adult protection training was provided was confirmed in staff files and by staff spoken with. Staff spoken with was however unsure about the contents of the whistle blowing policy and this should be addressed in staff supervision and staff meetings. A sample of service users cash held records were examined [See Standard 35] Not all of the service users rooms have privacy locks on their bedroom doors and the arrangements for the issue of keys for bedrooms and lockable facilities not clear. As there have been complaints made about missing items of personal property this is an area which must be addressed as is the main door entrance to the home which is not kept locked and is therefore at risk from unauthorised visitors and service users placed at risk. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users safety and comfort is compromised by a number of health, safety and environmental issues identified. EVIDENCE: A tour of the building was facilitated with a number of bedrooms examined. The home has been undergoing some refurbishment and has new soft furnishings carpets and been redecorated. Bedrooms were clean and well equipped and personalised. Radiators are guarded and the home appeared warm, comfortable and homely. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 18 There has been an ongoing problem with the plumbing and on the day of the inspection sewage was observed spilling from the drain to the front elevation and down a ramped pathway. Inside the home, in that particular area, the smell of sewage emanated into the corridors, which was unpleasant and affected the bedrooms around. An immediate requirement was issued for the Registered person to contact the Environmental Health officer for advice about the issue, which may present a health risk to service users, staff and visitors. The sluice room door did not fit flush and a five litre container of bleach had been left accessible to service users. This bleach was locked away at once, however a requirement made for this practice not to be repeated. In the kitchen it was established that although there was evidence that staff had been trained in food hygiene and that they were operating the safe food management system, there was actually no records of food probing and several opened items of food in the fridge that were not date labelled on opening and several sauce bottles with lids that had not been made airtight and were loosely placed on the jars which presented a food safety risk. The nozzles on cream had not been cleaned as directed on the canister. Staff were observed not to wear aprons when serving and assisting service users with meals. Infection control policies were in place and alcohol hand scrubs seen around the home. Adequate supplies of gloves and aprons liquid soaps and paper towels were also seen. Clinical waste arrangements were in place and foot operated bins seen and staff were observed washing their hands between tasks. The flooring in the toilet near the lounge was raised and presented a trip hazard-an immediate requirement was set for this to be made safe. A first floor window did not have s safety restrainers in place and urgent action required for this. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are not being fully met due to rotas not incorporating the level of dependency and design of the building. A review of the staffing levels is recommended. Service users are supported and protected by the homes recruitment policy and practices. Staff, are trained to do their jobs but outcomes for service users would be improved by staff training in equality and diversity and Dementia Care. EVIDENCE: Staff rotas evidenced that a satisfactory number of staff were employed on the day of inspection and that the skill mix was appropriate to need the needs of the forty-three service users at the home over a 24hour period. However the numbers provided did not appear to take into account the dependency levels of the service users residing at the home and the design of the building. The manager reported that she was trying to obtain reassessments for service users whose needs have changed. Staff stated that they felt under pressure and because of the design of the home with three floors to manage and felt they had no option but to keep some service users waiting on occasions but said they felt very bad about this and was raising their stress levels. The Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 20 inspector noted that during the inspection the lounge area was absent of staff for a period. Taking this into consideration, the views or service users about call alarms and that some service users were taken to the dining table early due to the numbers of other service users requiring staff attention for feeding a review of the staffing numbers is recommended. The registered provider is also requested to address the issue raised that some night staff expect service users to retire at 8pm. Staff files contained appropriate documentation such as two satisfactory references and Criminal Records Bureau checks (CRB). It was established that all new staff members received an appropriate induction process within Burkitt Nursing Home and that clear and concise records are maintained to evidence training courses attended, and courses planned for the future. It is recommended that training be provided for staff in Dementia Care and Equality and Diversity. Staff were not familiar with the GSCC but the manager evidenced copies in the home and said all staff were issued with a copy it is recommended that staff sign for receipt and a copy kept in their files. It is also good practice to review the code of practice in supervision sessions with staff. It is reported in the Pre inspection information dated May 2006 by the previous manager that nine out of 23 care staff have achieved NVQ at level 2 or above which equates to approx 40 of staff. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users live in a home which is run and managed by a person who is fit to be in charge, however the health safety and welfare of service users and staff are not fully promoted and protected and Urgent and Immediate action is required to ensure compliance. EVIDENCE: The manager has recently been registered having previously been the deputy been at the home. Qualified as a Registered General Nurse (RGN) she has very recently completed the registered managers award and confirmed she will send a copy of the certificate when she receives this. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 22 Through discussion with service users and staff it was evident that they felt confident in the managers ability to manage the home well and felt assured that any concerns would be addressed effectively and efficiently. The manager ensures that the home is run in the best interests of the service users, to aid this process service users are encouraged to attend monthly residents meetings within the home so that issues relating to the care provided to service users can be openly discussed thus identifying and addressing any concerns that the service users might have. Both staff and service users reported that there was a lot of tension and it was an unsettling period as the home has recently changed hands and the new owner has made changes in relation to budgets and policies and practices. Staff confirmed a meeting was to take place with the Provider to air out some of the tensions experienced. Provider regulation 26 visits are documented and annual service user surveys undertaken. Attention to dates is recommended to evidence which period the survey relates to. A sample of service users cash held records were examined and it was found, that although a receipt was in place, a staff member had made the transaction on behalf of the service user and had used a credit card to make the purchase and claimed the cash from the service users account retrospect fully. The registered person should ensure that clear guidance procedures are in place for staff, when shopping on service users behalf to ensure both service users and staff are fully protected. Where service users valuables are kept safe on their behalf these must be receipted for. As stated in the environmental section of the report there are a number of identified health and safety issues, which present risks to service, users and immediate and urgent action is required. Records in relation to lift servicing gas safety and electrical circuit safety were satisfactory. The fire door in the conservatory leading to the sluice and bedroom area on the ground floor was wedged open. There was no fire risk assessment in place to support this practice and this is required to ensure that current fire legislation is complied with. The fire officer visited the home in June 2006. In between the inspection and writing the report a copy of a letter from the fire authority to the home was received at CSCI on 29th January 2007 indicating non -compliance with fire risk assessment, [date of letter 23/1/07] Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 23 The letter indicates that building approval must be obtained before any alterations to the premises if permission is required for those alterations to be made. The letter indicates that the emergency lighting is inadequately maintained, that there were insufficient numbers of competent persons appointed to assist in undertaking preventative and protective measures and that training includes sufficient instruction take account changes an d new risks to employees and identified by the risk assessment an take place during working hours. There was no evidence that a system was in place for the prevention of legionella and this must be actioned urgently. The manager reported that contract quotes were being obtained currently. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 24 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X 1 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 1 Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP10 Regulation 12[4] [a] Requirement Timescale for action 23/03/07 2 OP19 23[5], 13[3],16[ k] 13[4] 3 OP19 The Registered Person must make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users, in relation to the identified issues throughout the report which includes the review of staffing levels and routines in the home. The health and safety risk 23/01/07 caused by the leakage of sewage must be resolved. Timescale for compliance 4pm 23/1/07 IMMEDIATE The non- slip flooring in the toilet 23/01/07 near to the main lounge must be made safe. Timescale for compliance by 4pm 23/1/07 IMMEDIATE Ensure the sluice door fits into 23/03/07 its frame when closed and that the room is kept secure when not in use. A ‘safety restrainer’ must be 18/02/07 fitted to the specified window. Timescale for compliance was agreed for by 4pm 18/2/07 DS0000065667.V324003.R01.S.doc Version 5.2 4 OP19 13, 23 5 OP25 13[4] Burkitt Nursing Home Page 26 6 OP38 23[4] 7 OP38 13[4] 8 OP38 13[3], 23[5] 9 OP38 23 Urgent Action Required A fire risk assessment must be completed, which takes into account the wedging open of fire doors. Timescale for compliance was agreed for by 4pm 18/2/07 All substances that are hazardous to health must be appropriately stored. Timescale for compliance was agreed for by 4pm 18/2/07 Urgent Action Required All food items, with limited shelf life, must be dated upon opening and seals on food containers are made airtight. Timescale for compliance was agreed for by 4pm 18/2/07 Urgent Action Required Ensure a system is in place for the prevention of Legionella. Timescale for compliance was agreed for by 4pm 18/2/07 Urgent Action Required 18/02/07 18/02/07 18/02/07 18/02/07 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 2 Refer to Standard OP2 OP2 Good Practice Recommendations Provide details of fees charged to the Commission For Social Care Inspection and to service users as required by Regulation. A copy of the service users contract should be kept on the individuals file and it is recommended that service users or their representatives sign that they have received a copy of the Service User Guide. Ensure that information is displayed which informs service users how to access a copy of the previous inspection report. Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 27 3 4 5 OP3 OP7 OP9 Expand the assessment documentation to include an Equality and Diversity section and Capacity for Consent. Care should be taken to ensure new care plans are initiated for new pressure areas and risk assessments undertaken for use of denture soak tablets Appropriate Risk assessment documentation and capacity of Consent forms must be in place for those service users who may wish to self medicate. Ensure the storage temperatures of medication are monitored. Ensure the complaints procedure is provided in large print and posted in an accessible position in the home. Address the issue, that not all bedrooms are fitted with a privacy lock and the issue of keys for bedroom doors and lockable facilities. Undertake a security review of the premises taking into account the vulnerability of service users and the unlocked main entrance. 6 7 OP16 OP18 8 OP27 Review the whistle blowing policy with staff Review the staffing levels in consideration of service users dependency levels as identified within the report. Address the comments made by service users and staff in relation to the reported stress levels of staff in the home Provide training for staff in Equality and Diversity and Dementia Care. Obtain signatures from staff that they have received a copy of the General Social Care Councils Code of Conduct The registered person should ensure that clear guidance procedures are in place for staff, when undertaking shopping on service users behalf to ensure both service users and staff are fully protected. Where service users valuables are kept safe on their behalf these must be receipted for. 9 OP30 10 OP35 Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 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 © 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 Burkitt Nursing Home DS0000065667.V324003.R01.S.doc Version 5.2 Page 29 - 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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