Inspection on 23/04/08 for Burkitt Nursing Home

This inspection was carried out on 23rd April 2008.

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

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.

Other inspections for this house

Burkitt Nursing Home 07/10/08

Burkitt Nursing Home 04/12/07

Burkitt Nursing Home 26/07/07

Burkitt Nursing Home 22/01/07

Burkitt Nursing Home 07/11/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Burkitt Nursing Home 41-47 Melton Road West Bridgford Nottingham NG2 7NE Lead Inspector Meryl Bailey Unannounced Inspection 23rd April 2008 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.V362946.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.V362946.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burkitt Nursing Home Address 41-47 Melton Road West Bridgford Nottingham NG2 7NE 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) 0115 981 4046 Mr David Hetherington Messenger Mrs Vicky Rotelo Care Home with Nursing 55 Category(ies) of Old age, not falling within any other category registration, with number (55) of places Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mr David Hetherington Messenger is registered to provide personal and nursing care and accommodation at Burkitt Care Home for service users of both sexes whose primary needs fall within the following categories :Old Age, not falling within any other category (OP) 55 One named service user shall be accommodated at Burkitt Care Home within category Physical Disability (PD). One named service user under the category PD named in the variation application number V38564 dated 8th February 2007 can be accommodated at Burkitt Care Home. One named service user under the age of 65 years, named in variation application number V39491 dated 7th March 2007, can be accommodated at the Burkitt Care Home. The maximum number of service users to be accommodated within Burkitt Care Home is 55 4th December 2007 2. 3. 4. 5. Date of last inspection Brief Description of the Service: The Burkitt is a care home registered to provide both nursing and personal care for up to 55 older people. 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. People are accommodated in mainly single bedrooms, 11 of which have en-suite toilet facilities. Some rooms were previously shared, but now provide spacious single accommodation. Some bedrooms continue as shared. There is a large lounge and small dining area on the ground floor and further sitting rooms on the first floor. The home is situated in West Bridgford and is convenient for public transport into Nottingham City. 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. The weekly accommodation charges vary depending on whether a resident has personal care needs only or needs a particular level of nursing care. These were confirmed by the temporary manager at the time of this inspection as ranging from £294 to £529 per week. A copy of the last inspection report is available from the home on request, but there is currently no Service User Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 5 Guide available. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. 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 and minimum standards of practice and it focuses on aspects of service provision that need further development. We reviewed all of the information we have received about the home since the last report of our key inspection in December 2007 and we have included information gained from an additional random inspection visit we made in February 2008. We considered this in planning the visit and deciding what areas to look at. We did not have time to send out surveys to people living at the home. We have introduced a new way of working with owners and managers. We ask them to fill in an assessment form called an AQAA (Annual Quality Assurance Assessment). It is about how well their service provides for the needs of the people who live there and how they intend to improve their service. They have to fill this in and send it to us, because it is a legal requirement to do this. We received one of these back from the manager at the end of March 2008 and this has helped us to plan this inspection. We did this inspection with one inspector. It was unannounced and took place on one day in the daytime, including lunchtime. The main method of inspection we use is called ‘case tracking’ which involves us choosing a sample of people who live at the home and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. A tour of the premises was made, but we did not see every bedroom. English is the first language of most, but not all of the people living at the home at the moment. The staff team come from a wide variety of backgrounds and experiences. During the course of this inspection we became aware of maintenance problems that were posing possible risks to people who live at the home and we issued an immediate requirement to prevent harm by attending to a water leak within 24 hours. Further action has been required. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 7 The person that owns this home will be expected to work with us to provide evidence of compliance and improvement to make sure they meet the requirements and provide good quality care to the people living at the home. What the service does well: What has improved since the last inspection? Assessment documentation and the placing authorities community care assessments have been obtained for new people that have been admitted to the home since the last key inspection. This means that people can now be assured when they move to the home that their needs will be assessed. The work of the activities co-ordinator has developed, which means that people have their individual social and recreational needs met, improving their quality of life. Since the last key inspection we have received notifications from the registered manager about incidents that have occurred in the home. This means that we can now monitor what actions are taken in dealing with incidents that affect people who live there. A Nottinghamshire Fire Officer has visited the premises and has confirmed that fire safety arrangements are at a safe standard. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 8 Work has been completed in ground floor bathroom after the last key inspection so that the hoist can be wheeled under the assisted bath and staff have all been shown how the hoist and assisted bath are used. Since the additional random inspection a moving and handling plan has been completed for those that use the assisted bath, so that people feel safe and comfortable. What they could do better: Provide an up to date service users’ guide to the home for current and prospective residents to provide information and enable people to make an informed choice about moving into the home. Supply a copy of an up to date Statement of Purpose and Service User Guide to the Commission in order for the Commission to monitor and regulate the service provided. Ensure people who live at the home are fully consulted and involved in drawing up their care plans and in reviewing the plans, so that they know, and fully agree with, how their needs will be met. Ensure staff write full and accurate records of attention given to the people who are looked after in bed to promote the health and welfare of these people. Ensure investigations into complaints are recorded in full with outcomes so that people can be assured they are listened to. Make available sufficient working baths and showers in order to meet people’s bathing needs and preferences. Use shared bedrooms only for those that make a positive choice to share with each other. Take account of the layout of the building when assessing the number of staff required to meet needs. As part of the system for monitoring and reviewing the quality of the service, provide a report of the results of the survey and an action plan to people who live at the home and their relatives. This is to ensure the home is run in residents’ best interests. Ensure the maintenance book is organised and complete all outstanding maintenance work to ensure the home is kept in a good state of repair and is safe for the people who live there. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 9 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.V362946.R01.S.doc Version 5.2 Page 10 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.V362946.R01.S.doc Version 5.2 Page 11 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, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Potential residents are assessed before admission, but do not have any written information about the home. EVIDENCE: We looked at the care plan of the person who was most recently admitted to the home. We saw evidence that an assessment had been carried out before the person moved into the home. We spoke with the person who told us that she came from Hospital and chose the home because of its location. She had not received a Service User Guide. The Senior Nurse said that there was no Service User Guide available and no Statement of Purpose for the service was seen. The new person had not had any involvement in planning her care (see next section). Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 12 Intermediate care is not provided at the home and standard 6 is not applicable. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 13 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The action needed to meet care needs is planned, but people who live at the home are not fully involved in the planning process. There are facilities for meeting health care needs and people receive their medication safely. EVIDENCE: We looked in detail at the care plans of four of the people living in the home. One of these was for a person admitted within the previous week. There were some draft plans that had been drawn up from the initial assessment. The person concerned was not aware of the plans. The Senior Nurse told us that that staff had not yet told the person about the care plan. The other three had established care plans. Two of these plans included moving and handling action plans and activity plans and all areas had, which had been discussed at the previous key inspection. There were records to show that staff had regularly reviewed all areas of care for these two every month. However one of the people concerned said they were not involved in reviewing the plans. Two relatives also told us that they had not been involved in care planning. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 14 The senior nurse told us that all plans are reviewed every 6 months with the person and their relatives present. Staff told us they get information from handover meetings when they start their shift, but they knew where to find information in care plans if needed. One person whose plan we looked at was cared for in bed. There was no record of the care plans being reviewed for the last two months. We made a visit to her room. There was a chart for staff to complete each time they attended to the person on a 2 hourly basis. Limited information was recorded on the chart and some notes were unclear. One staff member had already entered a record for 12 noon, though we were in the room at 11.45am. There was a note saying the person was “sat up”. We found her in a lying position. The chart had been completed prior to the action taken. We found the same for another person who was cared for in bed. A relative told us, “the staff are kind, but always in a rush.” Other people we spoke with described positive and respectful care from the staff: “they always do their best”, “they help me when I need it.” There were daily records kept on all four of those we looked at and evidence of visits from General Practitioners when required. There was a Nurse on duty 24 hours each day for those who had been assessed as needing nursing care. There were additional Community Nursing Notes stored securely. These were in respect of people who live at the home who do not need full time nursing. We looked at where the medication was stored for people and found everything safe and secure. We observed a nurse administering medication in the lounge at lunchtime and saw that she was following appropriate procedures in handling and recording what she gave to people. She took the trolley with her as she moved to different people, keeping all medication secure at all times. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Attention is given to individual social and recreational needs so that the quality of life for people at the home is improved and maintained. People make some choices, but do not have full control over their lives. Meals are mostly enjoyed. EVIDENCE: An activities worker is employed to work at the home on three days each week. At both the short inspection visit carried out in February 2008 and again at this inspection, the activities worker was observed playing cards and dominoes with people living in the home and also spending one to one time talking with people. Both the staff members and people living in the home that were spoken with were very positive about the current provision of activities in the home and how this is being developed. One person said they enjoyed talking to the activities worker about their interests and others said they enjoyed playing dominoes. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 16 Some people said that they chose to stay in their own rooms for the majority of the time and their meals were taken to them. Some choices and preferences were seen written into the care plans, though there were no signatures of agreement to the plans. There were some people sharing rooms, but no evidence that people made a positive choice to share with a particular other person. The senior nurse told us that one family had agreed to their relative sharing with another person when they were informed of the arrangement. The two residents had no prior knowledge of each other and no shared interests. There were several visitors to the home during this inspection. At least two relatives visited on a daily basis for the greater part of the day. One relative told us that the person they visited attends church regularly. In the Annual Quality Assurance Assessment it is stated that some people go out to a Roman Catholic church and one attends Baptist church. Anther person attended a specific day centre group on a regular basis and was assisted in maintaing friendships with people from that group. All visitors spoken with said they felt welcome by staff and there was a clear record kept of visitors to the home. The meals served on the day of the inspection looked appetising and nutritious. There was the choice of vegetable soup, gammon, vegetables, new potatoes or chips and Ham and mushroom pasta in a white sauce with vegetables. There was trifle or fruit yoghurt for dessert. Menu plans showed that there are meal options every day and always a hot option both at breakfast and at teatime. We observed staff sitting next to people who needed assistance with eating. There was a problem with leaking water in the dining area, but tray tables were provided for people to eat their lunch in the lounge. Several people spoken with said they enjoyed the lunch, “Its always good food here”, “I always have a choice and find something I like.” One person, who was receiving help with eating, refused the main course, but was clearly enjoying the trifle. One visitor later told us that the person they visited did not always enjoy the food given. A member of staff confirmed that a choice of food is always given and that staff approach each person during the morning to ask what they would like for lunch from the choices available. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People living at the home and their relatives / representatives can be assured that their concerns are listened to and acted on, but staff need up to date information to ensure they can protect people. EVIDENCE: There were records of complaints filed and available for inspection, showing that complaints were taken very seriously. Most of these gave detail of the investigation into the complaint made, but one complaint record was incomplete and only the letter of complaint and the word resolved were seen. The senior nurse stated that a full letter had been sent in response, but a copy had not been filed. All staff members spoken with demonstrated an understanding of their responsibility to alert the manager of any disclosure or suspicion of abuse. Training certificates were seen on staffing files and staff confirmed that they had undertaken training in adult abuse. However the local policy and procedure for Nottingham area that was found on the office shelf was out of date. The senior nurse was not aware of the new policy for Safeguarding Adults, but was aware of the need to contact someone from the local authority adult care team should she be informed of any allegations or suspicions of abuse. One of the staff had been trained very recently by the local authority Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 18 staff and had seen the new policy. It should be available to all staff at the home so that they know what action must be taken and what their role is if there are any allegations or suspicions. There have been no allegations of abuse in the home during the last year. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 19 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, 21, 23 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is clean, but despite improvements to some parts of the premises, maintenance work is not carried out very quickly, potentially risking the safety of people living there and limiting bathing choices. EVIDENCE: We made a tour of the building, but did not see all bedrooms. Although the home is registered to accommodate up to 55 older people, some rooms, which were previously shared, now provide spacious single accommodation. People in these rooms were pleased with their accommodation and some enjoyed looking out from their large bay windows. Some bedrooms continue to be shared, but there is no clear evidence of some people making a positive choice to share. 37 people were accommodated in bedrooms on three floors. Two passenger lifts were available. One of these had been repaired since the last key inspection of the home. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 20 There were domestic staff working every day and cleaning was ongoing during the inspection. All areas were clean and fresh. One relative told us, “its always clean here”. Another said, “I’ve never found any problem with cleanliness and it always smells fresh.” During our visit there was water continuously leaking outside a window and into the dining area in the home, making the wall and ceiling soaked. The senior nurse felt it unsafe for people to be in this area and was not allowing the dining tables to be used for lunch. The light switch had a small notice to warn staff not to use it and the curtain rail had already collapsed and been removed. A note in the maintenance book showed that the leak had commenced on 8th February 2008 and reported to the maintenance worker. We contacted the owner and required that this be attended to within 24 hours. The assisted bath that opens on one side was on the ground floor and was being used effectively during the inspection visit. This was, though, the only bath available in working order on the premises. Two others had been replaced, but the work was not finished. One relative has told us that bath time is rushed and people wanting to have a soak in a bath do not have the opportunity. There was a bath book that showed a time allocated once a week for each person. A staff member explained that at the time allocated each person was asked if they wanted a bath and some preferred a wash. Others were cared for in bed and had a full bed bath at their allocated time. We have asked the provider to for a more detailed assessment of how bathing needs are met and for a timescale for the completion of the two other bathrooms. We also found a toilet without a seat, which limited the number of toilets available on the ground floor. There was a sluice room on the ground floor and two on each of the other two floors. One of these had a broken concertina door. A nurse confirmed this had been awaiting repair for some considerable time. A relative told us that a window had been reported in August 2007, but still cannot be opened. We found a note of this had been entered in the maintenance book in February 2008. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff receive some training and are adequate in number to meet the needs of people who live there, but the layout of the building can cause some delays. EVIDENCE: At the last key inspection in December 2007, we found insufficient numbers of staff to meet care needs. When we carried at a further random inspection in February 2008 this had improved and there were six care staff working during the day in addition to nurses. At this inspection there were 37 people resident at the home, though three of those were in hospital. 20 had been assessed as needing nursing care and the others needed help with personal care. We looked at the staffing rota and it showed that one nurse and five care staff were on duty from 7:15am until 8:15pm with some changing shift at 2:00pm. In addition to this, a senior nurse was covering management tasks in the temporary absence of the manager and was available to provide additional nursing during the mornings. During this inspection she stayed throughout the afternoon as well and said that extra staff are available if needed in order to meet care needs. For example, when a person needed support to attend hospital an additional care assistant was made available. At night there was one nurse and three care assistants on duty. The following were also on duty: chef and kitchen assistant, two cleaners and one laundry worker. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 22 As reported under standard 8, there was some evidence that staff were rushing around to meet needs and one had already written down actions not yet taken to save her time later. The layout of the home on three floors meant that staff needed time to get to each person that stayed in their own room, when they are already attending to someone in another part of the building. The senior nurse in charge said that they aim to get to people within a maximum of ten minutes of a call for attention and we saw that one call bell was answered after five minutes. One person told us that he does have to wait, but had not timed how long. He thought this was because they were sometimes short staffed. A relative of another person living in the home told us that staff never have time to talk with anyone. Care staff told us they are allocated to a particular floor: two on the top floor, one on the middle floor and two on the ground floor. We saw that there were people on the middle floor that needed two staff for moving and staff told us that they have to ask for help from someone from another floor. The senior nurse in charge told us that the number of care staff would be increased to six if the number of people living there increased to over 40. The manager had already told us in the Annual Quality Assurance Assessment that 50 care staff have achieved National Vocational Qualification in care at level 2. There was some delay in receiving certificates, but some were seen in staffing records. Also, records relating to the nurse confirmed details of registration with the Nursing and Midwifery council. We looked at the files of one nurse and two of the care staff on duty and had discussions with them. Each of the files contained evidence that recruitment procedures included Criminal Records Bureau checks and obtaining references. There were also records of regular supervision meetings. We saw some copies of certificates and staff told us about the training they had completed, which included Dementia Awareness as well as safe working practices. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 23 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 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Promoting and protecting health and safety in the environment is not given sufficient priority, which places people at significant risk and the home is not run in their best interests. EVIDENCE: The manager is a registered nurse and registered with the Commission. She was not present during the inspection, as she had already informed us of an extended holiday. Arrangements had been made for a Senior Nurse to cover management tasks with support from the provider. We found that risks in the environment from a lack of maintenance work were already existing before the manager went on holiday. (See the environment section in this report). The Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 24 maintenance book was not organised sufficiently to show which work had been attended to. As already reported under the environment section, there were some things that had not been attended to for some considerable time. This meant that at least one person has never been able to have one window open, only one bath was available, the main dining area was not safe to use and the number of toilets available was limited. In addition we found that there was a problem with a fridge in the cellar and the chef was limiting the use of this. The windows in the kitchen were open wide with no fly screen and the fly trap needed to be cleaned. Staff were aware of these risks and said that they had reported them. On the positive side, we found from records and from talking to staff that they had been trained in Moving and Handling, Health and Safety and Fire Safety within the last year. Since the last inspection each person that uses the assisted bath has been assessed and had a plan regarding what help they required from staff. A trained nurse was available at all times and records we saw showed that one of the care staff had completed Emergency First Aid including Cardio-Pulmonary Resuscitation (CPR) training. Since the last key inspection we have received notifications from the registered manager about incidents that have occurred in the home and a Nottinghamshire Fire Officer has visited the premises and confirmed that fire safety arrangements are at a safe standard. Staff reported that since the last inspection the manager had given them a verbal report in a staff meeting of what had been raised in returned questionnaires from relatives and they were taking action to improve. A copy of the minutes of the staff meeting was submitted to the Commission, but there is no evidence of the outcome of the survey being given to people who live at the home or their relatives. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 25 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 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X 1 X 2 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 1 Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 5 Requirement Provide an up to date service users’ guide to the home for current and prospective residents to provide information and enable people to make an informed choice about moving into the home. Supply a copy of an up to date Statement of Purpose and Service User Guide to the Commission in order for the Commission to monitor and regulate the service provided. Ensure people who live at the home are fully consulted and involved in drawing up their care plans and in reviewing the plans so that they know and fully agree with how their needs will be met. Ensure staff write full and accurate records of attention given to the people who are looked after in bed to promote the health and welfare of these people. Ensure investigations into complaints are recorded in full with outcomes so that people DS0000065667.V362946.R01.S.doc Timescale for action 01/06/08 2. OP1 4, 5 and 6 01/06/08 3. OP7 15 01/06/08 4. OP8 12 (1) 01/06/08 5. OP16 17 (2) 01/06/08 Burkitt Nursing Home Version 5.2 Page 27 8. OP19 13 (4) 9. 10. OP21 OP33 23 (2) (j) 24(1) and (3) 10. OP38 23 (2) (b) 11. OP38 23 (5) 13 (3) can be assured they are listened to. Attend to the water leak in the dining area to ensure the safety of people in the home. This was an immediate requirement. Make available sufficient working baths and showers in order to meet people’s needs. As part of the system for monitoring and reviewing the quality of the service, provide a report of the results of the survey and an action plan to people who live at the home and their relatives. This is to ensure the home is run in residents’ best interests. Ensure the maintenance book is organised and complete all outstanding maintenance work to ensure the home is kept in a good state of repair and is safe for the people who live there. After consultation with the Environmental Health Officer provide an appropriate fly screen at the kitchen window to prevent contamination of food. 24/04/08 30/06/08 01/06/08 16/05/08 16/05/08 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. 3. Refer to Standard OP18 OP23 OP27 Good Practice Recommendations Obtain a copy of the new Safeguarding Adults procedure from the local authority. Bedrooms should be shared only by those that make a positive choice to share with each other Take account of the layout of the building when assessing the number of staff required to meet needs. Burkitt Nursing Home DS0000065667.V362946.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V362946.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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