Inspection on 04/12/07 for Burkitt Nursing Home

This inspection was carried out on 4th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Burkitt Nursing Home 07/10/08

Burkitt Nursing Home 23/04/08

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 Joanna Carrington Unannounced Inspection 4th December 2007 09:30 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.V355090.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.V355090.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 55 Category(ies) of Old age, not falling within any other category registration, with number (55) of places Burkitt Nursing Home DS0000065667.V355090.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 sevice 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 26th July 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 also registered to provide care and accommodation for three named people with a physical disability. The home currently does not have appropriate bathing facilities to adequately meet the needs of disabled residents. 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. There are 30 single bedrooms, 11 of which have en-suite facilities and 6 double bedrooms, none of which have ensuite 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 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, and Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 5 whether or not the placement is funded privately or by the local authority. Information about fees and what service is included in the fee is specified in the Service User Guide. The copy of the most recent inspection report is not freely available to residents and other stakeholders, which it should be. A copy must be provided if requested. Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This site visit, as part of the home’s key inspection took place on 4th December 2007. Inspections focus on outcomes for people that use the service. In order to do this the main method of inspection used was ‘case tracking’ which meant three residents were selected and their care was tracked through discussion with them and with staff, checking their care records and observing practice. Altogether, four staff members, four residents and one relative were spoken with during the course of the inspection. A sample of staff records were also looked at to make sure staff get the necessary training and that checks are carried out on staff before they start working at the home. A tour of the environment also took place in order check compliance with requirements made at the last inspection and to make sure the environment is clean, safe and comfortable for residents. Information about a home that is collected before the inspection is also used to make judgements about a service. This information could include notifications, information from other professionals and users of the service or their relatives, and also from any surveys that are sent out. Prior to the inspection three relative surveys and one resident survey had been returned. We also received two phone calls about the service prior to the inspection. This information was used to plan the inspection and to make judgements in the report. At the time of writing the inspection report seven relative surveys, one care staff survey and one resident survey was returned. Services are now required to fill in a document called an AQAA (Annual Quality Assurance Assessment) in which the registered manager identifies from their own quality monitoring what the service does well at and what they need to improve on. The AQAA was not used to plan this inspection because it was used for the last key inspection, which was in July 2007. What the service does well: The service does well at writing care plans and monitoring the healthcare needs of residents. Specialist healthcare professionals, such as tissue viability nurses and specialist diabetic nurses are involved in residents’ care when appropriate. Medicine management is effective in promoting the safety of residents. Relatives and friends are made welcome when they visit, which is important because it helps residents maintain contact with people that are special to them. The recruitment practices are robust, which means checks have been made to make sure staff members are suitable to work with and provide care to the Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 7 residents. The staff team receive regular training, which helps ensure the needs of residents are met. What has improved since the last inspection? What they could do better: Residents’ health and safety is at serious risk in the home for a number of reasons. What is of particular serious concern is that there are outstanding requirements from the two previous inspections, which are still not complied with. Measures for the prevention of legionella still need to be implemented and all the required fire safety tests still need to be undertaken. The fire risk assessment still needs to include the wedging of fire doors because doors continue being wedged open. The inner door to the lift needs to be permanently replaced because it keeps needing temporary repairs. Bathing facilities in the home still need to be improved, to ensure that residents can have baths safely and in a dignifying manner. The parker bath that was identified to be causing residents and staff problems at the last inspection is still causing problems now. Staff members reported that the hoist cannot be used safely in the bathroom because there is not enough room and that when attempts have been made to use the parker bath with the hoist the door has to be left open. Staffing numbers must be reviewed again to ensure they are appropriate to the needs of residents. Residents have to wait a long time for assistance, and staff members also recognise this as a problem and reported they are very tired because of working shifts with not enough staff. This is an outstanding requirement from the previous inspection. More activities and stimulation must be provided to residents, to promote and uphold their right to a quality of life. There is still not an activities organiser and in the meantime there have been no other arrangements to make sure residents have regular stimulation and are able to participate in their chosen activities and interests. This is an outstanding requirement from the previous inspection. Concerns that are made by residents and their relatives must be recorded and followed up using the Complaints Procedure. This helps ensure the matter is investigated and appropriate action is taken in a timely manner. Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 8 Quality monitoring based on the views of residents must improve, to ensure the home is run in their best interests. There are inadequate arrangements in place for seeking the views of residents and other stakeholders. When views have been obtained there is no evidence to indicate that these are acted on or that these views are used to identify ways to improve the service. The registered manager needs to be more aware of what incidents must be notified to the Commission. This is so that the home can be effectively regulated in ensuring the health, safety and welfare of its residents. 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.V355090.R01.S.doc Version 5.2 Page 9 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.V355090.R01.S.doc Version 5.2 Page 10 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): 2 (the home does not provide intermediate care) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission arrangements are not effective enough in ensuring residents needs are met. EVIDENCE: A case tracked resident that has been admitted to the home since the last inspection had a copy of the placing authority’s community care assessment on their file and also a copy of pre-admission assessment carried out by the registered manager. This assessment had not been filled in fully. Only healthcare needs had been assessed, sections on personal care and social needs were left blank. Burkitt Nursing Home DS0000065667.V355090.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 and 10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Care planning is overall, of a good standard but in practice, lack of resources mean needs are not being adequately met and residents’ dignity is not maintained. Medicine management continues to be effective in promoting the safety of residents. EVIDENCE: All three case tracked residents have care plans that provide detailed information on how to meet their health and personal needs. The care plan and daily records for one case tracked resident showed that the specialist diabetes nurse has been involved in giving strict advice on how to manage the resident’s diabetes. This guidance is clearly stated in a care plan specifically for the control of diabetes and records also show that the nurses are regularly monitoring the resident’s blood sugar levels and dietary intake. There are risk Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 12 assessments undertaken for pressure sores, nutrition, accidents and general physical assessment including weight, undertaken every month. There is evidence on all three files seen that care plans are evaluated every month and residents and/or their relative are involved in the reviewing of care plans and meet with the manager every six months to go through them and to sign to say they agree with them. The same as at the last two inspections, residents spoken with said they still have to wait a long time when they call for assistance. A resident said, “I’ve watched people wait for hours…we’re short staffed, you have to wait.” Two residents spoken with reported that they had not had a bath for at least two weeks. Another resident explained they have not had a bath for a long time; they have to have a bed bath because the assisted bath facility causes them discomfort to their back. The assisted bath facility was reported by staff to be causing problems at the last key inspection. Staff members spoken with also expressed frustration at not being able to meet residents’ care needs because of lack of staff and not having the right equipment. A staff member pointed out in the actual bathroom how when they have attempted to use the assisted bath facility the hoist does not fit in the bathroom enough to be able to shut the door properly. The staff member also pointed out how the lip on the door of the assisted bath facility is uncomfortable for residents with thin skin when they are transferred into the bath with the hoist. It was also reported that there have been occasions plastic bags have been taped to the floor so that a resident can be showered down by the bath’s shower attachment while sitting in a shower chair. A staff member was observed administering medication in a safe way and in a way that respected residents’ dignity. All three case tracked residents have a risk assessment for the self-administration of medication, which concludes that they are not able to manage this independently. Residents spoken with confirmed they are happy with the support they get with medication. Burkitt Nursing Home DS0000065667.V355090.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 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lifestyle experienced in the home still does not match residents’ expectations and does not satisfy their individual social and recreational needs. EVIDENCE: Like at the last inspection, both staff and residents spoken with commented that there has been very little activity going on in the home. One resident said “there is no entertainment at all and I haven’t been able to sit out in the garden”. Another resident mentioned that on occasion a musical balloon lady used to visit but that’s not happened since the summer.” The resident is a keen football fan and in the past staff have taken him to watch a football match. Last season he went three or four times but this season he has not yet managed to get to a game. The resident also feels that staff are generally too busy to talk with and a staff member spoken with also said they “haven’t got time to talk to residents.” This comment was also made relative surveys. Residents spoken with do generally feel that they are able to exercise choice and control in their daily lives. One resident remarked how she likes to spend time relaxing in her bedroom watching television while at other times she chooses to spend time in the lounge to enjoy a nice cup of tea. Another Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 14 resident expressed discontent at not being supported to get up and to go to bed when he wants to. It became clear from the care plan and from discussion with staff that this is for the management and treatment of pressure sores. However, there is no documentation on the resident’s care plan of his wishes, issues around capacity to consent and reasons why his wishes are not being accommodated. A relative spoken with confirmed that the staff team are always welcoming when she visits. A relative states in their survey that staff “interact well with residents and relatives and friends visiting.” The meals served on the day of the inspection looked appetising and nutritious. Menu plans show that there are three meal options per day and always a hot option both at breakfast and at suppertime. The cook explained that a new menu plan has been devised and will be implemented in the next week. There has been no consultation with residents about the new menus. Two residents spoken with commented that there used to be resident meetings, but these have not happened for a long time. Some of the comments about meals were not positive, one resident said that the meat is grisly and another resident said that the vegetables are often very watery. Residents surveys that the registered manager collected back in February 07, as part of their own quality monitoring show a theme regarding the quality of meals, but with similar comments being made now and no records of actions taken in response to the surveys, this indicates these views have not been acted on. Burkitt Nursing Home DS0000065667.V355090.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel their concerns, complaints and allegations are taken seriously and acted on but not using relevant procedures does not help ensure this happens. EVIDENCE: The complaints records show that there have been no complaints made since the last inspection. Residents spoken with confirmed they know how to make a complaint. A relative called the Commission prior to the inspection to share a concern. The relative stated that she has passed on concerns to the registered manager before and has always been satisfied with the response therefore it was agreed the relative would contact the registered manager directly with the concerns. The registered manager confirmed that she had received a phone call and had acted on the concern however the information had not been recorded as a complaint, in accordance with the home’s complaints procedure. A relative commented in their survey that the care service, “often don’t respond” to complaints, or they “respond at first then forget”. Another relative gave examples of two concerns in which there was an appropriate response, however there was no record of these concerns. Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 16 There have been no allegations of abuse / safeguarding adults investigations in the home this year. Staff members spoken with confirmed they have had training in safeguarding adults and demonstrated an understanding of their responsibilities to alert the manager of all allegations of abuse. Burkitt Nursing Home DS0000065667.V355090.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements to environmental issues have been made, which means residents now live in safe, and comfortable surroundings. EVIDENCE: When walking through the home it was evident the home is kept clean and hygienic. Three relatives in their surveys made positive remarks about the cleanliness and overall standard of the environment. One relative stated, “the care home is always kept clean and therefore smells fresh” and another relative stated, “since Elder Homes took over they have spent a great deal of money improving facilities. The rooms are spacious and very pleasant”. The room in which there was a bad leak at the last inspection has now been made good, and all of the bedrooms seen looked comfortable and were Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 18 personalised to suit individuals’ taste with their own furnishings and belongings. A resident that has recently moved to another shared bedroom said she is much happier in her new room. Since the last inspection the registered manager reported that some bedrooms have been redecorated. The leak in the conservatory has been repaired and some new blinds for the conservatory are on order to replace the old ones. At the last inspection the call bell was not working properly and some call bells could not be heard in certain parts of the home. This has now been rectified with a new call bell system, which was heard to be working correctly. There are still some outstanding issues regarding equipment and fire doors but these are reported under the outcome area Management and Administration. Burkitt Nursing Home DS0000065667.V355090.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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are protected by the recruitment procedures but overall staffing arrangements continue failing to ensure residents are in safe hands at all times. EVIDENCE: The staff files of four randomly selected staff members- including two that have commenced employment since the last inspection- were examined. The content of these files showed that staff members do not commence employment at the home until the return of two references and Criminal Records Bureau Check. Training certificates also showed that staff have regular mandatory training updates in moving and handling, fire safety, first aid and food hygiene, dementia care and safeguarding adults. Staff members spoken with confirmed they have regular training. There is an induction checklist for new staff, which the focus in on practical tasks. This process however does not follow the Skills for Care Common Induction Standards and there is no other evidence available to indicate when, through the induction process the registered Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 20 manager can become confident that a new staff member is competent to fulfil their role. There were mixed comments made by relatives in the returned surveys about the quality of staff. Three relatives made positive remarks about the staff team; they are always friendly during visits, are “attentive” and “nothing appears to be too much trouble” while comments in three other relative surveys included, “[the staff] never have time to chat”, and “[the relative-incare] has to ask for things several times, the [relative-in-care] has said several times “they’re not bothered are they” [the relative-in-care feels like (sometimes) things are too much trouble for them”. At the last inspection residents reported that they have to wait a long time for assistance because there is insufficient staff. The response from the registered manager and registered provider was that the needs of residents had been assessed according to their dependency level and the review of staffing levels found the level to be appropriate to residents’ needs. At this inspection, both residents and staff were again saying there is not enough staff. It was reported that residents are not getting their weekly bath because of staff shortage, call bells are taking a long time to be answered. One resident said that he has seen staff ignore some call bells because they are too busy. On the morning of the inspection there should have been six but there were only five care assistants. Staff reported that shifts are regularly run below the normal level of staffing, especially when people call in sick at short notice. All staff members spoken with said that they are completely exhausted. A relative expressed concern about staffing levels prior to the inspection because her mum managed to exit the building and be gone half an hour and no one noticed. Four of the nine returned surveys make reference to there not being enough staff and how this impacts on residents’ care. Burkitt Nursing Home DS0000065667.V355090.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 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 residents’ health and safety continues to be managed poorly, which places residents at significant risk and the home is not run in their best interests. EVIDENCE: At the last inspection a requirement was made to ensure staff are trained in how to transfer residents into the assisted bath facility safely or alternatively, if this cannot be achieved another form of assisted bathing to be provided. At this inspection both staff and residents reported that problems persist. Two staff members reported that it is very difficult to get the hoist or standing aid into the bathroom and then be able to shut the bathroom door. There is a bath on the first floor, with a swivelling bath chair but the bath taps were seen to be broken and it was reported that the water does not get hot enough. The Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 22 registered manager reported that a decision is being made to put shower facilities on the ground floor and moving the assisted bathing facility to the top floor, which was also mentioned in the improvement plan, received in September 2007. There was no evidence seen of any progress with this decision, or of any consultation with residents. It is of further concern that residents that require hoisting do not have a moving and handling plan, in accordance with health and safety requirements. On the files of case tracked residents there are moving and handling risk assessments but no plan identifying the weight and height of the resident, what is most suitable equipment to use and how staff should assist the resident with each type of transfer. There was evidence on a case tracked resident’s file that a relative has consented to the use of bedrails but there is no risk assessment for their use, to make sure this is the safest measure and to make sure risks such as entrapment or climbing over them are eliminated. At the last key inspection in July 2007 and the key inspection before that in January 2007 the practice of wedging doors open was highlighted as an issue that was not included in the fire risk assessment. The fire risk assessment was revised in October 2007 but still makes no reference to wedging doors open even though this practice was observed to be still happening throughout the home. The fire authority carried out and did their own inspection in January 2007, and in their letter to the Commission they indicate that there was insufficient testing of emergency lighting. Fire safety records show the testing of emergency lighting is still not happening. At the last key inspection in July 2007 one of the lifts was discovered not to be operating properly because the inner door was not closing. There is a record to show that engineers came out to fix the inner door but the record states that this was a temporary repair. There are also records to show that the lift was serviced back in February 2007 and in October 2007 and on both occasions the engineer has advised that although the lift is still in a serviceable condition to use, the ‘gate’ needs replacing. There was also another call out to the lift on 21/11/07 because it was not closing properly again. Since the last key inspection a contractor has been out to the home to carry out a legionella risk assessment. Records seen indicate that the assessment was completed end of August 2007. The contractor has carried out disinfection work but the risk assessment also concluded that ongoing measures should be undertaken to control the risk, such as cleaning showerheads and monitoring the temperature of water outlets each month. These measures have not yet been implemented and the registered manager reported that it is intended these measures will commence in January 2008. This is despite the requirement to ensure there is a system in place for the prevention of legionella first issued in January 2007 and then repeated in July Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 23 2007. Not implementing these measures now means the outstanding requirement from July is still not fully complied with. Surveys are distributed to residents on an annual basis, as part of the home’s quality monitoring. Returned surveys were seen but there are no records of an analysis of the results, and a subsequent action / development plan. The registered manager reported that she normally just talks to residents about the results. As mentioned in a previous section of this report, it was noted how some of the comments made in this survey were familiar with views shared on the day of the inspection; regarding staffing and meal times mainly. There are no surveys for other stakeholders such as relatives and visiting professionals. Two residents spoken with mentioned how there used to be regular resident meetings, where they could air their views about the home. Minutes of these meetings showed that the last meeting was prior to the last inspection in July 2007. The registered manager was unaware that the incident in which a resident exited the building unaccompanied should be notified to the Commission. Burkitt Nursing Home DS0000065667.V355090.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 X 2 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X X 1 Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? yes 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 OP2 Regulation 14 Requirement Residents’ pre-admission assessments must cover all aspects of their needs, to ensure that the home is suitable in meeting those needs. Residents must have their personal care needs adequately met and in a way that accommodates their wishes. Appropriate equipment must be provided in order to meet the needs of all residents. This requirement refers to the assisted bathing facility, that its been reported, cannot be used safely with a hoist. Timescale for action 01/02/08 2 OP7 12(1) and (3) 01/01/08 3 OP7 23(2)(n) 01/02/08 4 OP10 12(4)(a) Residents must receive their care 01/01/08 in a way that upholds their right to dignity and privacy. The assisted bathing facility cannot be used if the door has to be left open. A programme of regular activities & entertainment must be implemented to provide DS0000065667.V355090.R01.S.doc 5 OP12 16(2)(m) 01/01/08 Burkitt Nursing Home Version 5.2 Page 26 stimulation for residents & as far as possible meet their social and recreational needs. This is an outstanding requirement from the previous inspection, initial timescale 26/07/07 not met. 6 OP14 17(1)(a) A record must be kept of any limitations imposed on a resident as to their freedom of choice, in accordance with the Mental Capacity Act 2005. This is to protect residents’ right to make choices and retain control of their lives. All concerns and complaints received by residents and their relatives / representatives must be treated as complaints in accordance with the Complaints Procedure. This is to ensure concerns are taken seriously and acted on. The staffing numbers must be appropriate to the needs of residents. This is an outstanding requirement from the previous key inspection, initial timescale 26/07/07 not met. An effective system for monitoring and reviewing the quality of the service, based on the views of residents and other stakeholders, must be in place. This is to ensure the home is run in residents’ best interests. 01/02/08 7 OP16 22(3) 01/01/08 8 OP27 18(1)(a) 01/01/08 9 OP33 24(1) and (3) 01/02/08 10 OP38 23 (4) In consultation with the fire 14/12/07 authority, adequate precautions against the risk of fire must be in place. The fire risk assessment must be completed, to take into DS0000065667.V355090.R01.S.doc Version 5.2 Page 27 Burkitt Nursing Home account the wedging open of fire doors and the emergency lighting must be tested regularly in accordance with fire safety regulations and the fire risk assessment. This is to promote and protect residents’ health and safety. This is an outstanding requirement from the previous two inspections, initial timescale 18/02/07 not met. Our concerns will be referred to the fire authority. 11 OP38 13(4)(c) In consultation with the environmental health authority, measures must be put in place for the prevention of Legionella. This is an outstanding requirement from the previous two inspections, initial timescale 18/02/07 not met. The lift must be maintained appropriately to keep it safe and in good working order. This is to promote and protect residents’ safety. A requirement was made about the lift at the last inspection but only ongoing temporary repairs are being made to the lift since February 2007. The use of bed rails must be risk assessed for each resident that uses them. This is to ensure this is the safest measure for that individual. Residents that require assistance with moving and handling must have a moving and handling plan that complies with manual DS0000065667.V355090.R01.S.doc 14/12/07 12 OP38 23(2)(c) 31/01/08 13 OP38 13(4)(c) 01/02/08 14 OP38 13(5) 01/02/08 Burkitt Nursing Home Version 5.2 Page 28 handling operations legislation and this plan must be adhered to at all times. This is to ensure the health and safety of both residents and staff. 15 OP37 37 All incidents as specified under this regulation) must be notified to the Commission without delay. This is so that the home can be effectively regulated. 14/12/07 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 Refer to Standard OP30 Good Practice Recommendations New care assistants should have an induction that meets with Skills for Care Common Induction Standards, in order to ensure these staff members have developed the skills and knowledge to fulfil their role competently. Burkitt Nursing Home DS0000065667.V355090.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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. 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