Inspection on 07/10/08 for Burkitt Nursing Home

This inspection was carried out on 7th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Burkitt Nursing Home 23/04/08

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 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Burkitt Nursing Home 41-47 Melton Road West Bridgford Nottingham NG2 7NE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Meryl Bailey     Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Burkitt Nursing Home 41-47 Melton Road West Bridgford Nottingham NG2 7NE 01159814046 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Vicky Rotelo Type of registration: Number of places registered: Mr David Hetherington Messenger care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 Date of last inspection Care Homes for Older People Page 4 of 26 Over 65 55 0 Brief description of the care home 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 and range from £294 to £529 per week. Further information about the home and a copy of the last inspection report is available at the home on request. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our 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 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 sent surveys to people living at the home and the information given in these has been used Care Homes for Older People Page 6 of 26 in this inspection. We carried out the inspection visit with one inspector. It was unannounced and took place on one day in the daytime, including lunchtime. The main method of inspection we used is called ‘case tracking’ which involved 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. We looked at staffing records and other records connected with the running of the home. A tour of the premises was made, but we did not see every bedroom. What the care home does well: What has improved since the last inspection? What they could do better: They must ensure a Care Plan is in place for all people who have been admitted to the home. This is to ensure there are action plans to direct staff to meet each persons specific needs. They must ensure all risks to the health of people moving into the home are immediately assessed with actions needed recorded in the plan of care. This is to promote and maintain the health of all people who live at the home. We recommend they provide a programme of activities that takes account of the individual needs and preferences of people at the home and includes individual stimulating activities. We recommend they review arrangements at mealtimes to ensure people always receive their meals with some flexibility, but at appropriate times and together with people they are sitting close to. They must make arrangements for the replacement of wooden tray tables. This is in order to promote satisfactory standards of hygiene. Care Homes for Older People Page 8 of 26 We recommend that they make people aware that they can choose not to share a bedroom, so that people share only if they make a positive choice to share with a particular person. Having regard to the size and layout of the care home and the numbers and needs of people living in the home, ensure there are a sufficient number of competent staff to meet peoples needs at all times. This is to promote and maintain the health and welfare of people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have information about the home and are fully assessed prior to moving into Burkitt so that staff have information to enable them to meet needs. Evidence: The Service User Guide had been updated and was available in reception. A new person said she had seen information about the home. We looked at the files of five people and each had a full assessment of needs. They were detailed and included information about previous history and gave information on risks to health. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The action needed to meet care needs is mostly planned, but plans are not in place for the first week for people who move into the home and this means that health and social care needs may not initially be met. There are facilities for meeting health care needs and people receive their medication safely. Evidence: On four out of the five files there were detailed action plans to direct staff in each area of need. There had been monthly reviews which were written down and signed by nurses and the action plans had been updated as required. The manager told us that plans are reviewed approximately every 6 months with the person and their relatives present. Two relatives confirmed they have been invited to review meetings. One commented, Everything seems OK on paper. 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. An agency worker told us they were directed by permanent staff about how to meet peoples needs. One of the care plans we saw was not formulated until seven days after the person had moved in. On the fifth file we Care Homes for Older People Page 12 of 26 Evidence: looked at there was only an assessment. This person had moved from another nursing service five days earlier. We found this person sitting unsupported on a sofa. She was calling for help and was uncomfortable. Staff had walked past her, but not noticed as they were busy at the time. When asked staff attended to her, giving a choice of sitting in her own room or a more comfortable chair. We observed staff using the hoist to move her and this was done with care and dignity. Staff did not know which chair would meet her needs and were also not aware of the extent of her visual impairment and of how to meet needs relating to this. People told us that they receive good care from staff who always do their best. They also told us they have to wait a long time for help sometimes (see staffing section). For all those with established care plans there were detailed risk assessments to determine action staff were to take. These related to: pressure sores, nutrition, falls, manual handling, use of bed rails, medication, and infections. There were records of visits from doctors, opticians and district nurses for those not receiving full time nursing care. Treatment was given in peoples own rooms. Some people were cared for in bed. Due to concerns at the last inspection we checked the charts that staff use to write down the care they are giving. We saw that these were written more accurately and clearly than previously. 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 kept the medication secure at all times. Some visitors were present during the inspection and were either in the communal lounge or with people in their own rooms for privacy. When touring the building we observed staff knocking on doors to bathrooms and bedrooms. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some attention is given to individual social and recreational needs, but not all people benefit from stimuating activities to meet their individual needs. Meals are not always enjoyed due to long waits to receive them. Evidence: An activities worker is employed to work at the home on three days each week and two people said they enjoyed talking individually with the activities worker. She had helped one with lunch. Others had not had any time with the activities worker and most people sat in the communal areas with no stimulating activities. Since the last inspection the previous activities worker was not subsequently available and a new person has commenced. There was no programme of activities displayed, but relatives have told us that there are entertainers visiting the home. We saw various visitors at the home during the day of this inspection and there was a record of visitors in the reception area. In the Annual Quality Assurance Assessment it is stated that some people go out to two different churches. Various information was available in the reception area and this included avocacy services provided by Age Concern. Care Homes for Older People Page 14 of 26 Evidence: One person told us that breakfast had not been offered until 11.15. She refused as it was near to lunch time. The main course choice for lunch was Macaroni Cheese with vegetables, Minced Beef Cobler with vegetables and potatoes or a Cheese salad. Some people had to wait a long time for their food. People were served in the order that their names appeared on the menu choice list. Some people had their meals in their rooms, some were sitting in the dining area and others had tray tables where they were already sitting in the lounge areas. Most of these tables were unclean and damaged (see Standard 26). People sitting close together were not all served at the same time. Some people had their meal in front of them, but had to wait for cutlery. Those who needed assistance with eating had to wait until other meals had been served. There was a further wait for the second course. One person told us that the quality of the meals varied, but had generally improved over the last six months. She had eaten porridge for breakfast, which she described as beautiful this morning, but it depends who makes it. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home and their relatives or representatives can be assured that their concerns are listened to and appropriate procedures are followed to protect people. Evidence: There was information about two complaints held in a Complaints file. These were recorded in sufficient detail by the manager. The complaints procedure was displayed in the reception area. 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. Since the last inspection the manager had obtained a copy of the local policy and procedure for the Nottingham area. The manager told us of a recent allegation and of appropriate action taken so far within the local procedural guidance. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally kept clean and adequately maintained, with some improvements since the last inspection, but attention is needed to renewal of some items to ensure people are protected from infection. Evidence: We made a tour of the building, but did not see all bedrooms. One bedroom was currently being shared. The relatives of the people concerned had agreed to the arrangement, but there was no evidence that the people themselves had made a positive choice to share with each other. There were other double rooms that were being used by just one person. 44 people were currently accommodated in bedrooms on three floors. Two passenger lifts were available and in good working order. The problem found at the last inspection when water was found leaking into the dining area had been solved. Also work had been completed on bathrooms throughout the home, but in one bath the electric seat was not working. This was the only bathroom on the top floor. This meant people with bedrooms on that floor had to temporarily use bathrooms on other floors. There was an assisted bath on the ground floor and another bathroom on the middle floor. We saw that the electric bath seat was written in the maintenance book and records for the last month showed that maintenance problems had been dealt with within a week. A maintenance person is now employed to work between two care homes and is able to make a quicker response since the last Care Homes for Older People Page 17 of 26 Evidence: inspection. There were domestic staff working every day and cleaning was ongoing during the inspection. All areas were clean and fresh. Equipment seen was clean with the exception of the damaged wooden tray tables used in the lounge. These need replacing as they can no longer be cleaned sufficiently to guard against infection. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An insufficient number of competent staff are provided to meet all needs efficiently, but procedures are in place to ensure any new staff are fit to work in the home and appropriate training is arranged Evidence: On the day of the inspection visit there were 44 people altogether living at the home. 23 of those had been assessed as needing nursing care. We looked at the staffing rota and it showed that one nurse and six care staff were on duty from 7:15am until 8:15pm with some changing shift at 2:00pm. In addition to this, the manager was also available to provide nursing. 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. However, we found that one of the care staff had only commenced that morning and three care staff were from an agency. The effect of this was that people had to wait longer for attention. As already reported, one person told us that she was not offered breakfast until 11.15 that morning. Another person who was waiting for her lunch repeatedly said They are very, very understaffed. A visitor said that he helped a man the previous day as staff were too busy to attend immediately. During this inspection we alerted staff about specific people needing attention as they were too busy to notice. For example, as reported under Standard 7, we found one person was sitting uncomfortably, unsupported on a sofa and calling for Care Homes for Older People Page 19 of 26 Evidence: help. Another person needed assistance to change clothes after lunch and this had not been noticed. When asked why the serving of meals was taking a long time, an agency worker said that he had to rely on other staff to tell him who to serve. He had taken some meals to bedrooms, but did not know his way around the home. As part of our survey a relative told us that the regular staff work hard and are helpful but are just stretched too much. The registered manager told us that the number of staff has been based on dependency levels, but she has had difficulty recruitng sufficient regular care staff. She was continuing with the recruitment process. We confirmed at the last inspection in April 2008 that 50 permanent care staff had achieved National Vocational Qualification in care at level 2 and this percentage remained the same on this inspection. Records relating to the nurse on duty confirmed details of registration with the Nursing and Midwifery council. We saw some copies of certificates and staff told us about the training they had completed during the last six months, which included Safe Handling of Medicaton, First Aid, Continence and Tissue Viability. A sample of staff records showed that recruitment procedures included Criminal Records Bureau checks and obtaining references. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management procedures are well established for the running of the home. Evidence: The manager is a registered nurse and registered with the Commission. She was present during the inspection. Another senior manager form the company was present for discussion and feedback. In discussions with staff they confirmed that money held for people is secure and signatures of two people are always recorded to confirm all transactions are accurate. Meetings with people living at the home have continued and minutes were available. Since the last inspection the maintenance book has been better organised and it was clear that maintenance jobs had been completed. We also saw evidence of this during the tour of the premises. For example, an appropriate fly screen had been fitted at the kitchen window. There were records of temperature testing and serviceing of Care Homes for Older People Page 21 of 26 Evidence: equipment. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Ensure a Care Plan is in place for all people who have been admitted to the home. This is to ensure there are action plans to direct staff to meet each persons specific needs. 30/11/2008 2 8 13 Ensure all risks to the health 30/11/2008 of people moving into the home are immediately assessed with actions needed recorded in the plan of care. This is to promote and maintain the health of all people who live at the home. 3 26 16 Make arrangements for the replacement of wooden tray tables This is in order to promote satisfactory standards of hygiene. 30/11/2008 Care Homes for Older People Page 24 of 26 4 27 18 Having regard to the size 30/11/2008 and layout of the care home and the numbers and needs of people living in the home, ensure there are a sufficient number of competent staff to meet peoples needs at all times. This is to promote and maintain the health and welfare of people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 Provide a programme of activities that takes account of the individual needs and preferences of people at the home and includes individual stimulating activities. Review arrangements at mealtimes to ensure people always receive their meals with some flexibility, but at appropriate times and together with people they are sitting close to. Make people aware that they can choose not to share a bedroom, so that people share only if they make a positive choice to share with a particular person. 2 15 3 23 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!