CARE HOMES FOR OLDER PEOPLE
Burleigh House 41 Letchworth Road Baldock Hertfordshire SG7 6AA Lead Inspector
Patricia Rogan Unannounced Inspection 14th June 2006 10:00 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 Burleigh House DS0000064005.V300100.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. Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Burleigh House Address 41 Letchworth Road Baldock Hertfordshire SG7 6AA 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) 01462 893216 01462 894799 Manage Care Homes Ltd Sarah Jane Rayner Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability over 65 years of age of places (19) Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Burleigh is a detached Edwardian House situated in a residential area of Baldock. It is close to the A1 and within easy walking distance of local amenities and shops. The home has nineteen single rooms, ten with en-suite shower facilities and all are on the ground floor. In all there are fourteen toilets, 1 assisted bathroom, 1 assisted shower room, 2 conservatories and 1 dining room and lounge. There is ample parking to the front of the home and a garden to the rear. Accessed via the rear garden is a large wooden building which provides office accommodation for the manager and space for meetings. Fees at the time that this inspection took place, ranged from £400 to £460 a week. Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection which took place during one full day and one half day. One inspector made a tour of the premises and spent the majority of the day speaking privately with residents and staff to ascertain their views about the care provided at Burleigh House. Observations were also made of the interaction between staff and residents. Some care plans, policies and procedures, including medication administration and record keeping were also inspected. Time was also spent meeting with the manager and with the proprietor and speaking with some relatives and professionals who visit the home. What the service does well: What has improved since the last inspection?
The proprietor commissioned an independent audit of practice in Burleigh House based on the National Minimum Standards and is taking action to address any issues and training needs arising from that audit. The walls in the corridor have been painted creating a brighter appearance. There has been an improvement in the administration and storage of medication but the recording on the medication record sheets must be in accordance with regulations.
Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 6 The skin condition which had affected some residents has been eliminated. Locks which can be released in an emergency have been fitted to bathroom and toilet doors to provide privacy. During the first day of the inspection, it had been noted that the care plans lacked sufficent detail to reflect the resident’s care and social needs and the resident’s ability to carry out some things independently. When the second visit was made to the home, work had already started to improve these. The proprietor now ensures a report is completed following an unannounced visit which takes place each month and a copy of this is forwarded to CSCI. A policy is now in place which stipulates that staff must not bring their children into the home while they are working. There has been the beginning of improvement to the way that staff records are stored and files have been purchased with dividers for each section. The manager said a quality assurance has been commenced and this will include the views of residents and their family members. The manager has started a diary which records daily events and appointments. The Service User Guide and the Statement of Purpose is being amended to include up to date information. What they could do better:
The initial assessment of prospective residents lacked detail in some cases and all should include personal and social history to ensure resident’s needs and interests can be met. Care plans are stored in a cabinet which is not easily accessible and this does not encourage staff to look at the files and keep up to date with information. Risk assessments must set out what risk has been identified and clearly explain how the risk will be minimised and this must be relayed to staff. Refresher training in the correct way to use the Medication Administration Record sheets would benefit those staff responsible for medication. All residents should be weighed monthly. If there is a significant change, the GP should be informed. Any advice given and action taken should be recorded and dated. Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 7 Some residents said they would like to know during the morning what was going to be served for lunch and tea that day so that they can ask for an alternative in good time, if they did not like what was on the menu. When residents are given an alterative to the menu, this should be recorded. Staff should ensure drinks are available and accessible to residents at all times. Fluid intake should be monitored to prevent dehydration and additional drinks should be encouraged during the very hot weather. The manager said staff supervision is ongoing. However, she was unable to produce the supervision notes. These must be properly stored. An inspection of some of the policies and procedures showed that not all incorporate the latest legislation. It is important that all policies and procedures are reviewed and updated as appropriate. The office was disordered and very untidy and the manager was unable to locate several documents such as supervision notes and records of contacts with the Criminal Records Bureau (CRB) when these were requested by the inspector. Work had started following the first day of this inspection but a marked improvement is needed to present a credible, well managed office. A requirement was made at the previous inspection for soft paper hand towels to be put in all toilets and bathrooms. This had not been done in all rooms. The manager gave assurance that those missed would be addressed immediately therefore a requirement will not be made. The staff rota is recorded monthly on a highly decorated calendar and is difficult to read. The rota is a regulated document and should be recorded legibly and in a professional format. Residents’ photos should be updated if the resident’s appearance changes. Some residents said they were woken very early for breakfast and would prefer to lie in. Meal times should be flexible as far as possible. Residents should not be woken early for breakfast if they do not want this and they should be asked when they would like to have breakfast. Bedtimes should also be more flexible according to the residents’ choice. Line management responsibility should be more clearly defined for day and night staff. Tasks such as shopping for Burleigh House or taking residents to appointments should be delegated so that the manager is available in the home when she is on duty. Several residents said they could not always sit in the conservatories because of the heat and glare of the sun. This has been discussed at previous
Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 8 inspections. It was a hot day on the first day of the inspection and the central heating was on. Staff should be vigilant to ensure a comfortable temperature is maintained throughout the home. All staff should be reminded that they should report any repairs which may be needed. Senior staff should regularly carry out their own daily inspections of the whole premises to ensure the the home is maintained in a good state of repair for the benefit of the residents and staff. 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. Burleigh House DS0000064005.V300100.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 Burleigh House DS0000064005.V300100.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 is not applicable to this home) Quality of this outcome area is adequate. This judgement has been made using available evidence including visits to this service. All residents are assessed prior to moving into Burleigh House. The assessment is carried out by a senior member of staff. Assessments would be improved if more detail was included and the opinions of the residents and their relatives was recorded and their signatures were on the assessment. EVIDENCE: The assessments needed more background on personal and social history and the resident’s view of what assistance he or she felt was needed. Not all those assessments which were inspected had been signed either by a member of staff or the resident. Burleigh House DS0000064005.V300100.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality of this outcome area is adequate. This judgement has been made using available evidence including visits to this service. The care plans lacked many details essential to ensure all areas of a resident’s needs are being met. This was reported in the previous inspection. However, by the second visit of this inspection, the care plans were in the process of being improved. The manager said there is a good relationship with the local GP practice. There has been improvement in medication storage and disposal. The majority of staff were seen to treat the residents with respect. However staff were not always discrete when speaking to residents. EVIDENCE: Care plans did not demonstrate that the resident had been closely involved in drawing up the care plan. Most care plans had generalised statements such as ‘needs assistance with personal care’ without expanding on this to state what
Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 12 the resident is able to do independently and how the resident would like the care to be provided. Medication administration has improved since the previous inspection although there were some recording errors on the medication administration sheets. The respect shown by most staff is marred by those staff who are less discrete. A member of staff was heard to call across to a resident to ask ‘Do you need the toilet yet?’ Another resident was transferred to another chair and the care worker did not make sure the clothing was straightened to ensure modesty. Burleigh House DS0000064005.V300100.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality of this outcome area is poor. This judgement has been made using available evidence including visits to this service. Further work is needed to ensure residents are given the opportunity to follow personal interests and wherever possible to continue with hobbies enjoyed prior to moving into the home. The majority of the residents said they went out with relatives. Residents should be given more opportunity to choose when they want to get up and go to bed and how they would like to spend the day, including making it possible for residents to go out to attend community events if they do not have family members to assist them. All residents said they thought the meals were plentiful and freshly cooked however, several residents said they would prefer to see a daily menu and have greater flexibility regarding meal times. EVIDENCE: Some residents had retained a keen interest in hobbies or sports but had not been given the opportunity to continue with this interest. One resident said ‘being old does not mean that we all want to play bingo or exercise to music.’
Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 14 The visitors who were met during the inspection said they were made welcome by the staff. Some residents and one or two relatives said that they felt residents were not left to wake up when they wanted to in the morning and were sometimes discouraged from staying up as late as they wanted to. Residents said they were asked what foods they enjoyed and menus had been drawn up to include this. However several residents said they would like to be shown the day’s menu in the morning. They would like an alternative put on the menu so that a choice can be made before the start of dinner and tea. Burleigh House DS0000064005.V300100.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality of this outcome area is adequate. This judgement has been made using available evidence including visits to this service. Most residents said they were confident about making a complaint or that they would be happy for a friend or relative to make a complaint on their behalf. The proprietor has issued a newsletter urging residents and relatives to speak to the manager and staff if any issues arise. The manager was unable to locate records of complaints and investigations. Not all members of staff have had training in Adult Protection procedures. This is to be arranged in the near future. EVIDENCE: Concerns were raised at the previous inspection that not all residents felt they could make a complaint if it was necessary. During this inspection, several residents said they felt that they were being consulted more by the proprietors to ensure they were satisfied. The Hertfordshire Adult Protection Policy is available in the managers office and most of the staff have had training in this. Arrangements are in place for all staff members to have this training. Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality of this outcome area is adequate. This judgement has been made using available evidence including visits to this service. There were no outstanding maintenance issues and repairs are carried out as needed. Redecoration has started and the home is already appearing brighter and more homely. These efforts to improve the environment is delayed because it would appear that staff are not noticing or reporting hazards such as loose cushioning and uneven carpets. All rooms, bathrooms and toilets had been cleaned to a high standard. There were no malodours. EVIDENCE: The rear conservatory had been cleared of equipment and made tidier and plans are in place to replace the shabby furniture. However, a stained mattress had been left across chairs in the rear conservatory, which is a room used by residents. Rubbish should be stored in a more suitable place.
Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 17 As on the previous inspection, the ties on the dining chair cushions were loose and presented a risk of residents slipping as they sat down. A door mat across a fire exit was curling up and presented a risk of tripping. All areas of the home were cleaned during the inspection. Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality of this outcome area is poor. This judgement has been made using available evidence including visits to this service. The skill mix of the staff meets the service users needs, with more than half the care staff having gained their NVQ2. The manager was unable to locate the supervision records or a supervision rota. The frequency of formal supervsion for all members of staff could not be confirmed at the time of the inspection. Staff records would be easier to use if they were in individual files with dividers with a check list to ensure recruitment procedures have been followed. EVIDENCE: The registered manager and the manager are studying for their NVQ4 and over half the care staff have their NVQ2. All staff have induction and training in moving and handling procedures. Several staff members said they had supervision. No member of staff was able to confirm that they had formal, minuted supervision every two months. Not all staff said they were given a copy of the supervision notes. The manager spoke about her recent phone calls to the CRB and with the Home Office to expedite matters in order to ensure that staff were suitable to be in the care home as volunteers or an employeees. However, she was unable
Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 19 to locate her records of these contacts. Staff papers are stored loosely in slings and they are not in order. Work is now to be ongoing to improve this. Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality of this outcome area is poor. This judgement has been made using available evidence including visits to this service. The registered manager has been running the home for considerable time and residents and staff speak well of her pleasant, friendly approach. However, she did not appear to be in control of the administration of the home. There does not seem to be systems in place for ensuring such things as supervision fire risk assessments are completed. Considerable time has been spent by the manager and the proprietors to create a more workable environment. A quality assurance system is being prepared to include the views of residents, family memebrs and all those involved in Burleigh Lodge. Some residents felt that they lacked the opportunities to continue with a lifestyle more appropriate to the way they lived previously. The manager needs to be proactive in developing ideas with residents and staff to create a more dynamic and forward approach to care provision. Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 21 Procedures are in place to manage the resident’s financial interests. The office is in a cabin in the garden outside the home and the manager is less able to observe events and practice in the home while she is trying to keep up to date with paperwork EVIDENCE: Many people spoke highly of the manager and said she was friendly and approachable. However on each inspection, the manager’s office has been exceptionally untidy and the manager was not always able to locate papers, information or records. Some out of date client papers which needed to be filed were on the floor under a bin. The proprietors have been working with the manager to tidy the office and there was a noticeable difference on the second day of the inspection. Several residents felt that they would like to have more freedom in making decisions about how they wanted to spend their time but they felt little acttempt had been made to encourage staff to explore a more individualised approach to lifestyle in the care home. There is a policy regarding the protection of resident’s financial interests and the manager was familiar with this. The home cannot be seen from the manager’s office and therefore she is less able to monitor practice and events in the home when she is having to complete paperwork which needs to be done in the office. Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 22 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP10 Regulation 12(4)(a) Requirement Timescale for action 14/06/06 2 OP14 12(2) 3. OP19 13(4)(a) Staff must be discrete when discussing personal care with residents and when assisting residents The registered person should as 14/06/06 far as practicable enable service users to make decisions with respect to the care they receive and their health and welfare The registered person must carry 30/07/06 out frequent audits of the home to which service users have access are so far as is reasonably practicable free from hazards to their safety. 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 OP3 Good Practice Recommendations Assessment should contain greater information about service user’s opinoins and the assessments should be signed by the service user or their relative.
DS0000064005.V300100.R01.S.doc Version 5.2 Page 24 Burleigh House Burleigh House DS0000064005.V300100.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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