CARE HOMES FOR OLDER PEOPLE
Burleigh House 41 Letchworth Road Baldock Hertfordshire SG7 6AA Lead Inspector
Mrs Alison Butler Unannounced Inspection 19th January 2006 01:30 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 Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 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.V277968.R01.S.doc Version 5.1 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.V277968.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th May 2005 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. It has been extensively converted by the addition of a purpose built ground floor accommodation. It has nineteen single rooms, ten with en-suite shower facilities. 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. This also contains a purpose built office. Burleigh House aims to retain independence, whilst helping to maintain their self esteem, dignity and keeping their individuality. It also aims to maintain “a home from home atmosphere”. Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors carried out this second unannounced inspection for the year. One inspector spent the majority of their time talking with residents, staff and visitors in the home. The other spent time with the management and proprietor of the home. The inspectors also conducted a complaint investigation, which had been received by the Commission For Social Care Inspection. All parts of the complaint investigated by the commission have been upheld or partially upheld. Requirements have been made to address the concerns and reference can be made to them in the relevant sections of this report. Since the last inspection the home has changed ownership although the management and staffing arrangements have remained the same. What the service does well: What has improved since the last inspection?
The manager has ensured that the Commission For Social Care Inspection has been informed under regulation 37 of any event that affects the health, safety and wellbeing of any resident. A risk assessment is in place for the resident who uses a reclining chair. Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 6 What they could do better: 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.V277968.R01.S.doc Version 5.1 Page 7 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.V277968.R01.S.doc Version 5.1 Page 8 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): These standards were not inspected. EVIDENCE: For information on the core standards, see previous report dated 13th May 2005. Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 9 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 Information contained within the care plans should be more detailed to provide guidance to staff to meet individual residents needs. Residents receive a varied quality of care and are supported by staff who have a variety of experience and knowledge. EVIDENCE: The care plans examined at this inspection showed that they should provide more detail on how staff can meet the residents needs for example when the aim is to promote independence they should detail how this needs to be done or what the resident needs support in e.g. bathing, eating etc. Information on the health of residents was limited to who saw them and what was said. Resident’s comments varied from “they help me whenever I need a bath or shower”, “some try to make us do things that I can’t and I go without a wash“, “they put the flannel in my hand and tell me to get on with it”, and another said that they were “quite satisfied”. There appears to be a higher emphasis about encouraging independence, rather then looking at the individual’s needs and their capabilities. Although it is important to ensure residents retain a degree of independence it is equally
Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 10 important to ensure care and/or support is provided as required to meet residents assessed needs. Where residents are unable to attend to their own hair and do not use the facilities of the hairdresser, staff must ensure that assistance is provided in order to preserve the residents dignity. Although the medication was not looked at, it was discussed as part of a recent discharge. The deputy manager had not got a signature for medication leaving the home as part of an audit trial although the Administration and Control of Medicines in Care Homes and Children’s Services published by the Royal Pharmaceutical Society 2003 states that all medication entering and leaving the home should be recorded. Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 11 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): 13 & 15 Visitors are able to visit the home. The home promotes integration into the local community in accordance with the resident’s wishes. Residents praised the food although a number reported that they were not aware of the days menu for each day. EVIDENCE: One resident takes himself out into the local community. Staff occasionally support residents to go out and visit the local amenities of their choice. Visitors spoken to were happy with the majority of the staff and felt happy about the care but commented that “I have crossed swords with a couple after over hearing them discussing residents”. Residents and their relatives must be assured that staff will respect their right to confidentiality and privacy. There were lots of compliments on the food that is served at meal times, although residents are not always aware of what is on the menu until it arrives. The home have on display a board that details the meal of the day. The staff need to look at ways of ensuring all residents are aware of what the meals of the day are. Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 12 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 & 18 A complaints procedure is in place. Residents were aware of who they could speak to although not all were confident to report concerns. A number were concerned that by speaking out it may leave them at a disadvantage and their care would suffer EVIDENCE: A copy of the complaints procedure is available to prospective and current residents. Whilst some residents felt they could raise concerns, some felt they weren’t able to in case it caused them getting into trouble and felt they just had to put up with it. This is not acceptable, residents have the right to raise issues and feel secure that they will be addressed appropriately. The information was fed back to the deputy manager and the proprietor to look at ways to address this to make residents feel more at ease in raising their concerns. A visitor spoke with the inspector and also raised some issues but felt that if they raised them with the home their relatives may suffer. They had also been concerned that they had heard staff discussing residents whilst in the kitchen, this was also observed by the inspector during the inspection. The issue of confidentiality must be reinforced with staff as a matter of urgency. The Commission For Social Care Inspection received in October 2005 a serious complaint that necessitated a joint agency investigation under the Hertfordshire County Council Protection of Vulnerable Adults procedures. The police investigated part of the complaint that included an allegation of physical abuse. At the time of writing this report the outcome of this is not known.
Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 13 The Commission For Social Care Inspection investigated other parts of the complaint during this inspection and has upheld or partially upheld all parts of the complaint that they were responsible for investigating. Referrals can be made to the relevant sections of this report. Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 14 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, 21 & 26 The home offers pleasant, comfortable and safe surroundings to the residents. The home was clean and well maintained. The bathrooms do not provide full privacy as the doors have no locks. Infection control procedures could be enhanced by the provision of disposable hand towels in the bathrooms and toilets. EVIDENCE: The home was well maintained both internally and externally. The doors on the bathrooms and toilets must have locks fitted to provide residents privacy, the locks should provide access in the case of emergency. The home was cleaned to a high standard. Soft disposable hand towels must be provided in bathroom and toilets for the safe drying of hands and to prevent the spread of infection. The laundry is sited away from the kitchen. The residents clothes all looked well laundered on the day of the inspection. Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 15 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 & 30 The skills and experience of staff is varied. Staff are not adequately trained to meet the residents needs at all times. Robust recruitment procedures are in place. However, care must be taken to protect resident’s health, safety and welfare ensure that only employees attend to residents. Staff must respect resident’s privacy and confidentiality at all times. EVIDENCE: Adequate numbers of staff are available to meet the needs of the residents at the time of the inspection. Some residents were complimentary about some of the staff and that they were cared for. However some reported that they were “just left to get on with it even though I can’t”. It is felt that the staff appear to put more emphasis on the residents being independent rather than looking at whether they are able to complete the task. See also comments in Health & Personal Care section. Extra training is needed for staff to be able to identify resident’ s needs and ensure these are detailed within their care plans with clear guidance on what specific need each resident requires. Staff need to be reminded on the need for confidentiality when discussing residents as they have been overheard on a number of occasions whilst in the kitchen drinking tea. Staff must work within the General Social Care Code of Conduct guidelines.
Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 16 From the staff records examined all the relevant information had been obtained and was available for staff employed within the home. The complainant identified that a member of staff’s family was ‘assisting’ in the home. The required checks had not been undertaken by the provider. The provider should also ensure that where family members are working together there are robust procedures for supervision and whistleblowing. Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 17 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): 33, 35 & 38 The health safety & welfare of the residents and staff is promoted and protected on most occasions. The home does not always appear to be run in the best interests of the residents. See previous sections for comments. EVIDENCE: The home generally have good policies and procedures in place for dealing with the health, safety and welfare of residents. However, see previous section for comments. Where residents personal property is being used for the benefit of others written agreement must be recorded and copies of any other relevant documents must be obtained. There were cotton hand towels in bathrooms and toilets and the manager must ensure that soft disposable towels are available for the safe drying of hands and the prevention of the spread of infection. Advice must be sought from
Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 18 appropriate professionals e.g. infection control nurse with regards to the currently undiagnosed skin problems. A bath thermometer and recording book is available in the bathroom, although there were only two temperatures recorded in December and no further entries. It is recommended that staff take the temperature and record in the book to ensure that the temperature is monitored and does not present a risk of scalding to residents. The water was within the required temperature range on the day of the inspection. The proprietor must ensure that a Regulation 26 visit and report is completed on a monthly basis and a copy forwarded to the Commission For Social Care Inspection. This gives a clear report about the homes conduct and gives the provider the opportunity to action any issues identified. Although quality assurance was not fully examined at this inspection. The provider must provide an adequate quality assurance procedure that allows them to identify and address issues affecting the quality of care provided at the care home. Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X 2 X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 X X 1 Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15(1) Requirement The manager must ensure that care plans detail the needs of the residents and what action is required by staff to ensure that identified needs are being met at all times. The health, safety and welfare of residents must be protected at all times in line with their wishes and feelings. The manager must ensure that all medication entering and leaving the home is recorded in line with the guidance contained within the Administration and Control of Medicines in Care Homes and Children’s Services published by the Royal Pharmaceutical Society published in June 2003 Advice must be sought to eliminate the undiagnosed skin problems in the home. The proprietor must ensure that good professional relationships are maintained at all times with residents and visitors to the home. Appropriate checks must be
DS0000064005.V277968.R01.S.doc Timescale for action 28/02/06 2 OP7 12(2)(3)& (4)(a) 13(2) 10/02/06 3 OP9 10/02/06 4 5 OP8OP38 OP16 12(1)(b), 13(1)&(3) 12(5)(a)( b) 10/02/06 10/02/06 6 OP18OP28 19(3) 10/02/06
Page 21 Burleigh House Version 5.1 OP29 7 OP21 12(4)(a) 8 OP26OP38 13(3) & 16 (j) 18(1)(c)& (i) 9 OP27OP30 10 11 OP29 OP33 18 (4) 24 12 OP33 26 13 OP38 13(4)(c) undertaken for all people who have contact with residents Locks must be fitted to all toilet and bathroom doors, which respects the privacy and dignity of all who use them. These must be accessible in the case of emergency. The proprietor must put in all toilets and bathrooms soft disposable hand towels to prevent the spread of infection. Training must be carried covering in assessment and care planning to ensure staff are able to identify and meet the individual needs of the residents at all times The manager must ensure that staff are working in line with the GSCC Codes of Practice. The manager and proprietor must look at ways to ensure that anybody who raises an issue about the home feel that they will be dealt with appropriately and in a professional manner. The Proprietor must ensure a report is completed following an unannounced visit, giving details on the conduct of the home. A copy must be forwarded to the Commission For Social Care Inspection every month All relevant documentation and written agreement must be obtained to use residents property for the benefit of others 31/03/06 28/02/06 31/03/06 10/02/06 31/03/06 28/02/06 10/02/06 Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Burleigh House DS0000064005.V277968.R01.S.doc Version 5.1 Page 23 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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