CARE HOMES FOR OLDER PEOPLE
Burlington Court Roseholme Road Abington Northants NN1 4RS
Lead Inspector Moira Mosley Unannounced 10th May 2005 10.00 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 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. Burlington Court Version 1.10 Page 3 SERVICE INFORMATION
Name of service Burlington Court Care Home Address Roseholme Road Abington Northampton Northants NN1 4RS 01604 250225 01604 230746 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Burlington Care Homes PLC Vacant Care Home 102 Category(ies) of OP Old Age (76) registration, with number DE(E) Dementia - Over 65 (20) of places PD(E) Physical Disability - Over 65 (6) Burlington Court Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to 20 service users falling within the category of DE(E), Dementia over the age of 65 years, may be accommodated. 2. Up to 6 service users falling within the category of PD(E), Physical Disability over the age of 65 years, may be accommodated. 3. Up to 76 service users falling within the category of OP, Old Age not falling within any other category, may be accommodated. 4. Service users falling within the category of DE(E) will be accommodated only on the first floor of `Tudor Wing`. 5. To offer respite to a named service user as per variation application dated 11.01.05. Date of last inspection 25th October 2004 Brief Description of the Service: Burlington Court Care Home provides personal care for up to 102 service users when it is running at maximum capacity. The home currently caters for older people over the age of 65 years, including up to 20 service users with dementia. Burlington Court is located in Northampton, close to Abington Park, and is nearby to the local shops and facilities of Wellingborough Road. Within the home there are lifts serving the first floor and the building is designed around landscaped gardens. There are three wings, namely Tudor, Saxon, and Windsor wings, each with ground and first floor accommodation, including lounge and dining areas. The first floor of Tudor wing caters for service users with dementia related needs. All bedrooms have en-suite facilities and there are only three shared bedrooms. For enhanced security there is a camera system monitoring the external areas of the home as well as electronic security gates leading to the visitor’s parking bays. Burlington Court Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over 4 hours. The care of three residents was reviewed and this included looking at their care plans and other records including medication. Observations in the dementia wing and discussions with four of the residents were undertaken to assess the care being provided. An anonymous complaint was received about care issues and these were investigated during this inspection. The focus of this was in regard to the dementia wing of the home and the inspection was primarily based around these issues. The registered managers post is vacant, however an acting manager has been appointed and has been in post for three weeks. What the service does well: What has improved since the last inspection?
An acting manager is in post and application is being made to the Commission for Social Care Inspection for registration. The management processes are being reviewed and proactive changes being introduced to ensure staff have clear leadership and direction to meet resident needs. Burlington Court Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Burlington Court Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Burlington Court Version 1.10 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 standard(s) These standards were not assessed on this inspection. EVIDENCE: Burlington Court Version 1.10 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 standard(s) 7, 8, 9 and 10 The residents are at risk of not having their needs met because care plans; healthcare assessments and medication records are insufficient to demonstrate action needed or to be taken by staff. EVIDENCE: One resident was assessed as being diabetic, had dementia, was incontinent and daily records showed concern about her dietary intake. There were no care plans for continence or diet and the care plans for other identified needs were in insufficient detail to direct staff in what action they should be taking to meet the needs. Another resident had some care plans in place but the content was superficial, for example a care plan for mobility stated she ‘becomes wobbly, so uses a walking stick’ there were no further directions or links to a falls assessment. There was no evidence of a nutritional assessment for any of the residents despite there being concern about dietary intake and recent weight loss for one of the residents reviewed. The records did not show any referral to a GP or other healthcare specialist as a result of concern about the resident’s weight.
Burlington Court Version 1.10 Page 10 Pressure ulcer assessments were seen in two of the resident’s files, however there was no evidence of recent review and update in response to changing needs. There were no residents with pressure ulcers within the unit, however it was not evident if all residents had been reviewed to ensure that measures were in place to prevent the development of pressure ulcers. The medication procedures for the three residents showed an effective system for the storage, administration and recording of medication in the home. There was a large plastic container within the locked medicine cupboard that contained a large number of loose and unidentifiable tablets. A staff member explained these were tablets that had been refused by residents and were awaiting transfer to the pharmacist for disposal. There was no clear audit trail to account for this medication. The residents spoken to were very happy with the care they received and said the staff always respected their privacy and dignity when assisting them. They described the staff as being “nice” “delightful” and “very kind”. Staff were observed to be interacting positively with the residents and engaging them in activities and conversations. The staff spoken to demonstrated an understanding of the needs of the residents and one member of staff spoke about her approach as being how she would like her mum to be treated if she was in care. Burlington Court Version 1.10 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 standard(s) 12, 13 and 14 Residents are encouraged and supported to participate in activities, maintain family contact and exercise choice on a daily basis. EVIDENCE: The residents were observed to be involved in activities within the unit and staff were interacting positively and encouraging residents to join in and to converse with them and fellow residents. There were notices on notice boards about organised activities throughout the home. One staff member spoke about recent training in the care of residents with dementia and the differences this has made in their approach. The residents spoken to said there was a range of things to do both as groups and on an individual basis and one said the unit could be good fun. Staff and residents confirmed that visitors are welcome and the acting manager has introduced a system to increase the involvement of families and friends within the home. Two of the residents spoke about how they make choices on a daily basis including when they get up, go to bed, activities and meals. The staff spoken
Burlington Court Version 1.10 Page 12 to demonstrated an understanding about encouraging and supporting the residents to make choices where possible. Burlington Court Version 1.10 Page 13 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 standard(s) 16 and 18 Arrangements for protecting residents are not satisfactory placing them at possible risk of harm or abuse. EVIDENCE: The Commission for Social Care Inspection (CSCI) received an anonymous complaint about issues in the home whilst the inspection was being undertaken. These included: 1. Residents in poor physical condition 2. That there have been recent allegations of abuse and these have not been dealt with under the Protection of Vulnerable Adults (POVA) procedures. 3. There is insufficient bed linen. 4. That the boiler is not working and residents are being washed in cold water. 5. That staff were working excessive hours 6. That there is poor communication The issues raised in numbers 1 – 4 were investigated as part of this inspection and requirements have been made in regard to physical health needs and POVA procedures. The issues about bed linen and water temperatures are referred to in the report and there was no evidence to uphold this part of the complaint. Burlington Court Version 1.10 Page 14 Staffing issues were discussed and the CSCI have requested further information from the acting manager about this. The acting manager demonstrated that an effective system is in place for complaints received and these were being appropriately responded to. The procedure for the reporting of any allegations of abuse was not demonstrated and an investigation had commenced into an allegation made without following the Northants Inter Agency Policy. The daily notes for one resident showed an entry about a resident being physically aggressive towards a fellow resident during April 2005, with no evidence of any incident form, no direction for staff to respond to such incidents and no referral system in place for staff to raise these issues with the manager and ultimately with the POVA team. Burlington Court Version 1.10 Page 15 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 standard(s) 24 and 25 Residents are provided with comfortable accommodation suitable to their individual needs. EVIDENCE: Resident bedrooms showed evidence of personalisation and were clean and tidy with suitable bed linen. A storage cupboard contained a range of extra linen and towels to meet resident needs. The manager and staff confirmed there had been problems with bed linen and once this had been brought to the manager’s attention new supplies had been ordered. Hot water was available both in resident en suites and communal bathrooms, however the manager did confirm there had been a boiler problem earlier in the month and this has been rectified. Burlington Court Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 There is a proactive system in place to address the staffing and their training in order to meet resident needs. EVIDENCE: There were sufficient staff on duty to meet the resident needs however the acting manager identified that a review of dependency levels in relation to staffing provided was being undertaken and a recruitment drive was in place to recruit identified shortfalls. The acting manager confirmed a review of staff training and a training plan in progress to ensure all staff receive the necessary training to meet resident needs. The staff spoken to confirmed they had received both statutory training in areas including manual handling, fire safety and first aid. In addition there is in house training and a variety of courses have been supported including dementia care. Burlington Court Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 A proactive management strategy is in place to support staff and to involve residents and their families in the development of the home. EVIDENCE: An acting manager has been appointed and an application is being submitted to the Commission for Social Care Inspection for registration. The residents and staff spoken to confirmed that they were happy with how the home was being managed. The acting manager has identified a need to increase the involvement of residents, their families and friends and has already had meetings with many of the families to seek their views about the home and address any concerns raised. The staff spoken to confirmed there are staff meetings and the acting manager provided an action plan to address the need for further staff support, development and training in order to ensure resident needs are met by an effective staff team.
Burlington Court Version 1.10 Page 18 Burlington Court Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION x x x x x 3 3 x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x 3 x x x x x x Burlington Court Version 1.10 Page 20 no Are there any outstanding requirements from the last inspection? 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 7 Regulation 12()(a)(b) and 15 12(1)(a)( b) and 13(4)(c) 13(2) 17(1)(a) and schedule 3(3)(i) 12(1)(a)( b) 13(4)(6) Requirement A care plan must be developed for all areas of resident need and identify detailed action to be taken by staff. Healthcare assessments including nutrition and pressure ulcers must be completed and any action required clearly identified. A clear audit trail of all medication in the home including disposal must be maintained. The procedures for reporting and acting on any suspicion of abuse must be in line with the Northants Inter Agency policy. Timescale for action 10/07/05 2. 8 10/07/05 3. 9 10/07/05 4. 18 10/06/05 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 Good Practice Recommendations Burlington Court Version 1.10 Page 21 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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