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Inspection on 08/05/06 for Burlington Court Care Home

Also see our care home review for Burlington Court Care Home for more information

This inspection was carried out on 8th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is purpose built in a hotel style, and maintained to a good standard. Residents spoken to expressed their satisfaction at the care provided, and all appeared well groomed and well cared for. Excellent individual care plans are available for each resident, and these are regularly reviewed to ensure that staff have the necessary information with which to care for them. Comments in resident questionnaires included such things as "Staff are very helpful and caring" and "Staff are always there for us. I am happy about everything here."

What has improved since the last inspection?

Up to date records of staff training are now available. A total of twenty-two care staff are now qualified at National Vocational Qualification level two or above, with a further six currently working towards level three. This ensures that the skills required to care for the residents are in place. Two lounge areas have been redecorated. The kitchen equipment that was out of order at the last inspection has been repaired, and all equipment was reported as being in working order at the time of inspection. Duty rotas demonstrated that staff are no longer working excessive hours, which enhances their ability to care for residents.

What the care home could do better:

Two main areas for improvement were identified by resident questionnaires and were confirmed on inspection. The first of these was the provision of activities. Although activities are provided, there is no member of staff delegated to co-ordinate these and no evidence that residents have been consulted concerning the activities provided. Further work is required to ensure that activities meet the needs of the residents, and advertisements have been placed to employ an activities coordinator. The second area identified was the provision of food. Although residents spoken to stated that the standard of food was usually satisfactory, this was reported to be variable, with limited choices. The proper provision of food for specialist diets was highlighted at the last inspection and this remains inadequate.

CARE HOMES FOR OLDER PEOPLE Burlington Court Care Home Roseholme Road Abington Northampton Northants NN1 4RS Lead Inspector Mrs Linda Preen Unannounced Inspection 8th May 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 DS0000029409.V291020.R02.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. DS0000029409.V291020.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Burlington Court Care Home Address Roseholme Road Abington Northampton Northants NN1 4RS 01604 250225 01604 887664 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) Burlington Care Homes PLC Vacant Care Home 102 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (76), of places Physical disability over 65 years of age (6) DS0000029409.V291020.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Up to 20 service users falling within the category of DE (E), Dementia over the age of 65 years, may be accommodated. Up to 6 service users falling within the category of PD (E), Physical Disability over the age of 65 years may be accommodated. Up to 76 service users falling within the category of OP, Old Age not falling within any other category may be accommodated. Service users falling within the category of DE (E) will be accommodated only on the first floor of `Tudor Wing`. To offer respite to a named service user as per variation application dated 11.01.05. 3rd October 2005 Date of last inspection 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 near 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 visitors parking bays. Fees range from £331.60 to £425. DS0000029409.V291020.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Four hours were spent prior to the inspection reviewing previous requirements and recommendations, comments from residents and relatives and collating information provided by the service. The inspection took place over a period of seven hours as part of the statutory inspection programme. Four residents were chosen in order that their experience in the home could be monitored. This included looking at their records, talking to them and also to the staff concerning the care received. In addition to this staff rotas and medication records were seen. 25 comment cards had been received from residents and 3 comment cards from relatives. These comments were on the whole favourable, with reservations being recorded concerning activity and food provision. In addition to this, two letters had been received, by the Commission, from relatives congratulating the home on the standard of care provided. All of the residents in the home are currently from white ethnic backgrounds, which reflects the local community. What the service does well: What has improved since the last inspection? Up to date records of staff training are now available. A total of twenty-two care staff are now qualified at National Vocational Qualification level two or above, with a further six currently working towards level three. This ensures that the skills required to care for the residents are in place. DS0000029409.V291020.R02.S.doc Version 5.1 Page 6 Two lounge areas have been redecorated. The kitchen equipment that was out of order at the last inspection has been repaired, and all equipment was reported as being in working order at the time of inspection. Duty rotas demonstrated that staff are no longer working excessive hours, which enhances their ability to care for residents. 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. DS0000029409.V291020.R02.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 DS0000029409.V291020.R02.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): 1 and 3. Standard 6 is not applicable in this home. Quality in this outcome group is good. This judgement has been made using available evidence, including a visit to the service. Residents have the information required to enable them to make an informed choice concerning admission to the home. Thorough assessments and Terms and Conditions ensure that residents are confident that their needs may be met in the home. EVIDENCE: A Statement of Purpose and Service User Guide have been provided and these include all of the necessary information to make an informed decision on moving into the home. Copies of these documents were available in the entrance to the home, and resident feedback confirmed that they had been provided with this information. Comprehensive pre-admission assessments had been carried out on the residents chosen to case track, and these assessments were kept under review in order to reflect changing needs. All of the residents chosen to case track had contracts in place, informing them of the terms and conditions of occupancy. DS0000029409.V291020.R02.S.doc Version 5.1 Page 9 In practice, the majority of residents in the home have the choice of placement made by their relatives and friends owing to their frailty and inability to look round prior to admission. DS0000029409.V291020.R02.S.doc Version 5.1 Page 10 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 in this outcome group is good. This judgement has been made using available evidence, including a visit to the service. Good systems are in place to ensure that all aspects of resident need are identified and documented for staff guidance, to ensure that these needs may be met in the home. EVIDENCE: Four residents were chosen to case track, two from the older people group and two from the dementia category. Care plans for all of these residents were excellent with very detailed personal information provided to enable staff to meet individual needs. The plans are regularly reviewed to ensure that they are up to date and reflect changing conditions. Risk assessments are in place for pressure ulcers, nutrition and moving and handling, with appropriate referrals being made to Health Care Professionals where needs are identified. Residents confirmed that they are able to see a Doctor if the need arises, and community nurses visited the home during the inspection. Records of chiropody visits were also available. DS0000029409.V291020.R02.S.doc Version 5.1 Page 11 Residents with a diagnosis of dementia are cared for in a dedicated unit and staff in this area have undergone training in order to meet their specialist needs. Evidence was available that current research had been incorporated into the daily routine of this group and it was reported that by having the unit quiet and free from distraction during mealtimes, this had vastly improved the mealtime experience in the unit and increased the food intake of this group. Systems are in place to ensure the control of medication in the home. Records of the receipt, administration and disposal of medication were seen to be satisfactory. Staff were aware that medication must not be hidden in food or drinks if residents decline to take them. Residents choices concerning provision of care and how they wish to be supported were recorded and these choices were respected. For example one lady spoken to stated that she preferred to be as independent as possible and that staff supported her in this. Staff were observed to be dealing with a potentially embarrassing situation for one resident in a sensitive manner, giving due regard for his privacy and dignity. DS0000029409.V291020.R02.S.doc Version 5.1 Page 12 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 in this outcome group is adequate. This judgement has been made using available evidence, including a visit to the service. There is no evidence that activities are provided according to resident’s choices. The provision of food is adequate for normal diets but is still unsatisfactory for those with special dietary needs. EVIDENCE: Activities are provided for both resident groups. Such things as a weekly pottery group, bingo, garden planting, “Songs of Praise”, along with visits from outside entertainers and clothes sales are arranged, but there is no evidence that residents have been consulted about this activity provision. A “tick box” form records their participation but does not record their enjoyment. Two residents went out with a staff member during the inspection and one gentleman was planning to take some friends out to lunch on the day after the inspection in order to celebrate his birthday. Another lady was celebrating her birthday that day, and chef had provided a celebration tea for her unit. Lunch was observed to be served at small family type tables, which were attractively set with tablemats and condiments provided. Residents who DS0000029409.V291020.R02.S.doc Version 5.1 Page 13 needed assistance were offered this in a sensitive manner. Food was served in good portions and looked and smelled appetising. Residents spoken to confirmed that the standard of food was generally good but that although choices were offered, these could sometimes be monotonous. The acting manager had identified this as a problem and had recently asked residents for suggestions as to what they would like on the planned summer menus. A new chef has been employed since the last inspection and reported that all of his catering equipment is now in working order. Food stocks were good but there remains little evidence of the provision of specialist foods for those residents with a diagnosis of diabetes mellitus. For example, tinned fruit is only purchased in syrup, necessitating this being rinsed in water to try to remove the syrup coating. This is unsatisfactory as of course this syrup is also absorbed by the fruit. This was made a requirement at the last inspection and remains outstanding. Visitors are welcome at any time and those who arrived during the inspection were made welcome by staff on their arrival. Records of individual choices concerning the times of rising and retiring, daily routines, clothing and food were seen. Residents spoken to confirmed that they were encouraged to exercise choice in their daily life. DS0000029409.V291020.R02.S.doc Version 5.1 Page 14 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 in this outcome group is good. This judgement has been made using available evidence, including a visit to the service. Residents may be confident that their concerns will be addressed and that they will be protected from abuse. EVIDENCE: There has been one complaint received by the Commission for Social Care Inspection since the last main inspection. This concerned the provision of activities, the provision of specialist diet foods and the maintenance of kitchen equipment. These complaints were investigated and requirements made to address these issues. Some progress has been made in these areas but as stated above, further work is needed to ensure full compliance. Records of complaints received by the home, demonstrate that these are handled in an appropriate manner and residents may be assured that their concerns will be taken seriously. A complaints procedure is available and a comments box is in the foyer. Staff training records demonstrate that training has been provided concerning the Protection of Vulnerable Adults, and staff spoken to were aware of their responsibilities in this area. DS0000029409.V291020.R02.S.doc Version 5.1 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 the following standard(s): 19,20,22, 23,24,25 and 26 Quality in this outcome group is adequate. This judgement has been made using available evidence, including a visit to the service. Residents are provided with hotel style accommodation that is maintained to a good standard but there are no specialist environmental adaptations for those residents with a diagnosis of dementia. EVIDENCE: A limited tour of the environment was undertaken. All areas seen were clean and tidy and furnished and decorated to a high standard. Communal areas are large and do not give a homely atmosphere. Advice has been given in the past concerning this. A pleasant enclosed garden area is provided and access to this has been improved by the addition of another path in the last few weeks. Resident’s rooms showed evidence of personalisation with small items of furniture, pictures and ornaments on display. Some residents have personal televisions and radios in their rooms. DS0000029409.V291020.R02.S.doc Version 5.1 Page 16 There are no environmental adaptations for residents with a diagnosis of dementia, although they have a dedicated unit. For example: Corridor areas are dark and impersonal, with identical doors, leading off which adds to the confusion of this group, and although some pictures have been provided, these are above eye level and do not have relevance to the individual resident concerned. Advice was given to the acting manager concerning this. DS0000029409.V291020.R02.S.doc Version 5.1 Page 17 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 in this outcome group is good. This judgement has been made using available evidence, including a visit to the service. Procedures for the recruitment of staff provide safeguards necessary to offer protection to the people living in the home. Staff are provided with training and in sufficient numbers to meet the needs of the residents. EVIDENCE: Duty rotas, staff training records and a selection of staff files were monitored at this inspection. Duty rotas demonstrated that there are 15 carers on duty in the morning, 13 in the afternoon and evening and six at night to care for a total of 80 residents, which would appear adequate to meet the needs of the current group. This was confirmed by the resident feedback cards returned. In addition to this, management, administration, catering and cleaning staff are employed. Staff are employed in specific areas of the home where possible, in order to maintain continuity of care to the residents and to ensure that they have the skills required to meet specialist needs. Duty rotas demonstrated that staff are no longer working excessive hours, and discussions with the acting manager elicited that they are not rostered to work for more than fifty two hours a week. This ensures that staff do not become overtired and therefore less able to provide a good standard of care to residents. A selection of staff files was monitored. This demonstrated that recruitment practices protect residents from potential harm and that the relevant preemployment checks are made. An equal opportunities policy is in place and DS0000029409.V291020.R02.S.doc Version 5.1 Page 18 staff come from a variety of different ethnic backgrounds. English lessons are provided for those staff members recruited from overseas in order to ensure that they are able to communicate effectively with the residents and each other. Staff training records demonstrated that statutory training is provided as necessary and staff spoken to confirmed that they had received this training. There are currently twenty two members of care staff qualified to National Vocational Qualification level two or above, with six more currently working towards level three, and the acting manager working towards level four. Two staff are currently completing a Distance Learning Course on care of residents with Dementia based at Milton Keynes College. In addition, three staff are booked to attend a Quality in Care course on the 30th May, six staff are booked to do Care of the Dying on the 25th May and two more staff are due to attend a Dementia course on the 13th July. DS0000029409.V291020.R02.S.doc Version 5.1 Page 19 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): 31,32, 33, 35, 36 and 38 Quality in this outcome group is adequate. This judgement has been made using available evidence, including a visit to the service. Management of the home has been very unstable for some time but the current acting manager has made good progress in addressing outstanding issues in the home, evidenced by the greatly reduced number of Requirements made at this inspection. EVIDENCE: The acting manager has been in post for six months and is currently in the process of applying for Registration under the Care Standards Act. He is an experienced manager who is currently working towards the Registered Manager’s Award and National Vocational Qualification level 4 in care. He has DS0000029409.V291020.R02.S.doc Version 5.1 Page 20 worked hard along with his staff to improve the service provided at Burlington Court and to comply with the Regulations. Residents and staff appeared relaxed and comfortable in his presence and approached him freely during the inspection. A copy of a recent Service Review and plan was on display in the entrance to the home. This contained the results of resident surveys as well as a review of the last year and plan for the future. Residents meetings are held and minutes of these were available for inspection. In addition, staff meetings are also held. A comments box is available in the reception area for residents, visitors and staff use. As previously stated, a copy of the Statement of Purpose was on display along with a notice offering access to the last inspection report. Systems are in place to care for resident’s pocket money and other valuables, with good records kept of transactions. A sample of these records was audited and found to be correct. Advice was given that individual receipts should be kept for hairdressing in order to clearly evidence this item of expenditure. Receipts were available for other transactions. Records of the testing of fire alarms and emergency lighting were seen and found to be satisfactory. No Health and Safety issues were identified during the limited tour of the environment. Staff supervision records were seen. This supervision has been recently introduced and senior staff have received training in this area in order to facilitate this for such a large group of staff. DS0000029409.V291020.R02.S.doc Version 5.1 Page 21 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 DS0000029409.V291020.R02.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP12 Regulation 16(2) m &n Requirement Evidence must be available that residents have been consulted concerning activities provided and records available of their participation and enjoyment. Research based adaptations must be provided to the environment in the Dementia unit in order to maximise residents independence. Suitable foodstuffs must be provided to allow residents with Diabetes Mellitus to have the same choices as the other residents. Previous timescale of 1/2/06 not met Timescale for action 01/07/06 2 OP22 23(2) a 01/07/06 3. OP15 16(2) i 01/06/06 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 DS0000029409.V291020.R02.S.doc Version 5.1 Page 23 DS0000029409.V291020.R02.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 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 © 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 DS0000029409.V291020.R02.S.doc Version 5.1 Page 25 - 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!