CARE HOMES FOR OLDER PEOPLE
Burlington House Burlington House 51 & 53 Warren Road Torquay Devon TQ2 5TQ Lead Inspector
Susan Samways. Inspection performed by Clare Medlock Unannounced Inspection 22nd March 2006 11:00 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 Burlington House DS0000061310.V268223.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. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Burlington House Address Burlington House 51 & 53 Warren Road Torquay Devon TQ2 5TQ 01803 298810 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) Amanda Jane Sutherland Care Home 13 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (13) of places Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th September 2006 Brief Description of the Service: Burlington House provides accommodation and personal care for up to 13 adults who have a learning disability The home is sited in a residential area close to local facilities. Residents are encouraged to integrate with the local community as much as possible. The home’s facilities are domestic in nature and Residents are supported in maintaining their individuality and independence as much as possible. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Wednesday 22nd March 2006. The registered provider/manager was not present, however the care Manager was extremely helpful throughout the inspection. The inspection consisted of a tour of the premises, looking at resident care plans, other records and speaking with residents and staff. Not all standards and not all elements were inspected at this time. It is therefore recommended that the reader obtains a previous inspection report to obtain a full picture of events at the home. What the service does well:
Staff at Burlington House provide a very good standard of care for older adults with a learning disability. Staff at the home perform thorough assessments to ensure Burlington House is the right place for residents to be. Residents are able to approach all staff about all aspects of their care. There are Good relationships between staff and residents. Residents like living at Burlington House and are encouraged to maintain links with the community, their families and friends. Residents are also encouraged to participate in appropriate activities which include education and social events. Residents are involved in the running of the home and their views about the home are actively sought. Residents are encouraged to develop and maintain independence which is depended on ability and risk assessments. Staff at the home have respect for the Provider and say she is fully supportive, professional and able to manage well. The Care manager has an open and approachable manner with residents and staff. Staff at the home have a good knowledge of the residents and all share clear aims of the home. The staff are well trained and receive regular formal supervision. The home is clean, well decorated and comfortably furnished and has a homely atmosphere. Residents personalise their rooms to reflect their different tastes. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Staff at Burlington House are providing a very good service to Residents. The quality assurance methods should continue to ensure this level of service continues. The Provider should ensure staff, residents and visitors have access to the Statement of Purpose and Service User Guide. Staff files should be available for inspection. Ways in which this is possible should be explored by the Provider whilst continuing to protect confidentiality. Although the management of the medication system is adequate further action could be considered to reduce risk of errors occurring. These changes could include the introduction of photographs on the MAR (Medication Administration Record) Sheet and ensuring when entries on the MAR sheets are made these
Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 7 are checked by a second member of staff to ensure the prescription and drug dosage is written correctly. Further improvements to the way residents money is handled can also be made to protect both residents and staff from mistakes and misunderstandings. For all transactions two signatures could be obtained and when a transaction is made a receipt obtained and kept to show where money has been spent. The continued programme of maintenance should also be continued with the repair to the lounge carpet to remove the potential trip hazard. 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. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 8 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 Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 9 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): 1,3,4 and 5 The detailed assessment and settling in process means Residents, staff and relatives have enough information to decide whether Burlington House is the right place for them to be. EVIDENCE: It was not possible to inspect the Statement of Purpose and Service User Guide as these documents were not accessible to staff on duty. These documents should be available to residents, staff, visitors and other relevant persons. The Care Manager explained the detailed assessment process which has been used before a place is offered to a prospective resident. This process is detailed but also led by the needs of the resident. Documents and records confirmed that other key people such as the care manager, health care professionals and relatives are also involved. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 10 Discussion with the Care Manager confirmed that trial visits and overnight stays are performed to ensure the new resident, family, staff and existing residents are happy about the decision to move to Burlington House. The Staff at the home are very clear about the care the home is able to provide and therefore the nature of the residents for whom they could provide support. Records showed that staff training is focused on these areas and all staff are expected to complete a course of study regarding specific needs. Staff were observed interacting with residents and this was seen to be done in a positive and supportive way. The staff are well trained and use sign language and symbols to aid communication. Records show that specialist services are accessed as required e.g. diabetic services, Specialist Learning Disability Support team. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 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): 7,8,9,10 and 11. Residents can be confident that their care plans clearly identify their needs and how they will be met. Residents’ health and social care needs are well met and regularly reviewed. EVIDENCE: Three Care Plans were inspected on this occasion which clearly demonstrated that Residents have all their needs met and make sure staff are aware of all aspects of the care. All Care Plans were all very different and reflected the individualised needs of the residents yet all showed how care was planned and delivered. The system was able to spot changes in care and monitor trends and the common signs of the ageing resident group. Each Care Plan is signed by the resident. Care plans include a photograph of the Service User, their preferred name, support required with daily activities, a skills profile, likes and dislikes, body maps, medication and visits to professionals. Residents with conditions such as epilepsy and diabetes have detailed profiles regarding that condition. The system of Care Plans has been recently updated. These care
Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 12 plans were inspected and were seen to be up to date, well written and complete. Records confirmed that any changes in the general or specific needs of the Residents are identified and trends monitored. Observation confirmed these documents were ‘working documents’ and reflected the high standard of personal care given. Weight charts monitor weight gains and losses in those residents at risk. All resident seen on the day of inspection appeared well cared for. Residents were seen to have clean eyes, teeth, and were dressed in their own clothes. Residents who wore glasses had them on and footwear appeared appropriate. Residents are seen by other health care professionals including the General Practitioner, consultants and other health care professionals. Residents spoken to said they receive NHS services and have recently had ‘flu jabs’. All residents said staff were very kind and caring. Staff were seen to knock before entering residents rooms. The Medication system was inspected and appeared to be managed well. A monitored dosage system for medication is used and records were seen to be correct. The Care Manager confirmed that none of the residents are self medicating although some do apply skin creams and lotions. Two minor suggestions were made even though the home meet the standard. Discussion with the Care Manager explained how the subject of death and dying are managed at the home. Specific information given confirmed that staff at the home deal with this subject in a sensitive and appropriate way. Staff give support to the residents and allow involvement of how funeral services are conducted should residents wish to do so and where long term friendships have been made. Specific information confirmed that the home exceed this standard. Staff are given support by the Provider and offered counselling. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 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): 12,13,14,15 Residents enjoy a varied social life both in the home and in the local community. The dietary needs and preferences of the Residents are met with the provision of nutritious and varied meals. EVIDENCE: Residents access a wide range of activities both in the home and in the community depending on ability choice and risk assessment. These include college courses such as art, pottery visits to the cinema and theatre, swimming, going to restaurants and pubs and attendance at day centres as well as a variety of leisure activities within the home. All Residents are able to take an annual holiday if they wish. Resident meeting minutes showed the choices of the residents. These included no holiday, Bournemouth, Isle of Wight, and Blackpool. The home’s policy states that visitors are welcome at any reasonable time and Residents know that they can invite friends to their home if they wish. Relatives do occasionally visit but most live some distance away.
Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 14 Residents are actively involved in menu planning with each one taking turns to choose the main course and then, if possible, help in the preparation and cooking of the meal. The menu for the week is displayed in the dining room with the name of the Service User who has chosen the each meal. The staff are working with Residents to encourage them to broaden the scope of the menus and to consider seasonal variations. Special diets are catered for and alternatives offered for those who do not like what is on the menu. These changes are recorded on the menus for the week. One Service User particularly enjoys baking cakes and is supported by staff to do this. Residents spoken to said they are happy at the home and enjoy going to college and classes. Residents said they are able to have their rooms like they choose. Staff stated that the residents chose furnishings and decoration within their rooms. Residents were observed participating in the day-to-day running of the home e.g. clearing the table, drying up and wiping tables. Staff stated the housekeeper is employed to work with residents to keep their rooms clean and tidy. Records confirmed that there are regular, documented meetings involving residents and staff regarding life in the home. Part of the philosophy of care at Burlington House is to enable residents to be as independent as is practical, within the scope of individual assessed care needs and care plans. Records and assessments seen confirmed that residents are supported in taking risks. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 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 Residents’ rights are protected and they are safeguarded from abuse by staff training in adult protection procedures. The robust complaints procedure ensures any concerns or complaints will be dealt with appropriately. EVIDENCE: The home has a clear complaints procedure, which is available in symbols as well as text, a copy of which is displayed on the notice board. Residents’ views and concerns are listened to on an individual basis and at house meetings. Minutes of these meetings include a record of issues discussed and action taken. No complaints have been received by the Commission for Social Care Inspection about this service. Issues regarding the protection of vulnerable adults are included in the induction programme for new staff in order to raise their awareness of what constitutes abuse. The home also has two copies of the ‘No Secrets’ video which staff are encouraged to watch and discuss. Staff receive training in adult protection awareness. All staff are aware who to report any allegations to. Induction training includes dealing with aggression by Residents and detailed advice regarding each Service User’s behaviour is provided for staff. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 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): Burlington House provides Residents with a homely, comfortable and safe environment in which to live. EVIDENCE: A full tour of the building took place during the inspection. All areas seen were clean, tidy and free from offensive odours. The home is decorated and furnished in a homely way. The communal space includes two lounges and a dining as well as a large kitchen and laundry room which has an industrial size washing machine and tumble dryer. The home also has maintained the domestic washing machine and tumble dryer for those residents who chose to do their own laundry. All but one resident’s bedrooms were seen. One resident chose to use the lock provided. All bedrooms were decorated and furnished to a high standard and reflected the resident’s personal tastes and interests. One bedroom had an
Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 17 ensuite and access to the patio. The residents’ share the three large bathrooms. There are also separate toilet facilities. Outdoor space is small but the home is close to all local amenities and there is good access to local transport. A programme of planned maintenance and renewal of the fabric and decoration of the premises is in place. The home employs a housekeeper whose responsibility is to do the laundry and ironing. There has been refurbishment of the laundry room to include specialist flooring and commercial standard appliances. The home has an infection control policy in place and gloves and hand washing facilities were seen throughout the home. All staff undertake infection control. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 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 Staff have the skills, training and understanding to meet the needs of Residents. EVIDENCE: Staff rotas show sufficient staff to be on duty during the day and at night when two staff sleep-in. Additional Staff are employed to assist, prompt and encourage residents to keep their own rooms clean and tidy. A cleaner is employed on a part-time basis for the rest of the home. A housekeeper is also employed who is responsible for the laundry. A Chef has been recruited to manage the kitchen, do food shopping/ordering. All staff seen were relaxed, friendly and co operative. There appeared to be a genuine rapport seen between residents and staff. The Care Manager explained the recruitment process. The files for staff were locked away and not able to be accessed for this inspection. The need to have these documents was discussed at this inspection. The Care Manager explained that the Provider is committed to staff training and takes responsibility for the training programme which is provided in a variety of ways. These include in-house sessions, study days organised by the local social services and health services and distance learning courses. Staff are encouraged to access the training opportunities available and are given
Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 19 support by the registered person. Certificates showed that recent training sessions have included administration of medication, food hygiene, and moving and handling. In addition staff are required to complete NVQ 2 in Care and this is written into the employment contract. There are also opportunities for staff to undertake further training at induction, foundation and NVQ levels. The Care manager has been training to NVQ 4 standard and to be an NVQ assessor and has nearly completed the course. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 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): 32,33,25,36,37 and 38. The management style is open and receptive to the views of the Residents and others involved with the home. Safe working practices provide protection for both Residents and staff. EVIDENCE: The Care Manager was present throughout the inspection. She has been recently promoted to take on more management tasks. The Provider has significant management experience and has the Registered Managers Award. Residents and staff were both seen to freely approach the Care Manager. The response to residents and staff was seen to be supportive, relaxed yet professional. Staff spoken to said that the Provider makes time for the staff
Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 21 and any difficulties are addressed directly and quickly. Staff also said that she is open to ideas and suggestions as to how the service can be improved. Minutes confirmed that house, team and resident meetings are held monthly, , at which any issues of interest or concern to Residents can be raised, discussed and decisions made. Residents are encouraged to express their views and to ask questions. The meetings are also used by the Manager to inform Staff and residents of any proposed changes within the home and to seek their opinions. Progress has been made in the system of quality monitoring. The views of Residents are obtained both formally through use of surveys, which are in text and symbols, and at the monthly house meetings. Informally feedback is obtained on a daily basis from staff and residents. A plan for the maintenance and refurbishment of the home is in place. Future plans explained by staff included refurbishment of a toilet, decoration and replacement of the front windows. The registered person acts as appointee for some of the residents. Some residents manage their own bank accounts. Financial records were seen to be detailed, with each entry signed by the Resident or staff. It was suggested that two signatures be recorded to safeguard both staff and residents at the home. It was suggested that the management of residents finances is reviewed to show the system is transparent and safeguards residents, staff at the home and the Provider. It was also suggested that receipts for all transactions are maintained. An up to date record of Residents’ personal possessions was seen in their care plans. The system of staff supervision is well established with frequency ranging from weekly to every two months depending on experience. Staff spoken to said that they felt well supported and looked forward to coming to work. Records were seen to be kept of each session. The Care manager has completed a supervision skills course and is planning to conduct some of the supervision sessions. There is a rolling programme of annual appraisals. The home has policies in place covering all aspects of Health and Safety. All staff have had training in manual handling, First Aid, food hygiene and fire safety. Records of fire safety checks were seen to have been completed. Fire drills are also carried out. Environmental risk assessments were seen to be in place. Safety notices are in symbols as well as text. One carpet area was seen to be uneven which may cause a trip hazard. Staff at the home gave assurances that this would be made safe. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 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 1 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 x 2 3 3 2 Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 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 OP1 Regulation 17(2) Requirement The Provider should ensure the Statement of Purpose and Service User Guide can be accessed by staff and residents at the home. The Provider should ensure there are systems to access staff files at inspections. Timescale for action 01/06/06 2 OP29 17(2) 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. 1 Refer to Standard OP9 Good Practice Recommendations The Provider should consider: o Putting a Photo of Residents on the MAR sheets. And o Obtaining two signatures when a written entry is made on a MAR sheet, to reduce the risk of errors. The Provider should consider reviewing the System used for managing Residents money to include: o Obtaining two signatures for all transactions o Keeping receipts for all transactions o Ways to show the system protects both residents and staff.
DS0000061310.V268223.R01.S.doc Version 5.1 Page 24 2 OP35 Burlington House 3 OP38 The Provider should ensure the lounge carpet is free from trip hazards. Burlington House DS0000061310.V268223.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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