Inspection on 17/09/08 for Burnham Lodge Nursing Home

This inspection was carried out on 17th September 2008.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

Burnham Lodge Nursing Home 27/11/07

Burnham Lodge Nursing Home 05/04/07

Burnham Lodge Nursing Home 19/06/06

Burnham Lodge Nursing Home 04/01/06

Burnham Lodge Nursing Home 13/09/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

CARE HOMES FOR OLDER PEOPLE Burnham Lodge Nursing Home 147 Berrow Road Burnham-on-Sea Somerset TA8 2PN Lead Inspector Barbara Ludlow Unannounced Inspection 17th September 2008 08:40 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 Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burnham Lodge Nursing Home Address 147 Berrow Road Burnham-on-Sea Somerset TA8 2PN 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) 01278 783230 01278 781249 burnhamlodge@btinternet.com Elderly Medicare Limited Manager post vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 23. 27th November 2007 Date of last inspection Brief Description of the Service: Burnham Lodge Care Home can be accessed down a long drive fronting onto the Berrow Road in Burnham-on-Sea. The service provides nursing care for older persons aged over 65 yrs. The accommodation is homely and comfortable. On the ground floor there is a lounge and a sitting area with a dining table for people to take meals. There are 17 bedrooms, 13 single bedrooms of which 6 have en-suite facilities and 4 double bedrooms, 1 of which has an en-suite facility. Access to the first floor is via a passenger lift that can take a wheelchair. The home has a level patio area for sitting or walking, with a large rear garden where a summerhouse is located. Meals are offered to suit the individual. There is qualified registered nurse manager and registered nurse cover 24 hours per day supported by care and ancillary staff who are experienced in caring for older persons. Current fees are £620 - £655 per week (less free nursing care of £101 and privately funded people with higher rate attendance allowance have a further reduction of £67). Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. The Annual Quality Assurance Assessment (AQAA) was completed in October 2008 and returned to CSCI after this inspection visit. Questionnaires were sent to the home for people who live there, six were returned. A random inspection visit was made on 1/05/08 and another was planned for 17/09/08 however when the visit commenced a decision make this visit a key inspection. The visit was made by CSCI regulation manager Jackie Dolan and regulation inspector Barbara Ludlow. The visit was unannounced and commenced at breakfast time in the morning 08:40 and concluded at the change of day shift to night shift at 20.30. The manager designate was on duty and remained at the home to assist with the inspection process throughout the whole day. There was a registered nurse; three care staff, the cook, catering assistant and the new chef who was on induction. There was a domestic and the maintenance person on duty. There were seventeen people in residence, one person going out for the day. One person was here for day care. Daily life at the home and care practices were observed. All people using the service were seen and eleven visitors to the home during the day were seen and spoken with. Staff on duty throughout the day and the night staff were spoken with. A tour of the premises was made and records were sampled. The feedback from relatives reflected a good level of care. One person using the service explained a more negative side to the care and service. Progress had been made with the requirements made at the last key inspection. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 6 The inspector would like to thank all who contributed to the inspection process. What the service does well: What has improved since the last inspection? What they could do better: At registration the present owner agreed to increase the communal space by adding a conservatory, this has not been achieved. The communal space is limited to two areas; the layout of the main lounge is restricted and looks institutional, the smaller lounge is small and a thoroughfare to bedrooms in the wing. The lack of communal space impacts upon the choice of where people can sit and meet with their visitors, feedback from relatives has previously indicated that more choice of where to sit would be appreciated. The Aural thermometer should be used with covers and the instrument should be kept clean and hygienic. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 7 The dressing and equipment cupboard was unlocked. The manager was informed and a lock was added and the cupboard was secured before the conclusion of the inspection. The home had received a visit from the Health and Safety Executive Inspector; improvement notices were issued for bed rail height safety, two first floor windows that were widely opening and for a Legionella risk assessment. It was noted that the homes staff had reported that three alternating air pressure mattresses were malfunctioning. The manager was asked to remedy this; an immediate requirement issued at this visit and two new mattresses and one being repaired was confirmed to CSCI after the inspection. The people living at the home were having a long period of time between their tea and breakfast; we heard that the supper trolley with hot drinks had been stopped. It was confirmed that people who were able to ask could have a hot drink during the evening; others would be offered cold drinks when they received attention during the night. The majority of people at the home were not able to ask and would be reliant upon staff to offer them anything hot to drink or any snacks during the evening. This was discussed with the manager and an immediate requirement was issued to ensure that drinks would be offered and not be dependent upon people having to ask. CSCI received confirmation that the evening hot drinks trolley had been reinstated. 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. The summary of this inspection report can be made available in other formats on request. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 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 Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1.3, 6 is N/A Quality in this outcome area is good. The home has sufficient information available to people making enquiries. The statement of purpose needs to be updated and made more readily available. Pre admission assessment is undertaken to assess that care needs can be met at the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose was updated in June 2008; a copy of this document was taken but appears to require further updating with the management changes and contact information for CSCI. One visitor and their relative were asked about the inspection process. It was clear that they were satisfied with their choice of home and the brochure and price information available to them pre-admission. They could not confirm Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 10 having received a copy of the home’s statement of purpose or service user guide. Care plans were that were sampled were checked for pre-admission assessment and these were seen to be in place. Visits to the home are welcome, one such visit was undertaken during the random inspection and this was observed to be welcoming and competently undertaken. A copy of the homes current fee rates was supplied and four contracts were sampled and were up to date. Comment cards indicated that people had received contracts although there seemed to have been some delay with one before it was sent out. Four people indicated they had received information about the home before moving in one said they had not. Another person commented this was the only option at the time in Burnham on Sea. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Everyone has a care plan that gives details of all assessments and planning to meet their individual health care needs. Social care needs assessment for each person could be more detailed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Daily life throughout a whole day was observed at the home from breakfast time to the change of day staff to night staff at 20:00. People were treated with respect and kindness but there was not always a lot of interaction between the staff and person they were assisting. This also was identified at the last inspection and should be addressed through staff training. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 12 Care plans were sampled. The care plans contained personal and family information and details of the next of kin contact. Daily records were made and risk assessments were in place for pressure sore risk, manual handling, nutritional risk, weight and bed rail risk were recorded. The single assessment process and reviews (SAP) from social services were seen on file. These documents had been obtained when people were assessed for admission. There was continuity of health and social care, reviews had been made and there was evidence of reassessment for care as ‘continuing health care’ where needs had increased. Visits from health care professionals are recorded, such as the optician and the district nurse for continence advice. Vision call attends the home to carry out regular eye tests if required. Recent optical checks and dental checks were recorded. The home has a link nurse that has received training from the specialist continence nurse advisor and provides the link in house for continence management and updating. The aural thermometer appears to have been used with out cover caps and the instrument was not clean. This must be used in safe manner to reduce the risk of contamination and cross infection. This was stored in an easily accessed unlocked store cupboard with other equipment and dressings. This was brought to the attention of the manager and a lock was fitted to the cupboard before the conclusion of the inspection. The homes chiropodist visits regularly and people are seen every four or five monthly. Some people with chronic health conditions receive free chiropody care. There has been improvement with wound care mapping since the last inspection. One person only was reported to have a pressure sore this was being well managed. The medication administration records (MAR) were examined. Three medications where a varied dose to the prescription is administered did not have the changes indicated signed by the person making them nor was the entry countersigned by a competent other, as accurate. This should be done. The storage of medication was seen and was safe. The Controlled Drug store may not be compliant with the latest legislation and CSCI will make contact the home about this outside this report. The medication fridge was monitored daily and was maintained within a safe temperature range and this was recorded. Records were satisfactory for controlled drugs, medication orders and returns. Thirty five tubes of cream were seen for different people, this seems to have been over ordered and was brought to the attention of the manager. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 13 Comment cards were received from people living at the home. People all responded positively that they receive the care and support they need. When asked about medical call the people said they ‘always’ receive the medical support they need. One relative said they are not always informed that the doctor has visited or made changes to medication. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. The social care and social opportunities for people at Burnham Lodge are very limited. Families are made welcome and encouraged to visit and spend time at the home. The food is a good quality and attention to dietary needs at meal times is well met. Warm drinks and snacks in the evening are not routinely offered to all. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspectors heard that the night staff assist three people to get up each morning after 06:30 to 7:00am. People were up and dressed at the start of the visit, seven people were seen in the large lounge at 10:15 am, the television was switched onto a pop music channel, and no one was watching it. There was little interaction between the people and there were few call bells accessible for use. The lounge was not very warm at this time. A tray of juice drinks was brought into the lounge to be served as required during the day. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 15 Care plans have details of social history being recorded to give an insight into peoples lives. There was no activity coordinator at the home at this inspection. There had been some trial activities on one weekend, which visitors confirmed had been enjoyable. The manager was planning to interview someone for the role and was hoping to establish a programme of social activities in the coming weeks. Visitors are made very welcome and eleven people were seen during the day. Some are regular visitors and spend time helping their loved ones with meals and drinks and often assist others in small ways such as alerting staff when they are needed. It was noted that the lounge was unattended for periods up to 20 minutes during the morning and that during this time not all had access to a call system to alert staff if they need help. Staff were observed in the lounge moving people safely using manual handling equipment to transfer people from wheelchairs to armchairs, but there was little interaction with the individual at this time. Staff were not very communicative at other times for example where one staff was seen to recover a glass where a drink had been spilled onto the floor and across someone else’s slipper, there was no acknowledgement of this and no attempt was made to mop the spill up or dry off the person’s slipper. Staff need training to improve their communication skills. The statement of purpose indicated that the home would offer a range of social activities to meet the needs of residents who would choose to join in with activities. The menu for the day is written up onto a white board in the lounge, the menu for lunchtime was braised steak or faggots and new potatoes, parsnips and cauliflower cheese followed by strawberry flan or cheesecake and cream. At the last inspection it was reported that: The homes’ catering is well managed. The cook is experienced. And the cook has got to know the people in residence well and had a good rapport with them. All dietary likes and dislikes are recorded in the kitchen. The cook was seen at this inspection and the quality of the catering was seen to be of a good standard. A new chef was having their induction training on the day of inspection. People living at the home and their visitors confirmed that the food is good and is nicely presented. The inspector heard that on a recent Environmental Health Officer (EHO) visit a four star kitchen award had been achieved. One person asked about meals said there is ‘no supper here’ and it is a ‘long time’ between teatime and breakfast time. We heard that ‘some staff will offer you a drink in the evening if they are making one for themselves’ and that ‘It is lovely when they offer you a drink’ in the evening. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 16 This was investigated and the inspectors heard that the trolley with drinks is not routinely brought around in the evening any more. It was felt that hot drinks must be available. A potential gap between meals of sixteen hours between meals is unacceptable, a hot drink and snack should be offered to everyone in the evening. One person was seen at teatime, they were having bread and butter, a banana, yogurt and a cup of tea. Staff were asked about the evening time and they said that three or four people stay up later and are helped to bed by the night staff, others choose to go to their rooms or bed before 8pm. Comment cards were received from six people living at the home; some had help from their relatives. The responses to ‘are there activities you can take part in?’ People said there used to be a monthly minibus trip but there had been only one trip out so far this year. Another comment was that the activities are ‘very limited’. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. There is a complaints procedure and care is taken to help resolve any issues raised. Policies and procedures are in place to protect people from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure and contacts are detailed in the statement of purpose, the address and contact number for the commission need to be updated. There had been one complaint raised with social services and CSCI in the past year. The manager dealt this with in a responsive manner. Relatives gave positive feedback about feeling they could raise concerns. Staff recruitment files were examined for safe recruitment practice. One record on file only had one reference, the second one had not been taken up and there was no evidence of a telephone reference having been taken up. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 18 This was unsatisfactory and was requested by immediate requirement for this and all future recruitment. The manager confirmed future practice with CSCI. A Criminal Record Bureau (CRB) check had been obtained before the member of staff commenced working at the home. Comment cards were received from people living at the home. Four people said they know how to make a complaint and 2 said no. One person said the matron was helpful and another person referred to the box in the hall were comments can be left. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is poor. The service provides a homely but restricted environment. The internal environment has been suitably adapted but the layout and communal space have limitations. The home is kept clean and tidy but there are areas that need attention and could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 20 A tour of the premises was made. This included the lounge area, small dining /sitting room, kitchen, toilet and bathing facilities, laundry facilities, a sample of bedrooms, the offices, kitchen and staff /conservatory room were seen. There are seventeen bedrooms these include potentially four as double bedrooms. The double rooms do not have proper screens only mobile screens to separate the bed space for privacy. The home has two bathrooms. One is an assisted bathroom with a parker style bath is on the ground floor; this room also provides access to the linen store and access to the conservatory / staff room. The other bathroom is on the first floor. The shower facility is also on the first floor. The home has a number of aids and equipment to meet the needs of the residents that include hoists, pressure relieving equipment, assisted bathing facilities, grab rails and wheelchairs. The home had a Health and Safety improvement notice issued recently for bed rails that did not meet the safety guidelines. There was also a safety improvement notice for two first floor unrestricted windows. At this inspection three alternating air mattresses were in use for pressure relief these had been reported in the message book to be malfunctioning. The manager was issued with an immediate requirement to address this as soon as possible. This was confirmed as done within one week, one mattress had been repaired and two were replaced with ones newly purchased. Bedrooms can be personalised and many contained personal possessions such as photographs, soft furnishings and personal furniture and television sets. Hand washing facilities are available for staff throughout the home and this includes the provision of liquid soap and paper towels. Alcohol gel is available for staff to use. Other resources are available to aid in infection control such as gloves and aprons. Industrial style laundry equipment is accessed via the ground floor bathroom and is situated off the conservatory. At previous inspections it has been stated that: Due to the geography of the internal fittings staff have to access the laundry and their staff room via the kitchen or the assisted bathroom. The registered person is encouraged to review this situation as part of a redevelopment of the home. This comment remains valid. The floor in this laundry is part flagged and is not of any easy clean surfaced type. The replacement of the laundry floor to an easy clean surface was confirmed to CSCI after the inspection visit. There are steps up from the conservatory into the kitchen, these looked greasy and should be cleaned. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 21 The inspectors heard that the home’s lounge has not been redecorated for nine years and this is looking tired and is airless and would benefit from improved ventilation. Relatives visiting reported that the radiator in the small lounge / dining room hasn’t worked for two years; this should be attended and repaired as soon as possible. The home has limited communal space and the presentation is institutional due to the limited opportunity for arrangement. The exterior looks shabby, window frames and paintwork is in need of attention. An action plan was requested as a result of this inspection that must include the details of any plans for investment in maintenance and development of the home. This was submitted after the inspection visit. The home has a large lawned garden, which provides a pleasant outlook from the rooms at the rear of the house. Comment cards were received from people living at the home some helped by relatives. These reflected that the home looks tired and needs some redecoration. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate There is an experienced skill mixed staff team. Staff receive training to work safely and are encouraged to undertake NVQ training. Staff recruitment was safe but could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some of the homes staff team have worked at Burnham Lodge for a number of years and are familiar with the day to day running of the home. Staff training is made available to all staff. There is a manual-handling trainer in house to keep staff updated. Fire training is undertaken by an experienced part time administrator at the home. There was evidence of fire training updating being provided for four Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 23 people in April 2008 and prior to that the training was for twelve people in 2006. Staff asked confirmed that they had received training in moving and handling, dementia training and safeguarding vulnerable adults. Staff meetings continue to be held to improve communication between staff. Two staff recruitment records were sampled. One recruitment record demonstrated clear and thorough recruitment practice. There was evidence of staff training and development and supervision. The second file did not have two references and there was no reference to a telephone reference having been taken up and recorded. Two references must be obtained for people coming to work at the home and the outstanding reference must be obtained. An immediate requirement was issued and the records were photocopied and taken at the inspection. The management are minded to improve recruitment practice. A response was made to the immediate requirement but this did not confirm that the missing reference had been taken up. This has since been followed up and receipt has been confirmed. Comment cards indicated that staff are caring and appreciated. It was felt that more staff at mealtimes would be helpful and stop food going cold when people are waiting for help. Many visitors were helping their loved ones and others they had come to know at mealtimes. The AQAA indicated that staff are undertaking NVQ training and the home have introduced more training and people have updated their knowledge of infection control, dementia care and manual handling. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is poor. The home has a new manager. Management systems are in place to protect the interests of service users. Quality Assurance and staff supervision remain targets for management attention. The maintenance of some specialist equipment is poor and the home has improvement notices in place from the Health and Safety Executive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 25 There has just been an appointment to the manager position. Monthly regulation 26 visit records were seen for 2008 with the exception of the months of March and May. These records should be kept up to date. There had been no significant progress made with quality assurance during 2007, this was due to be reassessed at this inspection but again little progress is reported. Visitors were spoken with, they gave feedback on the environment and care. The management should ask people what they could do better and capture the feedback from relatives to help them plan their improvements for the service. At the last inspection it was reported that Small amounts of money are held for people who live at the home. The receipts for any purchases or expenditure are kept and are linked to invoice numbers on the computer system. Any money belonging to people in residence is held in a special residents trust bank account. No change to this system was reported. Accounts for fees were examined. Ledger and computerised accounts were seen. Four contracts and invoices were made available for inspection purposes. All were satisfactory. All records have restricted access and are securely stored at the home. Maintenance records for fire safety and equipment servicing were seen and these were up to date. The fire alarm was tested at 12:23pm during the inspection. The nurse call was checked by the homes maintenance person who was on duty and had been redecorating a toilet on the wing. This was not labelled as out of use at the start of the visit but was not accessible as there were paint pots and tools still in there from the decorating undertaken the night before. These were moved and the toilet made accessible during the morning. The home has improvement notices served by the Health and Safety Executive (HSE) for environmental safety improvements. These were for two widely opening first floor windows and bed rails that did not comply with the safety guidance. The record for hot water checking seen indicated that the hot water was in excess of 44 degrees Celsius on 16.09.08 and this requires adjustment down to be within a safe range. The manager said there was a fault found with the positioning of the hot water failsafe valve on the specialist bath. The manager has been told this will require attention to position the valve closer to the hot Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 26 bath tap outlet in order to remedy the problem and prevent the risk of scalding with hot bath water. The home was issued with an HSE improvement notice and was given advice about Legionella risk assessment. The management will be expected to comply with this within the agreed timescale. Comment from people living at the home indicated concern that the ‘home isn’t as happy’ a place as it was and one person felt the home is ‘short of staff on the management side’. The matron manager was described as helpful. People were supportive of the staff and visitors said they are satisfied with the care their relatives receive. Policies and procedures are in place but have not been reviewed annually. This is recommended to ensure they remain relevant and up to date with any changes to government legislation. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 27 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X 3 1 Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 28 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 OP33 Regulation 24 Requirement (1) The registered person shall establish and maintain a system for— (a) reviewing at appropriate intervals; and (b) improving, Timescale for action 10/01/09 The quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. The Registered Manager must develop effective quality assurance and quality monitoring systems. (Not met from 31/10/06, 4/02/08 and 08/05/08 2. 3. OP12 OP38 16(2) (m) and (n) 13(4)(c) 23(2)(c) An activities programme must be arranged to ensure that social care needs are met. Equipment in use for pressure relief must be checked and maintained in good working order. Subject to immediate requirement at the DS0000064241.V372178.R01.S.doc 10/12/08 10/11/08 Burnham Lodge Nursing Home Version 5.2 Page 29 4. OP38 5. OP38 OP26 inspection. Excessively hot water at bath tap 10/12/08 outlets must be properly controlled and adjusted to run within safe limits to reduce the risk of accidental scalding. 23(2)(a) The premises must be kept in 10/12/08 (b) (d) (e) good repair: an action plan is (h) (p) required to outline how and 23(3)(a) when the deficits will be addressed this includes: • The laundry floor • The kitchen steps. • The redecoration of the premises internally and externally. • Ensuring adequate ventilation in communal rooms. • Attention to enlarging the communal space available. • Improving access to the laundry and staff room. • One radiator that does not work needs repairing. 23(2)(c) 13(4)(c) Bed rails must be correctly positioned at all times. Bed rails must be also be monitored for wear causing excessive sideways movement that could cause the rails to become unsafe. By 14/05/08 This is now subject to an Health and Safety Executive improvement notice and compliance within the timescales agreed is expected. 10/01/09 6. OP38 7. OP15 16(2)(i) (4) A hot / warm drink and snack 10/12/08 must be offered to people at suppertime. People must not have to wait a long time between tea and breakfast without being offered any nourishment. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 30 8. OP9 13(2) An immediate requirement was issued at the inspection. The medication administration records (MAR) were examined. Three medications where a varied dose to the prescription is administered but the indicated changes had not been signed nor countersigned as accurate. This should be done. Nursing equipment must be stored clean and used in a hygienic manner, this refers to the aural thermometer. The registered person must comply with the requirements of the HSE with regard to Legionella advice given and risk assessment requested. This is subject to an Health and Safety Executive improvement notice and compliance within an agreed timescale is expected. 10/12/08 9. OP26 13(3) 10/12/08 10. OP38 23(5) 10/01/09 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. 2. 3. Refer to Standard OP1 OP13 OP38 Good Practice Recommendations The statement of purpose should be updated with the current management arrangements and updated CSCI contact details. There should be more community social opportunities and outings available from the home. Policies and procedures should be reviewed annually. Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Burnham Lodge Nursing Home DS0000064241.V372178.R01.S.doc Version 5.2 Page 32 - 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. 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