Inspection on 27/11/07 for Burnham Lodge Nursing Home

This inspection was carried out on 27th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Burnham Lodge Nursing Home 17/09/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Burnham Lodge Nursing Home 147 Berrow Road Burnham-on-Sea Somerset TA8 2PN Lead Inspector Barbara Ludlow Unannounced Inspection 27th November 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Burnham Lodge Nursing Home DS0000064241.V353442.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.V353442.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 Mrs Tracey Valerie O`Halloran 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.V353442.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. 05/04/07 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 £481 - £655 per week (less free nursing care). Burnham Lodge Nursing Home DS0000064241.V353442.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 Annual Quality Assurance Assessment (AQAA) was completed in June 2007 and returned to CSCI. Questionnaires were sent to the home for people who live there, their relatives and for staff at the home to seek their views of the service. 14 relatives responded, 5 staff and I person who lives at the home. Two inspection visits were made, the first was unannounced and the second on December 6th 2007 was announced and timed to meet with the owner of the home. The registered Manager was on duty on day one. Daily life at the home and care practices were observed. People who use the service and their visitors were seen and spoken with. Staff on duty at each visit were spoken with. A tour of the premises was made and records were sampled. The registered provider was present on day two and gave time and attention to the inspection process. The inspection feedback given was well received. This was a positive inspection; the feedback from service users and relatives reflected a good level of care. Progress has been made with the requirements made at the last key inspection, three remain outstanding and following a random inspection two requirements relating to the registered provider have been given extended timescales. The inspector would like to thank all who contributed to the inspection process. What the service does well: The home offers a friendly homely environment and a caring service. The catering at the home is well managed. Food is varied and well presented. People had been taken in during one evening in response to a local emergency, these people had to be assessed on arrival. Care plan records demonstrated a thorough assessment and recorded how their care needs could be safely met. There was a commendable response by the home’s staff to support these people at the time and in an emergency situation. Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Blood sugar monitoring equipment did not meet the guidelines from the Medical Devices Agency (MHRA) this was to be rectified. The condition imposed at registration for the communal space to be increased by the addition of a conservatory has not been met. CSCI will negotiate to extend this condition to allow the provider to improve the bedroom accommodation further. However the extension to the communal space is needed. The communal space is limited to two areas; the layout of these areas is restricted and looks institutional. The lack of communal space impacts upon the people living at the home, feedback indicated that more choice of where to sit would be appreciated. Care planning risk assessments must be accurately reviewed. Staff recruitment records were not clearly recorded; one member of staff for whom documentation had been forwarded to the home did not have their two references on the homes file. These must be acquired and the commission must be notified when they have been received. One person had started work three days prior to them receiving their CRB clearance. This is unsatisfactory person even though the inspector heard that the person did not have direct contact with people who live at the service. In this instance a Protection of Vulnerable Adults (PoVA) First check could have been requested making the recruitment practice fully compliant. Greater care must be taken with recruitment practice. Supervision must be fully implemented for all staff. A quality assurance monitoring system must be established to monitor the quality of care provided and work towards improving and developing the care service. Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 7 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.V353442.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.V353442.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. There is a good level of accessible information about the home. People are normally assessed pre admission to ensure their care needs can be met at the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the completion of the AQAA, there were 20 people in residence. At the inspection there were 17 in residence and one person for day care. The home has a statement of purpose and service guide, which are accessible in the foyer of the home. This was last reviewed and updated in June 2007. A copy of this was received for the CSCI home file, in line with Care Homes Regulation 6. Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 10 One person seen in bed had copies of the service user guide and statement of purpose next to their bed. The admission process would include a pre admission assessment to ensure care needs can be met. Care plans were sampled and included one person admitted since the last inspection. This person had a pre admission assessment on their file and a copy of the single assessment process carried out by their social worker. Reassessments had been made since admission to the home. The home’s nurses made regular reviews of risk assessments. These included pressure risk and manual handling and nutritional risk assessment. A copy of the homes conditions of residence was also received for inspection purposes. This details the charges that are made for extras, such as chiropody, hairdressing, newspapers, and hospital escorts. During the inspection process the home took three emergency admissions from another home for a short period of time. All three persons care plans were examined. The manager had attended the home to make the admissions and ensure that care needs could be met. Detailed care planning and risk assessments were undertaken and were put in place. This was completed at short notice and these were sufficiently detailed to enable staff to care for them and maintain their general health and welfare at a difficult time. Burnham Lodge Nursing Home DS0000064241.V353442.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. Detailed care plans were in place for all people in residence. The plans could be written in a more person centred way. Medications were safely administered but there was room for some management improvements. Staff were all kindly towards the people who live at the home, some interactions could be more person focussed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Daily life and aspects of care were observed during the inspection visits. People were treated kindly and with consideration. Not all staff dealt with people in a person centred way for example interactions were not always Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 12 focussed and meaningful. The inspector observed two people being transferred from chair to wheelchair; the interactions between two staff and the persons being hoisted were minimal yet these were opportunities for verbal exchange, and explanations with reassurance being offered to the person being moved. All other interactions were heard to be friendly, helpful and considerate. Care plans were sampled, these included three people moving into the home since the last inspection, three people admitted to the home in an emergency and two people who have been at the home for some time. The care plans had personal information and family information, such as their next of kin contact details. Daily records were made and risk assessments for pressure sore risk, manual handling, nutritional risk, weight, and bed rail risk were recorded. There was also evidence of medical history in a patient summary obtained from their General Practitioner (GP) and the single assessment process and reviews (SAP) from social services to aid the continuity of health and social care. Visits from other professionals were recorded such as the optician and the district nurse. On day one of the inspection, it was noted that that there was no wound chart for mapping wounds or body mapping for any injuries or bruising noted. Nor was there a form for the resident or family input towards review or updating of the care plan. The manager when asked showed the inspector the form developed for the care plans to record this information. These forms are due to be introduced into the care planning system. One care plan did not register a response to a recent change in nutritional risk; more care should be taken with the detail at the time of a review. The care plans could be written in a more person centred way for example individual detail of the preferences for oral hygiene where a person has undergone dental intervention and extraction. Health promotion was evident where professional visits were recorded to administer flu vaccination and give specialist advise on urinary incontinence. One relative felt they would like their loved one to have access to physiotherapy to help their relative retain some mobility. (This is only possible where there has been a G.P referral for specialist intervention unless privately funded.) A good care practice example was seen where a person had gained weight and the integrity of their skin had been maintained. They had received regular skin Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 13 care and attention to positioning when in bed to prevent pressure sore areas developing. The homes chiropodist visits regularly and the manager stated that everyone is seen four to five monthly. Some people with chronic health conditions receive free chiropody care. Vision call attends the home to carry out regular eye tests if required. Medications management was assessed at the second visit. The medication administration records (MAR) were examined. One hand transcribed entry had only one signature; two changes to prescription instructions had no signature to confirm who had recorded the change. The medication store had a number of appliances that were for people no longer in residence at the home, these items should not be held for longer than is necessary at the home. The home uses a lot of Lactulose, bulk prescribing is recommended to reduce the number of opened bottles in use and required on the medicines trolley. The home is not using a sharp safe lancet system for capillary blood sampling. The medical devices agency guidance indicates that individual sharp safe systems should be used by staff taking capillary blood samples. This is to reduce the risk of cross infection and needle stick injury. This system was highlighted for attention at the time of the inspection; the manager confirmed the action to be taken to bring the standard up to a level of good practice. The medical equipment store cupboard on the first floor was found to be unlocked and yet contained hazardous marked liquid that required safer locked storage. Staff removed the chemical at the time of the inspection; care must be taken to reduce such risks within the care home environment. Controlled drug storage and stocks were seen, the storage was safe however the old stock should be destroyed in a more timely manner and not be held for longer than is necessary. The medication fridge is monitored daily and was maintained within a safe temperature range, this was recorded each day. Burnham Lodge Nursing Home DS0000064241.V353442.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 good. Social histories are recorded and there is some organised social care activity with dedicated activities staff. Families and visitors are welcomed. Dietary needs are well catered for and meals are varied. Drinks are readily available and the kitchen is well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person gave a good account of their life at the home and how they choose to spend their time. They said they get up if and when they want to and have the benefit of a garden room where they can open their door for a garden view and fresh air. They had established a routine that was respected by staff who Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 15 were reported to treat them ‘very well’. They confirmed that their post was delivered unopened and that they retained a great deal of independence and control in their life. Activities were discussed with the people living at the home and their relatives. The inspector heard that they have recently had two ‘sing a longs’, and the Christmas party was planned for the Sunday 9th December to include families and there would be a buffet. The home has allocated activity time each week to an activities organiser who was not seen during this inspection. Activities and events are advertised and the notice for the party was seen in the main lounge. A film was played during the first afternoon of the inspection. This was organised by the cook and a choice of film was offered, the choice was ‘The Sound of Music’ which seemed to please all who were present. Families are welcomed and relatives were seen who come to the home most days and spend time with their loved ones. No concerns were raised during the discussions had with the visiting relatives. One visitor said they are made welcome and can have a drink at any time. Care plans had evidence of social history being recorded to give an insight into peoples lives and to influence activities to ensure relevant events are offered. The statement of purpose indicates that a range of activities and games are organised such as flexercise and quizzes. There is a monthly trip out and the manager said that usually three or four people go out each month. The homes’ catering is well managed. The cook is experienced. The recent Environmental Health Inspection had been satisfactory. The catering staff have all had food hygiene training as have a number of the care staff. There is a catering assistant. 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; this was confirmed for one new person to the home. The cook said that seasonally available fresh vegetables are prepared and currently the special diets include pureed meals and diabetic diets. The cook said they also use dietary supplements where needed such as nourishing drinks. A lunchtime menu included a choice of cauliflower cheese, chicken and mushroom in cheese sauce, curry, new potatoes, rice and fresh carrots. Dessert was chocolate chip sponge. A tea menu included, homemade soup, a choice of omelette, baked potatoes and sandwiches, jelly and fruit and mousse. Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 16 One person attending for day care commented that they hadn’t been involved in anything on that day but ‘it isn’t boring as there are people around all the time’. Burnham Lodge Nursing Home DS0000064241.V353442.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 adequate. The home has a complaints policy and procedure. The recruitment practice was not found to be rigidly compliant and must be improved upon. 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. There had been one complaint made to the home, which was reported to have been fully resolved in the past year. No complaints were made to CSCI in the past year. There was positive feedback from relatives but one commented that they ‘did not know how to make a complaint.’ Three recruitment files were examined for safe practice. One record on file was fully complete but one did not have copies of references. These must be obtained and confirmed with CSCI. One person commenced work at the home three days before their Criminal Record Bureau (CRB) check was returned, there was no evidence of a POVA First check having been taken up prior to the CRB clearance. This person was Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 18 not employed in a care role. Recruitment practice must be more robustly carried out. Burnham Lodge Nursing Home DS0000064241.V353442.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): 19,20.26 Quality in this outcome area is adequate. The service provides a homely but institutional environment. The internal environment has been suitably adapted but the layout and communal space have limitations. The home is kept clean and tidy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 20 The Inspector made a tour of the home seeing the lounge area, small dining /sitting room, kitchen, toilet and bathing facilities, laundry facilities, a sample of bedrooms, the offices and staff /conservatory room. 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 on the ground floor and 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. Bedrooms can be personalised and many contained personal possessions such as photographs, soft furnishings and personal furniture and television. One relative had commented in their feedback to CSCI that they had noticed strong odour when visiting. On day one a bedroom had a malodour and there was an uncovered incontinence pad bin in the en suite. This was brought to the manager’s attention. No strong / unpleasant odours were detected on day two, and the bin seen on day one been replaced with a more suitable lidded bin. The home was found to be clean. Hand washing facilities were available for staff throughout and included the provision of liquid soap, alcohol gel and paper towels. Resources were available to aid in infection control such as aprons and gloves. No comment was heard about the laundry processes. The industrial style laundry equipment is accessed via the ground floor bathroom and is situated off the conservatory. At the last inspection it was 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. Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 21 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 and skill mixed staff team. Staff have received training to work safely. Staff recruitment must be more robustly managed for all departments. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a registered manager who is a registered nurse, Mrs T O’ Halloran was available on day one of the inspection. The home has a registered nurse on duty at all times. There is a skill mix of staff and the home has two students who are undertaking adaptation training to register as nurses in this country. Senior carers at the home hold National Vocational Qualifications (NVQ) in care. The AQAA indicated that nine care staff hold an NVQ and three are working towards achieving an NVQ. This is currently just below the 50 of the care staff team. Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 22 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 has been taken up for all staff. Trained nurses have updated their knowledge of diabetes since the last inspection. A Manual Handling Trainer has been appointed and training will now take place in house. Fire training continues to be undertaken by an experienced part time administrator at the home. Staff meetings are held to improve communication. Feedback from staff to CSCI earlier this year indicated that this was something they wanted. Staff recruitment records were not clearly recorded, one member of staff for whom documentation had been forwarded to the home did not have their two references on the homes file. These must be acquired and the commission must be notified when they have been received. One person had started work three days prior to them receiving their CRB clearance. This is unsatisfactory person even though the inspector heard that the person did not have direct contact with people who live at the service. In this instance a PoVA First check could have been requested making the recruitment practice fully compliant. Greater care must be taken with recruitment practice. People who live at the home and their relatives commented on the kindness of the staff team and expressed their satisfaction with the care given. Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 23 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 adequate. The home is evolving under the new manager and there is still work to do. Management systems are in place to protect the interests of service users. Quality Assurance and staff supervision need to be targeted for management attention. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 24 The Registered manager has some designated office hours each week. The manager has made progress in a number of areas but there are areas where management attention should be focussed such as the development of quality monitoring and planning of staff development and training. Regulation 26 visit records were seen for January June and November 2007 but were not a complete month by month account. This was discussed at the meeting with the homes proprietor on inspection day two. The proprietor expressed his intention to spend more time at the home in a management capacity. The AQAA indicated that policies had last been reviewed in 2002. The manager stated that there are plans to review and update all the policies and procedures using the Registered Nursing Homes Association policies which will be incorporated with the existing policies. There has not been any significant progress made with quality assurance due to the efforts being made with care planning documentation and training for staff. The requirement date for this will be extended and will be followed up in 2008. 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. Accounts for fees were examined. Ledger and computerised accounts were seen. Contracts and invoices were made available for inspection purposes. All was satisfactory. A list of current fees that was not considered to be commercially sensitive was given to the inspector. All records have restricted access and are securely stored at the home. The home does not yet have Quality Rating with social services. Maintenance records for fire and equipment servicing seen were up to date. Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 25 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 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 1 X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 2 2 Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 26 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 04/02/08 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) 2. OP30 18 (1)(a) (c)(i) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) ensure that at all times suitably qualified, competent and experienced persons are working Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 27 04/02/08 at the care home in such numbers as are appropriate for the health and welfare of service users. (c) ensure that the persons employed by the registered person to work at the care home receive— (i) training appropriate to the work they are to perform. (this refers to the need for a training and development plan for all staff to meet all care needs) (Not met from 30/06/07) 3. OP36 18 1 (c) 2 (a) The registered person shall ensure that— persons working at the care home are appropriately supervised; and receive (i) training appropriate to the work they are to perform including structured induction training. (This refers to the need for formal supervision of staff). (Met in part by 30/06/07) 4. OP37 26 (4)(c), (5) Monthly regulation 26 visit 04/03/08 records must be recorded and be available for inspection at the home. (Timescale has been extended from 8/10/07 following discussion at the key inspection.) The registered person must 18/01/08 formally request an extension to the conditional timescale for extending the communal space in order to address the current breach of the third condition of registration. Clinical procedures must be DS0000064241.V353442.R01.S.doc 04/02/08 5. OP20 OP19 23(2)(e) 6. OP8 12(1) b 14/01/08 Version 5.2 Page 28 Burnham Lodge Nursing Home and 13(3) 13(4)(c) 7. OP9 13(2) adhered to in line with the medical devices agency guidance for capillary blood sampling systems. Prescribed unwanted medical 04/02/08 appliances and unwanted medications must be disposed of after the allotted time from when the service user permanently leaves the home. Amendments to prescribed medication on the MAR charts must be signed. 8. OP29 19(1)(b) (i) Schedule 2 References must be held on file for all staff. Confirmation that the two references referred to have been obtained must be made to CSCI in response to receiving this report. 14/01/08 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 OP8 Good Practice Recommendations The registered person should ensure that all clinical monitoring charts are completed fully and accurately to provide clinical information to aid staff to meet the residents care needs. The home uses a lot of Lactulose; bulk prescribing is recommended to reduce the number of opened bottles in use and required on the medicines trolley. The registered person should ensure that any chemicals subject to COSHH regulations are stored appropriately at all times. Efforts should continue to work towards a more person centred approach to care planning and care giving. DS0000064241.V353442.R01.S.doc Version 5.2 Page 29 2. 3. 4. OP9 OP38 OP7 Burnham Lodge Nursing Home OP8 Burnham Lodge Nursing Home DS0000064241.V353442.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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.V353442.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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