CARE HOMES FOR OLDER PEOPLE
Burrowbeck Grange Nursing Home Scotforth Road Lancaster Lancashire LA1 4XN Lead Inspector
Mrs Christine Marshall Unannounced Inspection 3rd November 2005 1:30 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 Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 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. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Burrowbeck Grange Nursing Home Address Scotforth Road Lancaster Lancashire LA1 4XN 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) 01524 841876 01524 848699 jim.brown@optimacare.co.uk Optima Care Limited Miss Christine Bewsher Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (22), Physical disability (1) of places Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 23 service users to include up to 22 service users in the category OP (older persons 65 and over) 1 named service user in the category PD (physical disability) 28th February 2005 Date of last inspection Brief Description of the Service: Burrowbeck Grange Care Home with Nursing is a detached property, in an elevated position, situated on the main A6 Lancaster Road. The home offers nursing care for 23 residents. There are 17 single bedrooms, one of which has en-suite facilities, and 3 double bedrooms; these are on ground and first floor levels. All bedrooms and lounge/dining areas are furnished to a good standard. There are adequate bathing and toilet facilities in place. There is wheelchair access to the home and there is a passenger lift in place. The registered providers are Optima Care Ltd, the Responsible Individual is Mr Jim Brown and the registered Manager is Mrs Christine Brewsher. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first of two inspection visits, scheduled from 1st April 2005 to 31st March 2006. All of the people spoken to and who were able at the home said that they preferred to be called residents. This unannounced inspection took place over an afternoon and was carried out by the home’s designated lead inspector. Optima Care Ltd has purchased Burrowbeck Grange and this inspection took place on the day of the transfer to the new owners. Mr Arthur Jones, the previous senior partner and Mr Jim Brown, the new Responsible Individual were able to discuss the home’s transition and future plans with the inspector. These discussions were very positive. The inspector undertook a tour of the home, including bedrooms, lounge and dining areas, and bathrooms. All areas were clean, hygienic and pleasantly furnished. Comment cards were received from residents, relatives and GPs prior to the inspection; all were very positive and showed that everyone is satisfied with the care that they receive. The inspector spoke with a number of the residents; all appeared to be happy with their environment and care. There were three visiting relatives available during the inspection visit who readily praised the home and the staff for their care. The manager, nurses and care staff spoke with the inspector and showed that there is a very good team approach to the care given to the residents. Everyone was very friendly, welcoming and co-operative with the inspector throughout the visit. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
The oxygen cylinders in the medication room should be chained to the wall for safe storage. The medication room temperature should be recorded daily to ensure that the creams and lotions are stored according to the recommended temperatures. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 7 Hand written medication instructions on the Medication Administration Records (MAR) should have the signature of the nurse who has written the instructions with a witness signature to confirm accuracy. Bathrooms are in need of some refurbishment and this will be addressed when the plans for the home’s extension are proposed. The carpets in the corridor between rooms 14 to 20 are rucked and need to be pulled tight to prevent any accidents. 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. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 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 Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 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): X No judgement has been made. EVIDENCE: Due to the change in ownership of the home, the standards in this section have not been assessed. The Statement of Purpose and Service Users Guide are to be reviewed and revised. These documents are booklets of written that tells the prospective client about what the home does, who the registered provider is, staff information, contracts of service, terms of cancellation and a complaints policy and procedure. These standards will be fully assessed on the next inspection visit. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 & 10 Residents are supported in their daily lives and protected by policies and procedures for dealing with medicines. EVIDENCE: Inspection of the medication systems and discussions with the manager confirmed that there is a safe method in place. There are policies and procedure in place for the safe administration of medications. The current Medication Administration Records (MAR) were generally accurate. All medication is carefully checked prior to being given. The trained nurses administer all medications. A suitable fridge for storing medications is in place and temperatures are recorded daily. There needs to be a thermometer in the treatment room to show that the
Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 11 room is kept at the recommended minimum of 25 degrees. The inspector gave general advice in respect of some aspects of medication storage and recording. Hand written medication instructions on the Medication Administration Records (MAR) should have the signature of the nurse who has written the instructions with a witness signature to confirm accuracy. The oxygen cylinder needs to be chained to the wall to comply with the Royal Pharmaceutical Society guidelines. Residents told the inspector that they do not look after their own medicines and that they were happy with this. There are self-administration risk assessments and forms for residents who wish to take responsibility for their own medicines. Residents said that their privacy and dignity were respected and the inspector noted that there was a very gentle and caring approach between carer and resident. A visiting relative told the inspector that the staff were always caring and professional. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 & 14 The manager and the staff support the residents in exercising choice and control over their lives. Social activities, family contact, privacy and dignity are daily considerations for each resident who lives at the home. EVIDENCE: There is a good social activities program at the home: These include regular activities such as bingo, quizzes, scrabble and dominoes. Exercises for mobility and breathing are also offered along with watercolour painting, reminiscence sessions and a knitting club for items for charity. Pamper days are on the agenda with pedicures, manicures and neck massages. Residents who were able said that they could join in if they wished, but could just have quiet time if they preferred this. They also said that they had full choice of what they wanted to do in their daily routines. The inspector spoke to a number of residents an each one said that they enjoyed having their relatives visit and that they were always welcomed by the staff at the home.
Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 13 Two visiting relatives told the inspector that they were always welcomed at the home and had a very good relationship with everyone there. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): x No judgement has been made. EVIDENCE: All of these standards have been assessed previously and have been met. An assessment will be undertaken on the next inspection visit when the new owners will have reviewed the policies and procedures. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24 & 25 Residents are provided with very clean, homely and pleasantly furnished surroundings and bedrooms are personalised and comfortable; this means that people feel at home with their photographs and belongings around them. EVIDENCE: Each bedroom is personalised with pictures, photographs and small items of furniture. Doors are fitted with locks and the residents are given the choice of whether or not they wish to retain the key. The inspector saw that there are aids and adaptations such as grab rails in toilets and special lifting and bathing hoists for the residents who need help with their mobility. There are also assisted baths for residents that cannot get in and out of the bath without help. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 16 There are adequate toilets and bathrooms throughout the home. Two of the bathrooms are in need of some refurbishment and the new owners are going to address this as part of their extension plans. The carpet in the corridor by rooms 14 to 20 is rucked and creased; this can be a risk to residents and staff and should be addressed as a matter priority. Generally the home is kept very clean and hygienic. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28 The residents care needs are met through good levels of staff, who mainly have the appropriate qualifications and experience necessary for the delivery of a good care service. EVIDENCE: The list of staff on duty showed that there are good levels of nurses, carers and domestic staff on duty at the home. The inspector spoke to carers and the domestic staff, who were very helpful and showed that there is a good mix of people in place. National Vocational Qualifications (NVQ) and staff training programs are in place; 80 of carers have already achieved the NVQ award and this is commendable. Residents told the inspector that they never had to wait very long for the carers to help them and that they were happy with the levels of staff on duty. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 A qualified and experienced person, who is registered with the Commission for Social Care Inspection, manages the home; the residents’ welfare is protected through good management. EVIDENCE: The registered manager, Mrs Christine Brewsher is a Registered Nurse who holds the Registered Managers Award. She has worked at Burrowbeck Grange for a number of years and is highly respected by her peers. The care staff told the inspector that there has always been an open and clear leadership within the home and residents said that they were more than happy with her approach. Care staff also told the inspector that they were confident that the change of ownership of the home would not alter the high standard of care that is given.
Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 3 3 3 3 X STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X X Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP9 OP9 Good Practice Recommendations A thermometer should be kept in the medication room and temperatures recorded daily. Hand written medication instructions on the Medication Administration Records (MAR) should have the signature of the nurse who has written the instructions with a witness signature to confirm accuracy. The oxygen cylinder in the medication room needs to be chained to the wall to comply with the Royal Pharmaceutical Society guidelines. The carpets in the corridor between rooms 14 to 20 are rucked and need to be pulled tight to prevent any accidents. 3 OP9 4 OP19 Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 21 5 OP21 Bathrooms are in need of some refurbishment and this should be addressed when the plans for the home’s extension are proposed. Burrowbeck Grange Nursing Home DS0000065247.V263840.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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