Inspection on 24/06/08 for Burrows House

This inspection was carried out on 24th June 2008.

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

Burrows House 28/06/07

Burrows House 28/06/06

Burrows House 09/02/06

Burrows House 16/02/05

Burrows House 04/11/04

Burrows House 05/08/04

Burrows House 07/11/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Burrows House 12 Derwent Road Penge London SE20 8SW Lead Inspector David Lacey Key Unannounced Inspection 24th June 2008 09:45 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 Burrows House DS0000006942.V366098.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. Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burrows House Address 12 Derwent Road Penge London SE20 8SW 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) 020 8778 2625 020 8659 6240 Servite Houses Limited Paul Thomas Davies Care Home 54 Category(ies) of Dementia (22), Old age, not falling within any registration, with number other category (32) of places Burrows House DS0000006942.V366098.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 Only - Code PC to service users of the following gender: whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 32) 2. Dementia - Code DE (maximum number of places: 22) The maximum number of service users who can be accommodated is: 54 21st November 2007 Date of last inspection Brief Description of the Service: This home is provided by Servite Houses, which has a number of facilities throughout London and the South East. The home is purpose built over two floors. Individual bedrooms and communal space are provided on both floors. The kitchen and laundry are on the ground floor. The home is separated into seven units. Each wing has two units, with its own kitchen, dining and sitting area. There are separate units for older, frail residents and for residents suffering with dementia. Staff are normally allocated to specific units. All policies and procedures are generated centrally with amendments made to reflect the local situation. The head office deals with recruitment of new staff. The kitchen is operated through an external contract agreement. The fees for this home range from £391.38 - £541.73 per week (information provided to CSCI July 2008). Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star, which means that people using the service receive an adequate service. This key inspection included an unannounced visit to the care home. To gain the views of people living in the home, we spoke with residents and relatives. We met with the registered manager and some members of the home’s staff. Documentation was sampled, such as care plans; records of care provided; staff recruitment files; and policies and procedures. An expert by experience was invited to take part in the inspection process and accompanied the inspector on the site visit. An expert by experience is a person who has a shared experience of using services and who can help an inspector get a better picture of what it is like to live in a care home. The expert by experience spent the day engaging with a number of people who live at the home. Key parts of the report compiled by the expert by experience have been used as evidence to support the judgments made. Since the last key inspection, we carried out a random inspection of the home and we have used findings from that visit in planning this present key inspection. Information from the home’s Annual Quality Assurance Assessment (AQAA) has also been used to inform the inspection process. What the service does well: Offers prospective residents and their families enough information to decide whether the home is right for them. Residents’ needs are assessed before they move in so they can be assured the home can meet their needs. Enables residents to choose to see their visitors at any reasonable time, and makes visitors to the home feel welcome. Makes sure residents have access to the health care facilities they need and that they get their medication as prescribed. Keeps the home clean and free of odour, and makes sure the environment is properly maintained and safe for residents to use. Displays pictorial menus for lunch and supper in the home, which is especially helpful for residents suffering with confusion. Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Deliver the planned programme of activities and make sure that up to date information about activities is made available to residents in formats suited to their capacities. At this inspection, it was evident that our previous requirement about activities provision had not yet been met in full, and we are taking enforcement action to make sure the home complies. Review regularly all areas of identified need in each resident’s care plan. Monitor the temperature of the medicines room to make sure it is always kept within safe levels for the effective storage of medication. Provide better facilities for residents’ clothes to be sorted and kept separately. Make sure each person can eat their food without difficulty, and that as far as possible meal times are enjoyable, relaxed occasions for every resident. Always check meal temperatures before serving from the hot trolleys to make sure they meet food safety requirements. Make it easier for people with confusion to find their way around the home. Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 7 Support all care staff to complete appropriate dementia training and apply their learning in practice. 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. Burrows House DS0000006942.V366098.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 Burrows House DS0000006942.V366098.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, 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered the information they need to decide whether to move into the home. Prospective residents’ needs are assessed before they move into the home. Residents receive contracts/statement of terms and conditions. Burrows House does not offer intermediate care, thus standard 6 does not apply. EVIDENCE: The home has produced a statement of purpose and a service user guide, which is made available to residents. The manager stated all residents or their families had been written to with copies of the guide to make sure they had all received a copy. Relatives met during the inspection said they had received enough information but that the placement had been arranged by social services. Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 10 From discussions and sampling of relevant documentation, it was evident the home had met our previous requirement to make sure that all residents are issued with a contract outlining the terms and conditions of their stay in the home. Care management assessments were seen on the files of a sample of residents whose placements in the home had been arranged by local authorities. It was evident from discussions and examination of relevant documentation that the registered manager also carries out pre-admission assessments of prospective residents. The assessments seen identified the residents’ needs, and formed the basis for care planning to meet those needs. Burrows House DS0000006942.V366098.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. This judgement has been made using available evidence including a visit to this service. There has been some improvement in care planning and the home has been doing more to enable residents and/or their representatives to be involved in their care. Care plans are kept under review though more work is needed to make sure reviews cover all needs identified. Residents can be satisfied with how most staff deliver their care and respect their dignity and rights. The home understands the need to comply with safe medication procedures. EVIDENCE: In general, the standard of care documentation had improved since the last key inspection. The care plans sampled were based on assessment of the person’s needs and offered enough guidance for staff in how to meet those needs. Supporting risk assessments were in place. Care plans were based on assessment of seventeen activities of daily living. The home had addressed our previous requirement to make sure all residents’ care plans are kept under Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 12 regular review, though there was still some room for improvement in the standard of some of the reviews seen. For example, in two plans seen reviews had not covered each of the seventeen areas of need that had been identified for each person (requirement 2). In one case only twelve areas had been reviewed and in the other only thirteen areas had been covered at the monthly review. This meant that some areas of need had not been reviewed to see if any change to particular aspects of the care plans were necessary. There were some entries in care documentation that had not been signed or dated. This is important for accountability and to enable effective audit (recommendation 1). These issues were raised with the manager who said the provider is reviewing the format for care plans and risk assessments, which should help to ensure all identified needs are kept under review and that staff always sign and date their entries. Staff had been formally reminded to sign and date care plans and risk assessments. The manager provided evidence that residents’ families or other representatives have been sent letters encouraging them to become involved in planning and reviewing their relatives’ care. This was in response to our previous requirement in this respect. There was also some evidence of involvement of relatives in the care plans sampled. Families have been advised their relative has a key worker who will liaise between the home and themselves about involvement in their relative’s care. This has been a recent initiative and the home may need to make sure its information has reached all the intended recipients. During our inspection, a visitor said she was satisfied with the care at the home but was nevertheless unaware that she could have input into her relative’s care plan. Most residents we met during our inspection visit were well groomed and all were dressed appropriately for the time of year. Some relatives of a resident suffering with confusion said she gets the care she needs and is happy living at the home. A relative told our expert, “It’s a miracle how (name) has recovered in this home. She has improved greatly since coming here”. A resident on the dementia unit said he was quite satisfied with the care he was receiving. People can choose to retain their existing GP, providing that GP agrees, or the home will make sure they are registered with a local doctor. It was evident the home supports its residents to access health care services, such as dentists and opticians, and to attend clinic appointments outside the home. Visits to the home by health care professionals had been recorded on residents’ files. A district nurse was working in the home on the day of our visit, visiting particular residents who the staff had asked her to see. She said that staff write information they want the district nurses to see in a ‘communications book’, and that communication between the home and the district nursing service is good. There are occasional pressure ulcers but they are rare as the staff call the nursing service early and arrangements are made for any pressure relieving aids needed. There were none amongst residents in the home at this time. A few residents living in the home have catheters, which are Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 13 looked after by the district nursing service. The district nurse could not recall the home ever having a resident who needed insulin for diabetes, and she had never been asked to give injections. A resident spoke about her incontinence but said staff would not help her to the toilet, even though she was “pouring with water”. A staff member said the resident was able to make her own way to the toilet but had forgotten that she was able to do so. Later, another carer made a similar comment, “she can make her own way to the toilet but she forgets to do so or forgets that she has been”. As well as not showing an approach based on respect for the person, these comments did not convey a good understanding of dementia, in that the condition may make residents seem unreasonable about things that actually they cannot help. By contrast, we saw an example where appropriate encouragement to be independent was given. A resident with restricted mobility was walking in the corridor towards the dining room for lunch. A carer was assisting her and maintained a good balance between ensuring her safety and helping her to be as independent as possible. He walked with her at her pace while giving encouragement, “you’re doing very well, don’t worry I’m right with you” until she reached the dining room. Achieving this goal seemed to help her to be in a positive state of being as she sat down for her lunch. There should be a consistent approach from all staff and the need for more dementia training to enhance the delivery of person-centred care is commented on in this report under standard 30. Part of a medicine round was observed and the practice when giving residents their medication was carried out safely. The home uses a monitored dosage system. The home’s medication policy and procedure, and a staff signature list were available. Ordering, receipt and disposal of medicines was satisfactory. Storage of medicines was generally satisfactory, though a thermometer needs to be placed in the medicines room. The temperature of the medicines room felt comfortable during the inspection but it was not possible to be certain it was within safe levels for storing medication (requirement 3). Some eye drops with a limited life had the date of opening recorded on the medicine administration record (MAR) but not on the container itself. Recording this on the MAR is acceptable but it is safer to record it on the container as well. The member of staff assisting with the medication inspection made this amendment straight away. Two residents were taking controlled drugs (CD), which were being stored properly and recorded in the home’s CD register. The manager was addressing an issue whereby a relative had taken a resident for a trip out from the home and been supplied with the necessary medication, including a CD, but had not confirmed the resident had taken the medication while she was out of the home. There were no residents administering their own medication at the time of this inspection, though the home has a policy and procedure for self-medication in place for when this need arises. Burrows House DS0000006942.V366098.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. This judgement has been made using available evidence including a visit to this service. Improvement is still needed to make sure that people’s social needs are fully met. Residents are supported to keep in touch with their families and friends, providing this is their choice. People are able to choose what they eat and staff make sure that choices are available. The quality and quantity of food served is satisfactory but more could be done to make meal times enjoyable occasions and to make sure all residents may eat their food without difficulty. EVIDENCE: Some activities took place during the day of the inspection visit but they did not match what was on the planned programme. The activities programme was on display in the reception area but was hard to read, being in small print on a dark coloured background (recommendation 2). The programme stated the activities for the afternoon of our visit included quizzes and reminiscence work. The only entertainment our expert by experience saw in one of the lounges was playing recorded music from the 1960’s. A carer in another lounge on the dementia unit was reading magazines with some residents who seemed to be Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 15 enjoying themselves. This carer was friendly with the residents and spoke gently with them, appeared to be enjoying her work and was working effectively. It was evident that individual residents had different needs and preferences. A resident sitting at the side of the lounge said although she didn’t like the noise and interruptions, she didn’t like being in her room either. Another resident commented there are no trips out from the home but said she had no complaint about this. A resident said she missed her pets but didn’t think the home would allow any. She also said she liked classical music but there was never any to be heard. One resident had some talking books in her room but other residents seemed unaware that a library service from Bromley council could visit the home. Another resident said she missed her ballroom dancing. Two residents simply said they wanted to go home. Of these, one said she didn’t like the atmosphere in the home. When asked what she meant by this, she said she didn’t enjoy being told what to do all the time. Another resident praised the staff but said that she was very lonely in the home, “They don’t talk to me and I don’t talk to them”. It was evident from observations and discussions that our previous requirement about activities provision had not yet been full met within the timescale set. We are taking enforcement action to make sure the home complies (requirement 1). The manager said activities provision is an aspect of service the home has been trying to improve. He stated the home is to appoint an activities coordinator to lead this area of provision. The manager was aware it is important that activities offered are suitable for all residents, which may mean planning specific activities to meet individual’s needs and preferences. Residents may choose to see their visitors at any reasonable time, and it was evident that visitors are made welcome in the home. The home supports residents’ choices to go out of the home with their relatives or friends for the day provided they are able to do so. An external company supplies the catering service for the home. The chef showed the inspector how the menu had changed. For example, there is a choice of hot suppers on three evenings each week rather than the previous reliance on soup or sandwiches, and cooked breakfasts are offered two days each week as well as cereals, toast, porridge and juices. The menu showed a choice for lunch each day, including a vegetarian option, which was also evident from the lunch served on the day of our visit. There were pictorial menus for lunch and supper on display in the home, which is especially helpful for residents suffering with confusion. The menu runs over a four-week period and is changed each week. Although the quality of food served is satisfactory and the portion sizes adequate, more could be done to make sure each person can eat their meals without difficulty. Meal times could also be made more of an enjoyable social event for residents (recommendation 3). Our expert by experience observed Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 16 lunch in one dining area in the dementia unit. Staff served the food efficiently but their interaction with residents was minimal. They did not engage in conversation or encouragement and the mealtime proceeded in more or less total silence. This was also the case in another area of the home where the inspector observed lunch, when it was also seen that choice for some residents at mealtimes could be improved. For example, a resident choosing the vegetarian option had gravy poured over it by the person serving the meal. The resident was not asked if she would like gravy or how much, and as it was apparently a meat based gravy, it was not consistent with the vegetarian meal she had chosen. The food served was presented quite well and looked appetising, though our expert noticed one resident without teeth was only able to eat the mashed potatoes in the meal given to her. It did not seem that her inability to eat quite large chunks of meat was taken into account by staff. Dessert was a choice of grapes, banana and orange. It was good to see fresh fruit being served but an additional, softer option such as yoghurt or mousse might be more palatable for residents with poor dentition. Our expert asked some residents if they had enjoyed their lunch and some confirmed they had. A resident from a minority ethnic group said food that was more culturally traditional could be had “if you inform them beforehand”. Another resident said the food is very good and, “I eat everything”. Two visitors told the inspector the food is good and that their relatives eat well. In the afternoon, our expert saw a resident given tea whilst in bed. The meal of sandwiches was appreciated but the resident had not been offered a napkin or bib and was given tea to drink, some of which spilt onto the resident’s clothing. Burrows House DS0000006942.V366098.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. This judgement has been made using available evidence including a visit to this service. People living in the home and their representatives can now be confident that their concerns will be listened to and acted upon. The home follows appropriate policies and procedures for managing complaints and for safeguarding adults. Staff members have become more aware of their responsibilities in protecting residents from abuse. EVIDENCE: The home’s complaints procedure is set out in its service user guide, which is supplied to everyone living at the home. It is understood the procedure is available in different formats on request, for example, in larger print. The home’s procedure has been followed when handling complaints received. Complaints records were seen on file, including details of any investigations and actions taken. The home’s self-assessment document told us that residents and their representatives are encouraged to raise comments and complaints. This can be done informally by talking with managers or staff, or issues can be raised at residents’ and relatives’ meetings. People spoken to said they knew how to make a complaint if they needed to and who to approach if they had any issues or were unhappy about something. Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 18 More safeguarding training has been provided to make sure all staff know about different forms of abuse and understand their reporting responsibilities if they witness or suspect abuse of residents. The home’s self-assessment information stated there had been three adult protection issues in the past year, and confirmed that either disciplinary action or further training had been carried out as appropriate. The provider has followed the appropriate safeguarding procedures and has attended meetings or provided information to external agencies as required. There is a clear system for staff to report concerns about colleagues and managers. In accordance with the company’s procedures, a senior manager investigated allegations made anonymously by staff and set out the outcomes in a report that was made available to social services and to the commission. The senior manager also held a meeting with all staff to let them know about the investigation and the outcomes. Burrows House DS0000006942.V366098.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, 22, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Over the past year, there have been a lot of environmental improvements that have benefited residents by making the home a more pleasant and safe place to live. There are still some aspects for development, for example, more could be done to help residents suffering with confusion to find their way around. EVIDENCE: The home was clean, tidy and the communal areas were free from odour. Since our last key inspection, the home has undergone significant refurbishment including re-decoration, new furniture and improvements to the garden area. The décor looked clean, well decorated and some rooms had pictures on the walls. A plasma television had been installed in the main lounge for residents to use. Two residents who showed the inspector their Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 20 bedrooms said they were happy with their rooms and that their chairs and beds were comfortable. One resident we spoke with had “found myself a nice little corner” to sit in. He said he was happy here, “the people are nice to me and I like the food”. Another resident said, “its very nice here, our own home”. A resident who was sitting with her visitors also said she liked it here, that her bedroom is comfortable and the people who look after her are kind. The visitors said the redecorations and refurbishments had made a positive difference to the home. There were a few items still needing attention, for example, a sofa in the main reception area was stained. The assistant manager gave assurance that a carpet no longer lying flat in one resident’s bedroom would be attended to. The home’s garden was pleasantly laid out with small shrubs and colourful flowerbeds. The garden is now well kept, has plenty of seating available and is another improvement from our last key inspection. The day of our visit was sunny and warm, so it was surprising that few residents were seen outside enjoying the fresh air and surroundings. Although there is some natural shade available, the overhanging glass awnings may intensify the heat, so the home may wish to consider offering more shade, perhaps in the form of a temporary gazebo for the summer months (recommendation 4). Many windows in the home have relatively low sills and we have been notified of a recent occasion when a resident attempted to leave the building via a window. It is understood that windows are checked regularly to make sure their opening restrictors are effective. Windows all around the garden quadrangle were smeared and needed cleaning. Towards the end of our visit, we saw a member of staff attending to this on one side of the quadrangle. This is important so that residents may look out on to the gardens, even if they are not able to go outside. It would be good to see evidence of regular audits to confirm that windows remain safe, secure and clean (recommendation 5). The redecoration and refurbishment of Burrows House has been continuing since our previous visit. However, the provider intends to offer more services to people with dementia so more should be done to make it as easy as possible for residents to find their way around, especially as the lay out is quite complex. Our expert by experience found no evidence of any special attempts to aid orientation for people with dementia. There was no reminiscence area, clocks on the walls were high up and not easy to read, and there were no season, day or date reminders. The only display to remind residents what was taking place that day was an activities programme that was hard to read as it was printed in a small font and against dark colourings (see comment under standard 12). Some residents’ bedrooms lack en-suite facilities so they need to use communal toilets and bathrooms. Generally, the communal toilets in each corridor are not suitably distinctive. An adaptation that has proven useful elsewhere for people with dementia is to paint doors in colours that show they are toilets. Such adaptations need to be carried out sensitively, so that people do not feel patronised. The manager said he would be planning further Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 21 environmental improvements and a recommendation has been made to support this additional benefit for those residents with confusion (recommendation 6). It was a warm day when we visited and the lounge for units F, G and H on the upper floor was hot. Some residents, especially those sitting by the windows, said they were feeling too hot and asked for the windows to be opened. This was done but an hour later it was observed the windows had been closed again. It is important that residents are kept comfortable in warm weather (recommendation 7). Portable fans could be considered, providing the relevant risk assessments are carried out. The laundry was running well on the day of our visit, with all machines working. The procedures for dealing with soiled laundry were satisfactory. The laundry assistant works 30 hours during weekdays and carers undertake laundry duties at the weekends. It was apparent that additional laundry assistant hours would be helpful, and the manager said this was under consideration. There is not much space in the laundry room, which means that people’s clothing is put into baskets shared among a whole unit, rather than individual baskets for each person. This is an issue to be addressed, as it could benefit residents, for example, by minimising the risk of individual items going missing or being given to the wrong person (requirement 4). It could also save staff time, for example, in looking for missing items. Burrows House DS0000006942.V366098.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. This judgement has been made using available evidence including a visit to this service. The home is trying to improve outcomes for residents by recruiting more permanent staff. The recruitment procedures support and protect residents, though not all information was available in the home for inspection. In general, suitably qualified staff are employed, though additional training could help to maintain a person-centred approach to meeting the needs of residents with dementia. EVIDENCE: The home was full at the time of this inspection, whereas it had vacancies at the time of our previous key inspection. The manager explained that local care managers have started arranging more placements at the home now improvements in services have been put in place. The manager confirmed the total care staff establishment is now thirty-one. The management team has been restructured so, in addition to the registered manager, there is an assistant manager and three seniors (two on the dementia unit and one on the unit for older persons). The staffing arrangement is one senior and five carers for each daytime shift on the three dementia units, and one senior and four or five carers on the older frail units (two carers downstairs and either two or three on the upper floor, depending on whether a morning or afternoon shift). The night staffing is two seniors and four carers at present, though the Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 23 manager is preparing a business case for one more carer at night. Some staff members told our expert that they felt the staffing levels were too low and that this was compromising the quality of care provided to residents. On further enquiry, it was understood nine new staff members had been recruited and were undergoing recruitment checks before taking up their posts. Agency staffing levels had been reduced but agency staff were still needed to cover vacant shifts, especially at weekends. The manager said agency staff are normally teamed with a permanent staff member to try to maintain continuity of care for residents. Members of the Servite staff ‘bank’ are also employed on a temporary basis to cover some shifts. The manager said assuming the present recruitment drive is completed successfully, it is intended to stop using agency staff altogether towards the end of this year. Several residents and two relatives who spoke with our expert praised the staff. Their comments included, “You have to be an angel to work here” and, “you need the patience of a saint”. A resident said, “I’d miss this home if I moved”. Another said, ‘the carers are very nice and (name) is wonderful”. We saw positive interactions on the day of our visit. One carer in particular was very friendly and encouraging with residents, taking the time to chat with them and find out what they were doing or what they wanted. However, some other interactions between staff and residents were neutral and task-oriented, and a few were rather abrupt. Four staff members’ files were sampled for inspection. The files contained most of the necessary recruitment information but one did not have any written references and two had only one reference on file. These matters were raised with the manager who explained that much of the staff recruitment for Servite is done centrally and some records, such as references, are held centrally. References need to be kept in the home unless formally agreed otherwise, in which case there will need to be arrangements in place so they can be inspected (requirement 5). There is an audit system for recruitment and selection that produces reports in electronic format. The manager showed me this system on screen, including information relating to individual staff members. CRB disclosures are also held centrally, with the organisation’s HR department confirming to the home’s manager the outcome of CRB checks on individuals. When questioned, the manager told me that Servite will start recruits on POVA First checks, though he also confirmed that staff at Burrows House never work unsupervised until a satisfactory CRB disclosure has been obtained. The home had access to an electronic spreadsheet that set out the training for all staff. This provides management information by showing when mandatory training has been completed or is overdue. The spreadsheet covered induction training for new staff as well as staff training in, for example, medication, health and safety, and adult protection. The home’s AQAA states all staff members undertake equality and diversity training. Staff files also contained details of training completed. The home’s AQAA dataset showed fifteen of Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 24 twenty permanent care staff had completed NVQ Level 2 or above, and that another five permanent staff members were currently working towards this qualification. A staff member told our expert that she liked “learning from the residents” and the fact that she had been able to attend a number of training courses since she had been working at the home. It was evident dementia training has been undertaken by some members of staff but it was not always apparent this has had positive outcomes for residents. For example, our expert by experience saw good care being delivered between a carer and a group of residents with dementia but also identified an instance where a more personcentred approach was needed. The home needs to do more to ensure all its care staff complete appropriate dementia training and are supported to apply their learning in practice. This will help to ensure a person-centred approach to dementia care is used throughout the home (requirement 6). Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 25 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, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives may be assured that the manager is fit to run the home. The home seeks people’s views in making sure it is run in the best interests of residents. Staff members have appropriate supervision. People’s health, safety and welfare is promoted and protected. EVIDENCE: Since the last inspection, Paul Davies has met the regulatory requirements for registration as the manager of Burrows House. Since his appointment, Mr. Davies has worked to bring about improvements at the home to benefit residents. Changes he has introduced at Burrows are beginning to have Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 26 positive outcomes although he was aware further work is still needed to bring about the necessary level of improvement in all areas of service provision. He said that he had been discussing with senior managers in the company that further work needs to be done on changing the culture in the home, so that all staff members share a philosophy of care that is person-centred. Some people visiting the home said in the past they had raised concerns about the home but now it is much improved. They said these improvements have been made since the manager came into post and that they have made a positive difference to the care their relative receives. They said most staff are more approachable and caring now, and they linked this change to the arrival of the manager. Our expert was told that staff had been asked not to talk to the inspecting team and that some staff did not want to be seen talking to her. The inspector raised this with the manager who said he was not aware any such instruction had been given. He said in his opinion it was important that we obtained the views of staff members as well as those of residents and their families. The home had met our previous requirement to establish and maintain a system for assuring the quality of care provided at the care home. It was evident from discussions and scrutiny of both paper-based and electronic documents that the methods being used provide for consultation with residents and/or their representatives. Monthly reports of the provider’s monitoring visits were on file and available for inspection. The most recent had been completed in May 2008, and it was evident residents and staff were consulted during these visits. The outcomes of regular audits are inputted onto electronic spreadsheets and forwarded to the provider. Examples of completed audits were seen during the inspection. The arrangements for supervision of staff have been improved. Supervision records were seen on the four staff files sampled, including a probationary review for a recently appointed staff member. It was evident the home was being run in a way that promotes the health and safety of residents, staff and visitors. For example, a fire inspection had taken place in September 2007, and there are two fire drills each year including for night staff. There was a current waste transfer contract in place. The monitoring of day-to-day maintenance had been recorded. Maintenance certificates sampled during the inspection were up to date and within the relevant timeframes, for example, the safety of the gas installation had been confirmed within the past year. The kitchen was in good order on the day of our visit. The catering company that supplies the catering service for the home audits the kitchen regularly. In January 2008, Bromley Council awarded the home 5 stars for food standards, stating the home’s kitchen has “very high standards” of food safety management and complies fully with food safety legislation. Staff working in the kitchen on the day of our visit had up to date food hygiene certificates, Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 27 with the exception of a newly appointed trainee who was working under supervision until he had completed the course. Kitchen cleaning records were up to date and maintenance items such as a fridge breakdown and cracked tiling had been identified and reported, and action was being taken to effect repairs. Our expert by experience saw proper attention given to cleanliness in one of the kitchenettes as a staff member washed her hands before serving food at lunchtime. Hot trolleys are used to take cooked food from the kitchens to the dining areas, where carers serve the food from the kitchenettes on each floor. It was evident the temperature of food is taken in the kitchen and that the food temperature probes are calibrated each month. However, the temperatures were not being checked again before the food is served to residents. This was raised with the manager so that staff members may be reminded to ensure they take the temperatures of food served and record this as well as ensuring the last meal served also meets required food safety temperatures (requirement 7). Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 28 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X 2 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 2 Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP12 Regulation 16 Timescale for action The registered person shall make 31/08/08 arrangements to enable service users to engage in local, social and community activities and to visit, or maintain contact or communicate with, their families and friends. Enforcement action is being taken. The registered person shall consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. Enforcement action is being taken. The registered person must 31/07/08 ensure all areas of identified need in each resident’s care plan are kept under regular review. The registered person must 31/07/08 ensure that a thermometer is placed in the medicines room and the temperature of the room monitored. This will make sure it is kept within safe levels for the DS0000006942.V366098.R01.S.doc Version 5.2 Page 30 Requirement 2 OP7 15(2)(b) 3 OP9 13(2) Burrows House 4 OP26 5 OP29 6 OP30 7 OP38 effective storage of medication. The registered person must provide adequate facilities for residents’ clothes to be sorted and kept separately, as far as it is practicable to do so. 17(2)Sch4 The registered person must ensure a copy of each reference supplied for a staff member is kept in the home. 18 The registered person must ensure all care staff complete appropriate dementia training and apply their learning in practice, as part of maintaining a person-centred approach to dementia care. 13 The registered person must ensure staff members always take the temperatures of food served and record this as well as ensuring the last meal served also meets required food safety temperatures. 16(f) 30/09/08 31/08/08 30/09/08 31/07/08 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 2 Refer to Standard OP7 OP12 Good Practice Recommendations The registered person should ensure that entries in care documentation are always signed and dated. This is important for accountability and to enable effective audit. The registered person should ensure that up to date information about activities is made available to residents in formats suited to their capacities. The programme on display in the reception area was hard to read, being in small print on a dark coloured background. The registered person should ensure each person can eat their food without difficulty, and that as far as possible meal times are enjoyable occasions for all residents. The registered person should consider offering additional DS0000006942.V366098.R01.S.doc Version 5.2 Page 31 3 4 OP15 OP19 Burrows House 5 6 OP19 OP22 7 OP25 shade in the garden for the summer months. There is some natural shade available but the glass awnings overhanging the veranda may intensify the heat. The registered person should consider providing evidence of regular audits to confirm that windows remain safe, secure and clean. The registered person should ensure the home’s environmental orientation facilities for people with dementia reflect best practice. This may make it easier for people with confusion to find their way around the home. The registered person should make sure the lounge for units F, G and H on the upper floor is kept at a temperature that residents find comfortable. Burrows House DS0000006942.V366098.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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