Inspection on 23/03/09 for Burton Lodge EMI Nursing Home

This inspection was carried out on 23rd March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Burton Lodge EMI Nursing Home 410 Burton Road Derby DE21 6AJ Lead Inspector Angela Kennedy Unannounced Inspection 23rd March 2009 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Burton Lodge EMI Nursing Home DS0000073168.V374697.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. Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burton Lodge EMI Nursing Home Address 410 Burton Road Derby DE21 6AJ 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) 01332 365240 01332 725588 www.redrosecare.co.uk Redrose Care (Derby) Ltd Care Home 31 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Burton Lodge EMI Nursing Home DS0000073168.V374697.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 the following gender : Either whose primary care needs on admission to the home are within the following categories: Old Age not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 31 Date of last inspection N/A Brief Description of the Service: Burton Lodge is a 31 bedded care home situated close to the centre of Derby. The property was originally a private dwelling that has been converted and extended into a care home. Bedrooms are located over 2 floors. All floors are accessed via a passenger shaft lift or staircase. There are a number of lounge areas that are all well used. People living at the home have access to a patio area and garden to the rear of the home. Information about the service is provided through the Statement of Purpose and Service User Guide, although these documents require updating. The current fees for the home at the time of this visit ranged between £364 £17 top up to £467.80 £17 top up. Burton Lodge EMI Nursing Home DS0000073168.V374697.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 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection took place over nine and a half hours. A second inspector was also present for part of this time to undertake observations of the care and support being given to a small group of people. These observations were the direct experience of this inspector who sat alongside five people for a couple of hours during a regular part of the day in a communal space within the care home. These observations provided insight into their general state of well being during this time and insight into staff interactions with these individuals during this time. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. At this visit there was no previous reports to examine. As the service was newly registered in December 2008. The focus of inspections undertaken is upon outcomes for service users and their views on the service provided. This process considers the provider’s and registered manager’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers, which is a legal requirement. This assessment gives the provider an opportunity to let us know about their service and how well they think they are performing. The information provided in the AQAA is reflected within this report. At this inspection one person was case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. The person case tracked and other people living at the home were spoken with. Their views of the service and the care and support provided are included within this report. Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 6 Two members of staff were spoken with at some length and their views and opinions of the care provided, the support and training given to them is included within this report. What the service does well: What has improved since the last inspection? What they could do better: Nine requirements were left at this inspection visit. Staff training records showed that staff training was up and running but still required further development to ensure staff had received the training they needed to undertake their roles effectively. This included training in food hygiene for the cook, dementia training for all staff and NVQ qualifications for the care staff team. Robust practices needed to be in place to ensure that thorough recruitment checks, that are required by law to keep people using the service safe are undertaken before staff are employed. Burton Lodge EMI Nursing Home DS0000073168.V374697.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. Burton Lodge EMI Nursing Home DS0000073168.V374697.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 Burton Lodge EMI Nursing Home DS0000073168.V374697.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 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People do not have accurate information about the home to make an informed choice. Individual’s needs are assessed prior to admission to ensure the service can meet their needs. EVIDENCE: The homes Statement of Purpose did not at the time of this visit clearly reflect the service provided. Information regarding the management and staff needed updating and the category of registration has changed since the provider’s registration in December 2008. The home’s Statement of Purpose does not include information regarding their dementia registration. However discussions with the operations manager for Red Rose Care confirmed that the service did not plan on accepting any new admissions to the service at this time. Other information in the Statement of Purpose that was not reflected in practice related to the home providing an activities organiser and that the cook Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 10 employed had the relevant qualifications for the job, which at the time of this visit was not accurate. As stated in the providers self assessment a full pre assessment was carried out for the person that was case tracked. This ensured that the service was able to meet their needs. The assessment covered both physical and mental health issues and information on the individuals personal care needs and included information on their prescribed medication. This ensured the home had the staff and facilities to support the care required. The information seen also included the initial needs assessment that had been undertaken by the local authority and subsequent assessment that had been undertaken by relevant health care and local authority services. A review of this person’s medical history had also been undertaken by the home and this was supported in the records seen. This information was provided by the family representatives for this individual and also provided some information on their life history, such as their former career and significant events in their life. Once this information is transferred into the relevant care plans it will enable staff to support this individual in a more person centred way. Burton Lodge EMI Nursing Home DS0000073168.V374697.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 good. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are met and they are supported to take their medicines in a safe way. EVIDENCE: The care plans in place for the person case tracked addressed their personal support and health care needs and instructed staff on the actions they needed to take to ensure those needs were met. The care plans seen had been reviewed on a monthly basis but no written evidence was seen to demonstrate that this individual or a family representative had been involved or consulted in the development of these plans. The information in care plans used terminology such as ‘encourage and assist’ This information could have been more detailed on the level of support that was required by identifying what the individual could do independently and areas were they needed some level of support. This would then ensure that all Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 12 staff worked consistently and that this person’s independence and skills were promoted and maintained. As stated in the providers self assessment there was evidence to demonstrate that any changes identified in the support provided were recorded on a daily basis and incorporated if required into the Care Plan. Areas such as social needs did not have a care plan in place in the person’s file seen. There was a document called a spiritual social diary in place that recorded visits from family and friends and activities or social events that were participated in. (This is discussed further in the ‘Daily Life and Social Activities’ section of this report). As stated in the ‘choice of home’ section of this report, information regarding this persons’ life history had been gathered with family at reviews but this had not been transferred into care plans or placed on a life history record. Once this information is transferred into the relevant care plans it will enable staff to support this individual in a more person centred way. Although there was no care plan regarding prescribed medication there was reference to prescribed medication in another care plan. This related to staff administering medicines as prescribed. Within this persons file there was a care plan regarding their diet and this care plan provided information regarding this person’s daily routine, such as their preferred rising time and time they liked breakfast. This enabled this person to maintain the routines that they preferred, thereby promoting and respecting their wishes and choice. Where risks had been identified assessment were in place that related to the identified risk. Risk assessments within the file seen identified any risks and the actions that were to be taken to minimise the risks. This ensured this person’s well-being and safety was maintained. The risk assessments seen included, pressure ulcer assessments, moving and handling assessments, falls assessments, continence assessments, nutritional assessments, which included regular records of weight and dependency assessments, including an assessment regarding this person dependency in evacuating the home in the event of a fire. Records seen demonstrated that this persons health care needs were being met. This included records of visits from health care professionals, such as chiropodists, dentists, optician, G.P and District Nurses. It was confirmed that district nurses were performing some clinical procedures such as catheterisation that the nurses at the home were not trained to do. Discussions with operations manager regarding this confirmed that this training had been booked. The home supports people to manage their medicines in a safe way. Medications were stored correctly and records were in place to demonstrate Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 13 that medication was received, administered, and disposed of appropriately. Appropriate records were in place that demonstrated that room temperatures and clinical fridge temperatures were maintained. This ensured medication was stored at the required temperatures and remained safe and effective to use. The controlled drugs practices were looked at and demonstrated that staff ensure the practices regarding controlled drugs are managed in a safe and appropriate way. It was noted that the home did not have a pill counter; this would assist in counting medication in an efficient and hygienic way. People spoken with confirmed that the staff team were respectful of their privacy and provided personal care support in a respectful way that ensured their dignity wasn’t compromised. This was also observed throughout this inspection visit. Burton Lodge EMI Nursing Home DS0000073168.V374697.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were not fully supported to follow their personal interests and their social well-being was not actively promoted. EVIDENCE: As explained in the summary of this report, observations of the care and support being given to a small group of people was undertaken at this visit. Staff were observed using the appropriate moving and handling techniques to ensure people were supported in a safe way. There were plenty of occasional tables that enabled drinks to be placed next to individuals. Drinks were available to everyone on a regular basis. However the drinking vessels used were not suitable for everyone. Staff were observed filling up juice drinks throughout the morning as well as making mugs of tea. The glasses were very large and at least two people were seen to struggle with getting their hands around the circumference of the glass. One person did struggle to hold their glass and place it on the table next to them. Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 15 During part of the observation the television was turned on but no attempt was made to turn the music off. This meant that the room had both the sound from the television and the radio, which is not conducive of a relaxed environment. Also due to the lay out of the room only a very few people would actually be able to see the television screen clearly. One person was seen to lean round to try to see the television screen. During this observation period it was noted that staff interaction with three of the five people being observed was continuous for the majority of the time. This included staffing making conversation with individuals and supporting them to look at nostalgia cards. For the other two people observed the observations showed that staff interactions with them were less frequent and for the majority of the time these two people appeared to be in their own inner world showing no signs of a positive mood. The interactions that were seen between staff and individuals was positive and demonstrated a relaxed pace was used. Staff were observed to be considerate in waiting for a response from individuals, when asking questions such as their preferred meal choice for lunch and the general atmosphere was friendly. Information in the provider’s self-assessment said that people were able to participate or not in activities as they choose. However there were no scheduled activities in place and the operations manager stated that although the company had advertised for an activities coordinator no interest in the post had been shown. People spoken with felt there was little to do during the day, one person said, ‘we just sit here’. As stated earlier in this report there was some evidence in the records of the person case tracked to demonstrate that they had participated in some activities. The activities in their spiritual diary over the last two months recorded a visit from their relative, attending a valentines party, an ‘old musical’ singing session and reminiscence with old movies session at the home. The operations manager confirmed that there was a policy in place regarding advocacy services but said that these services were not advertised within the home. This means that the people living at the home and their relatives may not be aware of this service or how to access it. Discussions with one visitor took place. They confirmed that there appears to have been some improvements in the service over the last couple of months. They felt that the general level of care provided by the staff was good and said that their relative seemed happy with the meals provided. This visitor said that they were not aware of any activities taking place at the home. They did however confirm that their relative preferred to stay in their own room and did not come downstairs very often stating that they preferred to take their meals in their room. Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 16 On the day of this visit, between 11.35am and 12 midday individuals were supported to make their way to the dining table. However the lunchtime meal was not served until 12.50pm. This meant that some people had been sitting waiting for their meal for over an hour. Food preferences and requirements were recorded in the file of the person case tracked. In discussion with a visitor it was identified that her relative had the same meal for breakfast every day and in conversation with a member of staff her relative had confirmed that this was ‘a bit boring’. The operations manager said she would ensure this person was aware of the different options available. Menus were being reviewed at time of inspection and ran over a four-week period. The cook had been in employment since November 2008 and did not have a food hygiene certificate. This is essential training to ensure that safe working practices are followed to maintain the health, safety and welfare of the people using the service. The cook had not received any training in nutrition and the operations manager confirmed that this had been identified and would be undertaken in the near future. There was some evidence that demonstrated that individuals were supported to exercise choice, such their preference at meal times on what they preferred to eat and where they preferred to eat. There was little evidence to demonstrate that consideration was given to supporting peoples individuality or social preferences. Burton Lodge EMI Nursing Home DS0000073168.V374697.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 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Peoples concerns are responded to but this is not always done in a transparent way, which may lead to people feeling that their concerns have not been addressed appropriately. Staff may not have the skills and knowledge to protect the people using the service from abuse. EVIDENCE: As stated in the providers self assessment three complaints have been made to the service since its new registration. These complaints had been addressed and records were seen showing the actions taken and outcomes of these complaints. One complainant felt that outcome relating to their complaint was not satisfactorily met at the initial stage of the service responding to them regarding their investigation findings. This has now been resolved following a meeting with the complainant. In the providers self-assessment it was acknowledged that the service could improve their communication with the people using the service and their relatives and visitors. Two safeguarding referrals / investigations have been undertaken. These led to reviews of care being undertaken by the Local Authority and Primary Care Team as applicable. These reviews led to several areas of care being raised Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 18 where relevant information in support plans was missing. These areas have now been addressed. Following the safeguarding referrals / investigations it was agreed that one of the issues was the lack of medical/ health history available for each person at the home. This has now been addressed with relatives and G.P’s, who have been consulted regarding the previous healthcare history of individuals. The records seen of the person tracked demonstrated this. None of the people spoken with were able to confirm that they knew how to make a complaint but one person said they would tell their son if they were unhappy. One relative spoken with was aware of the complaints procedure and confirmed they would use it if they needed to. They said that they were not aware of our contact details and were shown the complaints procedure displayed in the home, which included our contact details. The operations manager said that the home used the Local Authority policy regarding safeguarding. Two staff on duty were spoken to. Of the three staff on duty, two were employed at a sister home in Sheffield. Both care staff spoken with were aware of the safeguarding policy and had a good understanding of procedure to follow in the event of any safeguarding concerns or allegations. Staff training records showed that 9 staff out of 14 staff employed at the home had received training in Safeguarding adults within the last 2 years. Staff that have not received this training may not have the skills and knowledge required to protect the people using the service from abuse. Burton Lodge EMI Nursing Home DS0000073168.V374697.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The improvements and refurbishment of the home ensure that a well maintained environment is provided to keep people safe. EVIDENCE: The provider’s self-assessment stated that Redrose Care has completely redesigned the downstairs of the home. It stated that they had redecorated several rooms, replaced the bedroom furniture, were upgrading all en suites as they are redecorated, they had replaced equipment and beds and redesigned the ground floor bathroom and widened some of the door spaces. A tour of the communal areas of building showed that extensive work was being undertaken to improve and upgrade the home, this work was ongoing at the time of the inspection visit. This included, a refitted bathroom with bath Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 20 hoist. The ground floor was being refurbished this included the dining area and lounge which had been restructured and was in the process of being refurbished and the managers office, which is now is situated on the ground floor next to the communal area, providing better access to the office, with a view of the dining area to enable the manager to oversee this communal area. Further work was planned such as a shower room that was no longer in use being converted into a wet room. The operations manager confirmed that any environmental changes to the building were done in consultation with the fire officer. As stated earlier in this report the layout of the lounge that was being used at the time of this report meant that only a very few residents would actually be able to see the television screen that was situated on the wall. As stated earlier in this report staff were observed using the appropriate moving and handling equipment when assisting individuals with reduced mobility. The laundry room was seen and provided the relevant equipment to ensure clothes and linen were laundered at the appropriate temperatures. The operations manager confirmed that the laundry was staffed 7 days a week between 9am and 3pm. Individuals spoken with indicated that they were pleased with new décor and refurbishment of the home. All areas seen were clean and tidy. It was noted that occasional tables were situated next to armchairs to ensure people had somewhere to place their drinks securely. Burton Lodge EMI Nursing Home DS0000073168.V374697.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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of staff are on duty to support the people living at the home. The recruitment practices are not robust and therefore do not ensure people are protected from abuse. EVIDENCE: As indicated in the provider’s self-assessment the staffing levels were sufficient to meet the needs of the people living at the home. Discussions with staff on duty and rotas seen demonstrated that one registered nurse and two care staff were on duty throughout the day and night. People spoken with said they thought there was enough staff to support them. One member of staff said that they thought staffing levels were good and said that the staff worked well together. The operations manager confirmed that the staffing levels would be increase as more people moved into the home. She stated that the staff numbers would however be determined on the needs of each person and not on the number of people living at the home. Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 22 Due to the recent staff turnover two of the staff on duty on the day of this visit were employed at the company’s sister home and were for the present time rostered on duty at Burton Lodge until a full staff compliment was in place at the home. The operations manager confirmed that recruitment remained ongoing. The skill mix in place ensured that new staff were appropriately supervised by more experienced staff. For example, two full time day staff that had worked at the home for some time had moved to nights and new staff worked on days. This ensured that staff that had the knowledge and skills managed the more isolated shifts. This service ensured that staff had, or were working towards the relevant qualification required, to enable them to meet the needs of the people they supported. The records showed that of the care staff employed, four had achieved an NVQ 2 in care, three were working towards this qualification and two staff were working towards an NVQ 3 in care. Training records seen demonstrated that mandatory training was provided to staff. The records demonstrated that four staff had undertaken dementia training. However from observations on the day of this inspection (see standards 12-15) it was noted that all staff would require training to ensure they were able to work affectively with people with dementia. Although some people were observed to receive regular interactions with staff it was also noted that others did not. This did not promote their well-being. Further training would improve staffs understanding of what people with dementia need to improve their quality of life. As stated earlier in report the cook that had been in employment since November 2007 had not undertaken a food hygiene course. The operations manager also confirmed that the cook would be attending training in nutrition to enhance his skills. Discussions with operations manager regarding training for nurses in catheterisation confirmed that this training had been booked. Until this time district nurses were undertaking this procedure as required. The recruitment records of two staff were looked at. Not all of the documents required by law were in place. The application forms requested a five-year employment history rather than a full employment history. From this and other written information provided by these two members of staff it was identified that there were gaps in their employment that had not been accounted for. References from last employers were not in place, as the last employers had not been identified in the written information given in the application form. The operations manager amended the company’s application form on the day of this inspection visit to ensure that future applicants provide a full employment history and confirmed the reason for any gaps in employment. This will ensure that the people using the service are protected by a thorough recruitment practice. The operations manager confirmed that all staff files would be reviewed to ensure that the appropriate information and references Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 23 were in place. Other records required by law were in place such as identification documents, Criminal Records Bureau Checks and POVA first checks. Evidence of up to date registration with the Nursing and Midwifery Council was also seen in recruitment records held. The information in the provider’s self-assessment stated that there was a comprehensive induction programme. However this was not seen in the staff files looked at. Induction checklist were in place in one staff file looked at, in the other staff file no induction information was seen. The operations manager stated that she was awaiting new induction workbooks to enable new staff to complete these. On discussion with the member of staff that had no induction information in their personal file, they confirmed that they had received a thorough induction and felt that they were supported well by senior staff. This person said that they had not worked in care services for older people before but felt that they had been supported and trained well and felt that they was able to support people well. This member of staff also said that they had received training in using the hoist and that they had started their NVQ2 in care. They said that the training provided was good and felt that staff respected individual choices. They gave an example saying that people were able to get up and to go to bed when they chose to. Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The development and monitoring of practice has improved the standard of care provided. This needs to be further developed to ensure that the home is managed in the best interest and safety of those people using the service. EVIDENCE: No manager was in post at the time of this inspection visit. A new manager was due to take up post the following week. Since February 2009 the operations manager has been managing the service. The recent turn over of staff and management has resulted in many changes for the people living at the home, those spoken with confirmed that the staff Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 25 were caring and supported them. As stated earlier in this report the staffing levels were sufficient to meet the needs of the people using the service. Staff training records showed that staff training was up and running but still required further development to ensure staff had received the training they needed to undertake their roles effectively. As stated earlier in this report this included training in food hygiene for the cook, dementia training for all staff and NVQ qualifications for the care staff team. As stated earlier more robust practices need to be in place to ensure that thorough recruitment checks that are required by law to keep people using the service safe are undertaken before staff are employed. The monies held in safekeeping for the person case tracked was looked at against the financial transaction records held. The records corresponded with the monies held and this demonstrated that all monies spent and received had been accounted for. It was noted that not all transactions had two signatures; this should be done as a good practice measure. As the service was newly registered in December 2008 no quality assurance questionnaires have been sent out to the people using the service or their representatives. However there was evidence to show that a relatives meeting had taken place and another was booked for April 2009. Minutes of staff meetings and staff supervision records was also seen that demonstrated that staff were supported within their role and that staff communication was ongoing and promoted. A sample of health and safety service certificates and checks was undertaken and all were found to be satisfactory, this included records of weekly fire alarm tests and other fire safety checks, certificates of gas safety, bacteriological analysis of water certificate (legionella check) and lift service certificates. Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NA STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Schedule 1 Requirement Timescale for action 23/09/09 2 OP12 16 (m) (n) 3 OP15 16 (2) (j) 4 OP18 13 (6) The statement of purpose must be amended to reflect the service, facilities and categories of registration provided. This should also include the current management and staff employed and clearly reflect the qualifications and experience of all staff. People using the service should 23/05/09 be consulted about their interest and preferred choice of activities. From the information gathered a programme of activities should be developed and provided on a regular basis. An assessment should be 23/05/09 undertaken for each person using the service, to ensure the drinking vessels used are suitable for them. Alternative drinking vessels must be provided to individuals as assessments dictate. All staff must undertake 23/06/09 Safeguarding Adults training to ensure they have the knowledge required to protect people using the service from abuse. DS0000073168.V374697.R01.S.doc Version 5.2 Burton Lodge EMI Nursing Home Page 28 5 OP29 19 Schedule 2 6 OP29 19 Schedule 2 7 OP30 18 (1) 8 OP33 24 9 OP38 16 (j) and 18 (1) (a) Full employment histories and a satisfactory written explanation of any gaps in employment must be in place for all staff working at the home. This is to ensure that people living at the home are protected by the homes recruitment policy and practices. Urgent action letter sent. Two written references, including where applicable a reference relating to the persons last period of employment must be in place of all staff working at the home. This is to ensure that people living at the home are protected by the homes recruitment policy and practices. Urgent action letter sent. Staff employed must receive appropriate training that relates to their job, such as full induction training and dementia training. Effective quality assurance and quality monitoring systems must be put into place at the home. These systems must be based on the views of the people that use the service and their representatives. The cook must undertake a food hygiene course as a matter of urgency. This is to ensure that safe working practices are followed to maintain the health, safety and welfare of the people using the service. Urgent action letter sent. 20/04/09 20/04/09 23/05/09 23/09/09 20/04/09 Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations Written evidence should be in place to demonstrate that people using the service or their representative have been involved or consulted in the development of their care plans. Information gathered regarding individuals life history, should be transferred into the relevant care plans. This will promote person centred care. A pill counter should be purchased for medication such as controlled drugs. This will assist counting medication in an efficient and hygienic way. Independent advocacy services should be advertised in the home to ensure people using the service and their representatives are aware of these services, what they do and how they can be contacted. Complains should be dealt with in a transparent way to ensure people are aware that their complaints have been addressed appropriately. The layout of the lounge referred to in this report, should ensure that facilities such as the television are accessible to everyone using the service. All care staff should undertake NVQ training to level 2 or above in care. This will ensure they have the qualification required. Two signatures should be provided on individuals financial transaction records to further promote and safeguard people from financial abuse. 2 3 4 OP7 OP9 OP14 5 6 7 8 OP16 OP20 OP28 OP35 Burton Lodge EMI Nursing Home DS0000073168.V374697.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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