Inspection on 05/09/07 for Burwood Nursing Home

This inspection was carried out on 5th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Burwood Nursing Home 06/02/07

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Burwood Nursing Home 100 Dunyeats Road Broadstone Poole Dorset BH18 8AL Lead Inspector Marjorie Richards Key Unannounced Inspection 5th September 2007 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 Burwood Nursing Home DS0000067456.V349331.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. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burwood Nursing Home Address 100 Dunyeats Road Broadstone Poole Dorset BH18 8AL 01202 693224 01202 695047 burwood.nh@ntlworld.com 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) Mrs Sarah Jane Jessup Mrs Dawn Holbrook Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2007 Brief Description of the Service: Burwood Nursing Home is registered with the Commission for Social Care Inspection to accommodate twenty-six people in need of nursing care. Mrs Sarah Jane Jessup is the registered provider and Mrs Dawn Holbrook is the registered manager. The home is situated approximately three quarters of a mile from the village of Broadstone, which has a good selection of amenities. A bus stop is located near the home’s entrance and there is ample off-road parking available for visitors in front of the home. Burwood Nursing Home comprises two main buildings, the original house and a more recent extension. Both buildings are linked by a corridor, which opens into a very large conservatory, creating a pleasant sitting area that can also be used for dining. There is a separate dining room and, in addition, a smaller lounge on the first floor. Accommodation is provided in twenty-two single and two shared rooms. All rooms except one have ensuite facilities. The remaining room has a wash hand basin. All rooms are currently used for single occupancy. Residents are encouraged to participate in a programme of activities organised within the home. An inter-denominational Christian service is held in the home at significant times such as Christmas and Easter, for anyone wishing to take part. Members of the clergy will also visit individual residents upon request to provide Holy Communion each week. The home is set in spacious, well maintained grounds with mature trees and shrubs. Beautiful gardens surround the home and provide a colourful display of flowers for residents to enjoy. There are patio areas and lawns where residents may sit outside if they wish. Burwood Nursing Home provides 24-hour nursing and personal care, all meals, laundry and domestic services. The fees for the home, as confirmed to the Commission for Social Care Inspection (CSCI) at the time of inspection, range from £570 - £760 per week. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 5 Additional charges include hairdressing, chiropody, dry cleaning, toiletries and newspapers. A copy of the home’s inspection report is made available to anyone wishing to read it. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choosing a care home .aspx Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 18.75 hours on the 5th and 11th September 2007 and was conducted by two Inspectors. The main purpose of this unannounced inspection was to review all of the key National Minimum Standards and check that the residents living in the home were safe and properly cared for. There were no requirements and only one recommendation as a result of the last inspection at the home in February 2007. On the 11th September, the Commission for Social Care Inspection Pharmacist Inspector also visited to look at medication practice within the home. (See standard 9.) Twenty-four residents are currently accommodated. A tour of the premises took place and records and related documentation were examined, including the care records for five residents. Time was spent observing the daily routine during the inspection, as well as talking with residents and some of the staff on duty. On the first day of inspection, the manager was not on duty and the deputy manager very ably assisted the Inspectors. Discussion took place with Mrs Holbrook, the registered manager on 11th September. Mrs Jessup, the registered provider also made herself available for much of the inspection and this was appreciated. Prior to the inspection a number of comment cards were sent out to the home on behalf of the Commission. Of those returned, four are from residents, six from General Practitioners, three from other healthcare professionals and eleven from relatives and visitors. Comment cards speak very positively about peoples’ experiences of Burwood Nursing Home. Examples of the comments received are included (anonymously) in the text of this report. The Annual Quality Assurance Assessment (AQAA) form had been completed by Mrs Holbrook and provided to the Commission for Social Care Inspection in advance of the inspection. Recent legislation has made it a legal requirement for all registered services for adults to complete an AQAA every year. The completed assessment is one of the ways in which the Commission for Social Care Inspection will assess how well the service is delivering good outcomes for the people using it. For the purposes of this report, people who live at Burwood Nursing Home are referred to as residents as this is the term generally used within the care home. The Inspectors were made to feel welcome in the home throughout the inspection. What the service does well: Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 7 Prior to moving to the home, prospective residents are assessed by the homes manager and/or deputy manager, to ensure that Burwood Nursing Home can meet their needs. They and their relatives or representatives are also invited to visit the home to look around, meet with the manager, staff and other residents and ask any questions before making a decision about whether or not to move in. A relative commented, I have been given all the information I need, in terms which the layman can understand. Residents moving into the home say they were well received. I was made to feel most welcome from the moment I arrived at Burwood. On arrival, a very warm welcome was extended to me by everyone. Burwood Nursing Home provides a clean and comfortable environment, where residents feel their personal, health and social care needs are met. The residents describe the home as a very friendly place in which to live, where the staff are helpful, cheerful and supportive. Feedback from residents during the inspection and from comment cards confirms that people feel the level of care and support is very good, with good outcomes for residents. For example: I receive very good care, 100 of the time. (Resident) I would be happy for my relatives to be resident in this establishment. (GP) I have been impressed with the care given individually to me and the professional and friendly approach of all staff. (Resident) The staff treat residents with respect and provide encouragement for them to pursue their own lifestyles, wherever possible, and to make choices about their daily lives. Residents are able to bring their own possessions into the home to personalise their bedrooms and this was witnessed in many of the rooms viewed during the inspection. Activities and outings are arranged for those residents who wish to participate. Residents are supported to maintain contact with family and friends, enabling people living in the home to continue to enjoy relationships that are meaningful to them. Residents confirm that their visitors are made to feel welcome. Residents are able to choose where to take their meals, but most prefer to eat together in the dining room. All residents spoken with were very positive about the quality of the meals provided. Residents commented, The food is very good. I look forward to mealtimes. We can always ask for something else if we dont like what is on the menu, but that doesnt happen very often. They look after my likes and dislikes with meals very well. The food is freshly cooked, which I enjoy. Relatives commented, “I have enjoyed meals here and they have always been of good quality.” “The food here always looks and smells most appetising.” The home has systems in place to ensure that any complaints will be listened to and acted upon and residents are protected from possible abuse. Residents Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 8 stated, Senior staff have impressed upon me the need to report to them immediately any problem I might have and this will be rectified immediately. I have no complaints. The home provides a welcoming and homely environment, which is clean and free from unpleasant odours. Residents confirm that this is always the case and that their bedrooms are regularly cleaned. Comment cards from residents state, A very high standard of cleanliness. Towels and linen changed regularly. The home is definitely clean and fresh. The home employs a settled staff team in sufficient numbers to meet the needs of residents. Residents and staff agree that Burwood Nursing Home is a good place in which to live and work. Comment cards from residents state, The staff always listen and act on what I say. Staff answer call bells very promptly. People are cheerful. My bell is answered always. I am happy. Comment cards from relatives state, The staff are first-class. The staff are excellent. Comment cards confirm that people think highly of the home. In response to the question, ‘What do you feel the care service does well?’ the following replies were received: Just about everything. (Relative) Looking after people individually. (Relative) Good care is always given. Staff are very helpful and willing to help and assist. (Healthcare professional) Sensitive individual care. (GP) Excellent all-round. (GP) What has improved since the last inspection? What they could do better: Some improvements in the completion of assessment and care-planning documentation are needed to ensure residents’ safety. All aspects of each resident s health and personal care needs must be recorded, regularly reviewed and updated as necessary. It is most important that all documentation is updated to clearly inform staff about the care support that is needed. Health care needs must be clearly documented in each residents care plan, including meeting the individual needs of a diabetic resident or a resident requiring support with nutritional wellbeing. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 9 Care records must be sufficiently detailed to enable staff to meet all current and changing care needs. Additional documentation, such as fluid monitoring and dietary intake charts, must be put in place where a high level of risk is identified. Some aspects of the audit trail, recording, monitoring and storage of medicines must be improved. The home must record administration of topical creams and nutritional products. All staff must receive suitable training, appropriate to the work they are to perform. Staff should receive at least three paid days training per year and this needs to be fully evidenced in training records. All parts of the home must be kept free from hazards to resident safety. Potentially hazardous substances must not be left accessible to vulnerable residents. The home needs to use approved lancing devices for blood testing to ensure that residents and staff are protected from infection. 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. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 10 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 Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 11 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): 3 (Standard 6 is not applicable at Burwood Nursing Home.) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Burwood Nursing Home. Information provided about Burwood Nursing Home and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met are offered places there. EVIDENCE: An Enquiry sheet is completed when people first contact the home regarding a new admission. Pre-admission assessments were seen for three residents who had recently moved into the home. The assessments contained detailed information regarding the prospective residents’ personal and medical needs. Documentation included reference to individual preferences, such as the preferred mode of address. Details included information regarding health and Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 12 social care professionals currently involved in meeting the prospective residents’ needs and, where relevant, they had provided written information to support the home in making an informed decision as to whether they can meet people’s needs. The deputy manager confirmed that she and Mrs Holbrook usually visit people who are considering moving into the home. Prospective residents and their relatives or representatives are invited to visit Burwood Nursing Home to look around, meet with the manager, staff and other residents and ask any questions before making a decision about whether or not to move in. Comment cards from relatives relative stated, I have been given all the information I need, in terms which the layman can understand. Having toured all the nursing homes in our area, we felt this is the only one where we would feel happy to have our relative. A residents comment card says, Before admission, senior staff visited me and discussed my care needs. My needs are being continually assessed and met. A letter of confirmation is then written to the prospective resident so that they may feel assured their care needs can be met. The Annual Quality Assurance Assessment (AQAA) submitted by the service also refers to the warm welcome that people and their friends and relatives receive when they visit the home. Contacts with relatives were recorded on one of the files seen before the resident moved in; the home working with the family to ensure that the resident was reassured that their needs could be met. Two residents who have recently moved into the home commented that they felt comfortable and well cared for and another resident said, I was made to feel most welcome from the moment I arrived at Burwood. One comment card said, On arrival, a very warm welcome was extended to me by everyone. A summary of needs in relation to activities of daily living is compiled and provides useful information for staff members providing care when people first move into the home. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 13 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Burwood Nursing Home. Residents have good access to healthcare services, but some improvements in the completion of assessment and care-planning documentation are needed to ensure residents’ safety. The home has procedures for administering residents’ medication as prescribed but some aspects of the recording, handling and monitoring of medication could be improved to safeguard residents. EVIDENCE: Care plans were viewed for five people living in the home. Clinical assessments are completed appropriately in order to inform the development of care plans. Brief details of reviews are recorded, mostly stating no change. From discussion with the deputy manager, examination of daily records and from observation, some changes had occurred in residents’ needs. For example, one resident was recorded as underweight on admission but gained weight satisfactorily over a period of months until average weight was achieved. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 14 However, the care plan evaluations still state no change and do not accurately reflect the positive outcomes of care provided. The responsibility for maintaining care plans is divided between the Registered Nurses working in the home. Detailed daily records are completed. Medical abbreviations are used. It is important that clear wording in documentation provides a picture of care and support that all can understand. The manager is consulting the Resuscitation Council website, regarding appropriate consultation and documentation in respect of decision making about life support in care homes. Separate records detail contacts with external health and social care professionals. Baseline observations, including temperature and blood pressure are recorded on admission and details of any pre-existing conditions. Clinical risk assessments, which assess aspects of the physical vulnerability of residents, are utilised. On one of the files seen a very high nutritional risk identified had informed a care plan, meeting the resident’s nutritional needs. According to the care plan the resident requires a puréed diet. These details are also displayed in the home’s kitchen. However on the first day of the inspection the resident was observed being given chopped vegetables, mashed potatoes and partially pureed chicken in gravy. The daily records show that the resident had previously choked on non-puréed food. The care plan also states that the resident is to be sat up for thirty minutes after food. The resident was not sat up to eat lunch, nor after receiving help with eating. This was discussed with Mrs Holbrook. She explained that the care plan was not correct in stating that the resident had a poor swallow reflex and the resident was now no longer in need of a puréed diet. Mrs Holbrook said staff were fully aware of these changes. However, it is important that all documentation is updated to clearly inform care support. One care plan for a resident who had experienced previous weight loss did not detail the date, Prideaux score, weight or ideal weight. Discussion took place with the deputy manager about the need for the home to record fluid intake for those residents who, according to their assessment and care plan, require help to sustain a fluid intake of three litres in each twentyfour hours. The deputy manager immediately introduced a form for this purpose. By the second day of the inspection, Mrs Holbrook had devised and put in place a very clear chart to monitor the fluid intake of all those residents the home had identified as being potentially vulnerable in accessing sufficient fluids. Mrs Holbrook said that she would review the use of the forms according to outcomes from the monitoring undertaken and a review of risk assessments. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 15 From the assessments seen, one resident is prone to pain. There is no care plan regarding alleviating the resident’s pain. On visiting, the resident appeared well cared for, comfortably positioned and very alert. It was clear that staff do everything they can to minimise pain for this resident. Some care plan records are incomplete. For example one plan stated, Has bowels open every……days. A continence care plan indicated that pads needed changing, but did not inform staff how often. One diabetic care plan did not contain sufficient detail regarding the individual resident’s needs. However, another diabetic care plan did contain all of the relevant information, including details regarding how to recognise a hypo or hyper-glycaemic attack and general information regarding meeting the needs of residents with diabetes. Mrs Holbrook says she is aware of the need for continuity in the standard of recording and is working to achieve this, by supporting Registered Nurses to complete and update plans appropriately. The care plan for one recently admitted resident stated that help was needed with personal care, but only in very general terms. However, the care plan for a resident who had been at the home for some time, contained very informative details regarding when, where, what and how the resident needed support with personal care. Consents were seen for the application of bed rails, which had been signed by the resident, or their representative. Detailed risk assessments have been completed to support consultation with residents and their families and Mrs Holbrook confirmed that these are reviewed three monthly. The deputy manager says that various health and social care professionals visit the home on a regular basis and this was supported by entries on contact sheets. This includes visits from the Diabetic Specialist Nurse, an Occupational Therapist and the Stroke Nurse. One resident is having visits from a physiotherapist and there is a programme of exercises in their room. An aromatherapist also visits the home, by arrangement with individual residents. Feedback from residents during the inspection and from comment cards confirms that people have confidence in the home and feel the level of care and support is very good, with good outcomes for residents. For example: I would be happy for my relatives to be resident in this establishment. (GP) Burwood is just a lovely friendly place with wonderful staff. (Relative) I receive very good care, 100 of the time. (Resident) I have been impressed with the care given individually to me and the professional and friendly approach of all staff. (Resident) I feel they have been especially caring in looking after my relative. (Relative) Excellent care standards. (GP) Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 16 There are procedures in place for the ordering, receipt and disposal of medicines received into the home. Mrs Holbrook says that no residents are currently able to self medicate. The medication policy does not include procedures for staff on handling and recording new residents’ medicines and administering household remedies. One person’s care plan did not describe the current arrangements for administering their medicines but the Registered Nurse was able to describe the correct procedure. Medicines and foods residents are allergic to are well recorded and this helped prevent one person having a medicine they were sensitive to. Controlled Drugs (CD) are well recorded. Records indicate that oral medicines are given as prescribed but some records of creams and nutritional products are incomplete. The quantity of some medicines in stock for one new resident did not agree with the records and the Registered Nurse thought this was due to errors in recording the quantities received on admission. The details on the medicine record chart were not signed as checked by a second person to protect the resident. The correct administration of other peoples’ medicines could not be checked, as there is no system for recording a recent stock balance or the date of opening a new pack. The home is not using approved lancing devices for blood testing, potentially putting residents and staff at risk of infection. There are secure cupboards in residents’ rooms for storing their medicines and reserve medication is also stored securely. Storage of some medicines did not comply with legal requirements and the manager has agreed to improve this. Staff monitor the actual rather than maximum and minimum temperatures of the fridge where medicines are stored. These were in the correct range. Staff were observed knocking at bedroom doors before entering and offering personal care discreetly. Staff interact with residents in a friendly and relaxed manner. It was clear from the time spent with residents that they feel comfortable and at ease with staff and appreciate their gentle and caring approach. Staff were seen to be treating residents with courtesy and kindness, with due regard for dignity and respect. The bedroom doors in the new wing of the home have glass vision panels. Many are partially obscured with the addition of an opaque film, but not all. This was discussed with Mrs Holbrook, who says that all residents have been asked if they are happy with this arrangement and the panel would be totally obscured if a resident expressed a wish for total privacy. However, Mrs Holbrook said she would again speak with residents about the vision panels and record outcomes. Residents commented, I am really so pleased I came here. Not everyone is as lucky to find a place as good as this.” They respect my privacy when I Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 17 want to be on my own, but they know I enjoy company sometimes. The staff are always very polite and respectful. They always address me as I would wish to be addressed. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 18 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Burwood Nursing Home. The home is flexible in its approach to the provision of activities and meals, enabling residents to retain control over their lives wherever possible. Residents are supported to maintain contact with family and friends. EVIDENCE: Details about the activities available are displayed in the entrance hall. These include a piano sing-along every week, hand massage, board games and visiting pets, including dogs, kittens and a hamster. The mobile library visits every three weeks. An activities book was seen, which records details of events in the home and residents’ participation. One resident’s file seen stated that they had participated in two group activities since the end of July 2007. The deputy manager says that a lot of time is spent with residents one-to-one and this includes aromatherapy. She confirms there is an activities coordinator in the home twice weekly, between 3 p.m. and 5 p.m. Outings are arranged and recently a group of residents visited Wimborne model village. On the first day of the inspection several residents went out on Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 19 a boat trip around Poole Harbour. In discussion, two of the residents said how much they were looking forward to going out. One resident was sitting in the garden waiting for transport for the excursion and commented on how much pleasure the garden gives them. On returning from the outing, one resident commented, It was so enjoyable to be out, we had perfect weather for boating. It was nice to be like a normal person again. They bought us all an ice cream and I had a lovely time. One comment card stated what admission to Burwood Nursing Home had meant to the resident personally. My social life will improve and I will be able to get out and do the things I have always enjoyed. The staff here are supporting me and helping me to achieve this. A good social history was seen on one file, another was in the process of being developed for a new resident. One social care plan also included a life biography. One resident proudly showed the Inspectors a poem that a member of the care staff had written for them. Mrs Holbrook says that visitors are welcome to visit the home at any time. Residents, relatives and staff confirm that visitors are made to feel welcome and visiting times at Burwood Nursing Home are unrestricted. Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. A telephone is always available to residents so they may make or receive calls from family and friends. Residents are able to have their own telephones installed in their bedrooms if they wish, at their own expense. Comment cards from relatives confirm that they are always kept informed about their loved ones and fully involved in any decision-making. Relatives also comment, The Nursing Home takes a personal interest in residents and family members. Family and friends who visit are always warmly welcomed and I am sure this helps them to enjoy their visit. This is important, in what for some could otherwise be a stressful experience for both visitor and resident. There are clear details regarding relatives and people with whom residents have meaningful relationships. Compliments letters had been received from family members, which expressed the confidence relatives feel in the care provided to their relatives at Burwood. As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. Residents confirm that they can spend their time as they please. Care plans included reference to the wishes and preferences of residents regarding daily living. Some residents say that they prefer to stay in their rooms and care staff respect this wish. One resident said that on arrival in the home, They asked me about what time I like to get up and go to bed, all sorts of questions like that. They fit in with me. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 20 Residents are able to bring their own possessions into the home to personalise their bedrooms and this was witnessed in many of the rooms viewed during the inspection. Lunch on the first day of inspection was Turkey a la king or sliced beef, with broccoli, parsnips and mashed potatoes, or salad. This was followed by homemade cheesecake or fresh fruit. Homemade chocolate cake and jam tarts were served with afternoon tea. For the evening meal, residents enjoyed homemade fishcakes with tomatoes, followed by mousse, yoghurt or fresh fruit. A range of alternatives, such as salads, omelettes and soups, is always available to suit individual taste and preference. Mealtimes can be flexible to fit in with care needs, outings, appointments etc. Special diets are catered for. The home has ample supplies of frozen, tinned and dry foods available and a variety of fresh fruit and vegetables. Some foods are decanted from their original packaging, e.g. custard powder, but not dated. This was brought to the attention of the deputy manager on the first day of inspection and rectified straight away. The following comments were received from residents: The food is very good. I look forward to mealtimes. We can always ask for something else if we dont like what is on the menu, but that doesnt happen very often. They look after my likes and dislikes with meals very well. The food is freshly cooked, which I enjoy. Relatives commented, “I have enjoyed meals here and they have always been of good quality.” “The food here always looks and smells most appetising.” Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to Burwood Nursing Home. The systems in place provide residents with the confidence that their complaints will be listened to and acted upon and they are protected from possible abuse. EVIDENCE: The home has a detailed complaints procedure. Mrs Holbrook has an office close to the entrance of the home and it was observed that anyone visiting the home is welcome to chat with the manager and discuss any concerns, reflecting openness to any issues arising. Mrs Holbrook confirmed that no complaints have been received since the last inspection visit to the home. The four comment cards received from residents all stated that they all knew how to make a complaint. Residents stated, Senior staff have impressed upon me the need to report to them immediately any problem I might have and this will be rectified immediately. I have no complaints. Relatives commented, I would always voice any problem directly to the matron. The complaints procedure is displayed at the Nursing Home, were it ever to be needed. Adult protection training took place in 2005, following a video based programme. Mrs Holbrook said that she is currently resourcing external training to update staff and reflect local No Secrets guidelines. The inspectors Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 22 discussed with the deputy manager the referral procedure in the case of an allegation of abuse arising in the home. A suggested amendment to the Adult Protection policy and procedure was immediately put in place during the inspection. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 23 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Burwood Nursing Home. Environmental standards are good, providing residents with comfortable, clean and well-maintained surroundings in which to live. EVIDENCE: Inspection of the premises confirms that routine maintenance is being carried out. Maintenance records are kept and prompt attention is paid to any minor defects and repairs whenever necessary. The home provides a welcoming and homely environment. A gradual programme of refurbishment and redecoration is in progress. There are vases of fresh flowers placed all round the home and one resident commented on their enjoyment of the perfume from the scented lilies in one bouquet. Individual bedrooms are personalised and there is a homely atmosphere. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 24 The main communal area is a spacious conservatory on the ground floor, which is accessed from the corridor linking the two buildings. Two large vines are growing within the conservatory, providing a selection of black and green grapes. A range of seating is provided. Further communal space is provided, which includes an attractive dining room where residents can share the dining experience and two other areas for residents wishing to dine together in smaller groups. There is also a small lounge on the first floor. The home is set in spacious, well maintained grounds with mature trees and shrubs. Delightful gardens surround the home, providing a colourful display of flowers for residents to enjoy and creating pleasant views from many of the home’s windows. There are lawns and patio areas where residents may walk and sit outside if they wish. One resident was observed sitting in the garden on the first day of the inspection, enjoying the surroundings. The home has an attractive fishpond, which is netted for safety reasons. One small area of netting is missing. The deputy manager confirmed that this is being repaired. A tour of the home confirms that Burwood Nursing Home is clean and free from unpleasant odours. Residents confirm that this is always the case and that their bedrooms are regularly cleaned. Comment cards from residents state, A very high standard of cleanliness. Towels and linen changed regularly. The home is definitely clean and fresh. The home has a spacious laundry, which is well organised. Infection control training is part of the home’s mandatory programme of training for staff. One of the sluice machines is currently out of action, but the deputy manager subsequently reported some delay in repairing this whilst awaiting a replacement part. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 25 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 Burwood Nursing Home. The home has systems in place for the robust recruitment and employment of staff, in sufficient numbers to support the people living at the home. The home is working to further develop its training programme to ensure that all staff are fully competent in their work and residents can be assured they are always in safe hands. EVIDENCE: Examination of the staffing roster, feedback from those living in the home and their relatives, as well as observation during the days of inspection demonstrated there is a sufficient number and skill mix of staff to meet the current needs of residents. The home employs a very settled staff team. Rosters were viewed for the first day of the inspection. Records accurately reflect the staffing levels in place on the day of the visit. There are normally six members of care staff on duty in the morning and five in the afternoon, in addition to a Registered Nurse. At night, there is one Registered Nurse and two wakeful care staff on duty. Rosters are devised to meet the needs of people living in the home. For example a member of the care staff team comes in early to help with serving breakfasts to those residents who want to eat early in the morning. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 26 A cook and a kitchen assistant are responsible for the catering Monday to Friday and there is one person in the kitchen at the weekend. Comment cards from residents state, The staff always listen and act on what I say. Staff answer call bells very promptly. People are cheerful. My bell is answered always. I am happy. Comment cards from relatives state, The staff are first-class. The staff are excellent. Staff say they enjoy working at Burwood Nursing Home and feel they are well supported. The home employs a total of twenty-seven care staff and is working to achieve the recommended target of at least 50 trained members of care staff with National Vocational Qualification (NVQ) level 2, to ensure residents at Burwood Nursing Home are in safe hands. The deputy manager confirmed that three members of staff possess an NVQ at level 2; two members of staff hold an NVQ at level 3. Four more staff are waiting to commence NVQ level 2 training and one member of staff is taking an NVQ level 3. The Annual Quality Assurance Assessment (AQAA) states that the home has recently changed its provider for the National Vocational Qualification training and is now looking to encourage more staff to undertake the training. The deputy manager says that she and a member of night staff are NVQ assessors. Three recruitment records were seen, which contained appropriate documentation in line with good recruitment practice. The records for the Registered Nurses included a check of their entry on the register of the Nursing and Midwifery Council. Individual training records are kept on files and copies of certificates are held. Both Mrs Holbrook and her deputy are trained moving and handling instructors. The deputy manager says that no members of staff start work without instruction. Food hygiene training is undertaken as part of the induction process and the manager confirmed that all staff working in the kitchen have basic food hygiene training. One member of staff holds a recognised first aid qualification. Infection control training is undertaken within the home and staff members are asked to complete a questionnaire to verify that they have achieved a satisfactory level of knowledge. It is advised that aprons are used when care staff enter the kitchen to reduce the risk of cross infection. A record of induction training was seen for a member of staff who had recently started work in the home. The deputy manager confirmed that the programme meets with the criteria of Skills for Care, the National Training Organisation. Staff members are allocated to a mentor to support them with the training. A well-thought out induction pack is given to new care staff members which Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 27 includes the Code Of Practice of the General Social Care Council and relevant policies and procedures. Training records were viewed for two Registered Nurses working in the home. One Registered Nurse had completed seven hours training in the past year, including an update on continence appliances, nutrition, and assessor standardisation and included a one-hour update in moving and handling skills. The other Registered Nurse’s file detailed eleven hours of training in the past year, which included a one-hour Parkinson’s disease course, one-hour first aid update and two hours catheter management and problem solving training. It was advised that if Registered Nurses are taking courses outside the home as part of their professional development that they share this with the service, so that they can contribute to the skills base at Burwood Nursing Home. From the records seen, it is not possible to evidence that staff are receiving a minimum of three paid days training per year. This was discussed with Mrs Holbrook, who explained that she is in the process of further developing the training programme, including accessing specialist training. Mrs Jessup confirmed that appropriate training is taking place and she will look at ensuring this information is recorded more fully in future. The Knowledge Sets on the Skills for Care website were discussed as valuable resources for basic areas of mandatory training. The website can be accessed at www.skillsforcare.co.uk. Comments from the home’s own Quality Assurance survey in 2007 demonstrate that staff are benefiting from the training provided. The training is excellent and in-depth. It is put into practice on every shift. The training I have received is helping me to give appropriate care to the residents. The training is put into practice every time we go into work. A comment card from a relative states, If a less experienced member of the care staff needs advice or help, this is readily sought and promptly given by a suitably qualified and experienced colleague. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 28 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Burwood Nursing Home. The management arrangements at Burwood Nursing Home and the quality assurance system ensure that the residents live in a home that is well managed and the service provided meets their needs. However, some improvements are needed so that the home always operates to ensure the safety and protection of residents. EVIDENCE: Mrs Holbrook has now completed the Registered Manager’s Award. On the first day of the inspection the deputy manager was in charge. The shift ran smoothly, with staff members consulting her appropriately and she knowledgeably showed the inspectors around the home and brought records, as accessible, for the inspectors to review. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 29 On the second day of the inspection it was clear from communication between Mrs Jessup, Mrs Holbrook and the deputy manager, that they all take an active part in the day-to-day management of the service. Mrs Jessup takes a personal interest in the day-to-day running of the service and accompanied residents and staff on the outing to Poole harbour. The home keeps complimentary letters. These speak very highly of the standard of service provided at Burwood, the care and sensitivity of staff members. The commitment to achieve high standards in the quality of care delivered are also reflected in audits which take place, which includes a monthly audit of accidents occurring in the home and details of action taken to prevent future incidents. Comment cards confirm that people think highly of the home. In response to the question, ‘What do you feel the care service does well?’ the following replies were received: Just about everything. (Relative) Looking after people individually. (Relative) Communicating with professionals and patients. Maintaining dignity of their patients. (Healthcare professional) General care and attention whenever needed. (Relative) Social, personal, medical and emotional care. (Relative) Caring towards clients. Organised care. Good professional standards. (GP) Good care is always given. Staff are very helpful and willing to help and assist. (Healthcare professional) Sensitive individual care. (GP) Excellent all-round. (GP) Everything. (GP) Mrs Holbrook says that, in order to protect residents, it is the policy of the home wherever possible not to have any involvement in their personal finances. Therefore those residents who are unable to handle their own affairs, or choose not to, have a relative or other representative to deal with their finances etc. Mrs Holbrook says that the home does not currently hold any monies on behalf of residents and she and Mrs Jessup also confirmed that they do not act as appointee for any residents living in the home. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, hoists and portable electrical appliances are regularly serviced and maintained. Training takes place in relation to aspects of health and safety in the service, including in- house first aid updates and moving and handling. The home has three hoists, which includes one stand aid. Pressure-relieving equipment is also in place, according to the needs of residents. However, during the first day of inspection, it was found that substances that could be potentially hazardous to health (such as bleach, ant killer powder, Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 30 lime scale remover and oven cleaner) were not always stored securely. The deputy manager took immediate action to remove these and place them under lock and key. In addition, the door to the cellar did not have a lock fitted, leaving it potentially accessible to vulnerable residents. Immediately behind the door, steep steps go down into the cellar and further supplies of potentially hazardous cleaning fluids, such as bleach, are stored on the steps. The deputy manager took immediate action to temporarily block access to the door and arranged to have a lock fitted the next day. On the second day of the inspection, all substances that could be potentially hazardous to health were observed to be securely stored and the cellar door was locked. Radiators do not have low surface temperatures and are not guarded to ensure residents cannot come into contact with very hot surfaces. However, risk assessments are in place to help ensure that residents are kept safe. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is arranged. Routine checks are carried out at appropriate intervals. Both in-house training and training from an external training provider takes place to ensure that staff are fully aware of the action to take in the event of a fire. The home has put in place a Fire Risk Assessment. The last visit from Dorset Fire and Rescue Service was in June 2007 and Mrs Holbrook confirmed that advice given has been complied with. The home has also completed a Smoking Policy. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 14(2)(a) (b) and 15(2)(b) (c) 12(1)(a) 13(4)(c) Requirement Timescale for action 31/10/07 2. OP8 3. OP9 13(2) All aspects of each resident s health, personal and social care needs must be recorded, regularly reviewed and updated, as necessary. Health care needs must be 31/10/07 clearly documented in each residents care plan, including meeting the individual needs of a diabetic resident or a resident requiring support with nutritional wellbeing. These should be sufficiently detailed to enable staff to meet all current and changing care needs. Additional documentation, such as fluid monitoring and dietary intake charts, must be in place where a high level of risk has been identified. The home must record 31/10/07 administration of topical creams and nutritional products and there must be an audit trail for medicines, which is monitored to ensure that they are given as prescribed and accurately recorded to safeguard residents. DS0000067456.V349331.R01.S.doc Version 5.2 Burwood Nursing Home Page 33 4. OP30 18(1)(c) 5. OP38 13(4)(c) 6. OP38 13(4)(a) and (c) The registered persons must ensure that all staff receive suitable training, appropriate to the work they are to perform and that this is fully evidenced in training records. The home must use approved lancing devices for blood testing to protect residents and staff from the risk of infection as per MDA alerts 2004/044 & 2006/066 at www.mhra.gov.uk. The registered persons must ensure that all parts of the home are free from hazards to resident safety. Vulnerable residents must not be allowed access to potentially hazardous substances or to the cellar. 31/12/07 30/09/07 30/09/07 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 It is important that clear wording in documentation provides a picture of care and support that all can understand. It is therefore recommended that medical abbreviations are not used. To ensure that prescribed medicines that are handwritten on the medicine record chart have been transcribed correctly a second nurse should countersign. The home should monitor the maximum and minimum temperature of the fridge used to store medicines. 3. OP10 It is recommended that residents be consulted about the use of glass vision panels in bedroom doors, as these potentially affect their rights to privacy and dignity. DS0000067456.V349331.R01.S.doc Version 5.2 Page 34 2. OP9 Burwood Nursing Home 4. OP28 It is recommended that 50 of care staff working in the home should hold a National Vocational Qualification (NVQ) in Care. Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Burwood Nursing Home DS0000067456.V349331.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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