Inspection on 19/04/07 for Butterley House

This inspection was carried out on 19th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Butterley House 24/04/06

Butterley House 25/01/06

Butterley House 09/11/05

Butterley House 06/07/05

Butterley House 22/03/05

Butterley House 29/06/04

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Butterley House Old Coach Road Ripley Derbyshire DE5 3QU Lead Inspector Brian Marks Key Unannounced Inspection 19th April 2007 09:00 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 Butterley House DS0000019955.V334322.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. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Butterley House Address Old Coach Road Ripley Derbyshire DE5 3QU 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) (01773) 745636 01773 748574 Mrs Patricia Diane Smith Ms Jean Fountain Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Plus Five (5) Day Care Places Date of last inspection 24th April 2006 Brief Description of the Service: Butterley House is a large detached building, which has been adapted and extended as a care home. The home is situated on the outskirts of Ripley, set back from the main road, bus route and local amenities, in a rural location. The home provides personal care for up to 37 people aged 65 years and over and is also approved for up to five day places. All bedrooms are single, the majority with en-suite facilities. The home is on two floors and access to the first floor is by stairs and a stair lift. The three lounge areas, conservatory and dining room are on the ground floor. On-site laundry services are provided. The home has well set out garden areas, which are accessible to service users. The current range of fees is £310 – £360 per week. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place at the home over a period of a day. Additionally, time was spent in preparation for the visit, looking at previous inspection reports and other relevant documents and preparing a structured plan for the inspection. At the home, apart from examining documents, care files and records, time was spent speaking to the proprietor, manager, deputy manager and 7 of the staff working at the home during the visit. The care records of five people who live at the home – two recently admitted and three established – were examined in detail and two of these were personally interviewed, along with five others and five visitors who were at the home during the day. In addition two completed resident surveys were returned before the inspection. Since the last Key Unannounced Inspection of the home on the 24 April 2006 a Random Unannounced Inspection visit was carried out on 18 October 2006 to further evaluate progress with requirements previously made. What the service does well: What has improved since the last inspection? During the Random Inspection in October 2006, good progress was noted with requirements made at the previous Key Inspection in April 2006, in particular with the ‘bedding in’ of new care planning documentation, reviewing care plans, management of medication, the fitting of extensive new carpets to ground floor corridors and dining room, recruitment practices and staff training. Since then this progress has been continued and the care records and files now serve as practical working documents that everybody can use to provide a safe and consistent care service. Similarly the records and Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 6 administration systems for managing medicines have continued to receive attention and these generally support a robust and safe service also. What they could do better: 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. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 7 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 Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 8 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 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Everybody living at the home has had their care needs assessed at the time they come to the home so that people can be reassured that the home will meet their needs. This is limited by not completely looking at and accounting for areas of risk in their lives. EVIDENCE: The new documentation for care planning and recording, introduced in 2006, is now in place for all residents and all of the files examined had ‘front sheet’ details completed and initial assessments of need. Whilst some of the files examined contained further completed assessments including specific risk assessments, this process had been left incomplete for most. The documentation format allows for easy description of areas of risk in relation to pressure sores, safe moving and handling and nutrition as well as a description of general areas of risk that may be present, but not using this has meant that staff could be failing to work safely with residents. Additionally some of the files examined contain assessments and descriptions of the social lives of the people being admitted, which gives a picture of the whole person and help staff Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 9 to care for them as individual ways rather than being focused solely on health and personal care needs. The home does not provide an intermediate care service so Standard 6 does not apply. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care of all residents, including health care, is planned and given in ways that respect individuality and privacy and, where appropriate, people living at the home are encouraged to be as independent as possible. EVIDENCE: All of the care records examined had care plans that described how staff support and help people at the home and, whilst those of the established residents described strengths and weaknesses in both physical and social areas, the latter had not been carried out for the new residents; the manager described this as taking place over a period of some weeks as they got to know the person. The care staff spoken to confirmed that these are now used by all staff to support their work and that the files are a much more useful and accessible tool to support their work than previously. Where the care plans identify key problem areas they link directly to the daily event records and all areas of care practice are evaluated on a two-monthly basis and revised where necessary. Not all indicated the resident’s involvement in the care plan process, to confirm accuracy and to indicate that they are individually aware of their contents. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 11 From discussion and examination of care records the health needs of residents are attended to; these include Parkinson’s disease, diabetes, mobility problems and falls, diet and nutrition, mental health and medical issues linked to possible skin breakdown. Residents are encouraged to retain their own GP if practical, and the manager reported good relations with local practices and District Nurses. One resident described how she continues to manage her diabetic problem in conjunction with kitchen and care staff, and another how she is assisted to keep up appointments at outpatient clinics, which helps with continuity of care. All residents spoken to, or their relatives, commented that staff care for them in ways that respect their dignity and privacy and this was underpinned by entries in the care plans examined. A number of residents spoken to spend a lot of their time in their rooms and this does not affect the levels of support they receive from staff; all said that staff respond promptly to the call system. The home operates the Monitored Dosage System for medicines management on behalf of the people living there, and the examination of records and storage areas indicated that this is generally satisfactory, with procedures followed that ensured safety and consistency. For example, the record sheet of each person contains their photograph to make sure that administration of the medicines is to the right person. Issues previously raised as requirements have been dealt with but the following were identified for further action to ensure complete safety and proper administration: The dispensing of one item of a person’s medication had not been written up for a number of days. The home has continued to use a secondary dispensing system used at home by a recently admitted resident, which could cause confusion for staff not fully acquainted with it. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents at the home enjoy a life that they find satisfying with good contacts maintained with family and friends, and the catering of the home is a service viewed very positively by them. EVIDENCE: From discussion with residents, staff and management and examining records, reasonably active lifestyles are encouraged, and the appointment of somebody to lead activities for two half days a week has seen some improvements in people becoming more involved. Residents have continued to enjoy the opportunity to air their views about activities and events at an irregular residents meeting, and this makes sure that the subject is regularly discussed. Routines around the home are quite flexible and people spoken to were quite clear about being able to please themselves around the home. ‘I make decisions about my own life here and can come and go as I please’. ‘I’m encouraged to independent’. Contact with families is encouraged through an ‘open door’ policy, and good numbers are regularly seen at the home during inspections. Some are very regular in their visits and support the care activities of the staff in practical ways. There is a weekly church service that is popular with residents. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 13 During a visit made to the kitchen and from discussion with the kitchen staff it was evident that improvements in the catering service have continued, with all the recommendations made at the last visit by the Environmental Health Officer dealt with, although the storage area for fresh fruit and vegetables had not been replaced and the nutritional value of meals had been reduced. Arrangements for meals are regularly discussed at the residents’ meetings (mentioned above) and individually with individual residents. Everybody spoken to was positive about the standard of meals served at the home. ‘The food is very good with the same standard throughout the week’. ‘The food is good and they cater for individual preferences – I don’t like fish’. ‘Meals are good with lots of home baking’. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 this service. The home responds to complaints made by residents and their representatives according to a written procedure, and aims to protect residents from harm. EVIDENCE: The home maintains records in relation to the concerns and complaints that are raised, and those that had been made recently had all been resolved satisfactorily. People are informed of the procedure for making a complaint within the information that is given out at the time of coming to live at the home and a copy is on display in the home’s entrance. Good standards in relation to training staff about the abuse of vulnerable people have been continued and the new deputy manager is an accredited trainer who will be able to continue this activity with regular updates for staff and general awareness raising. There have been no instances or reports of any untoward incidents at the home recently. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. 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 this service. Good standards of maintenance, cleanliness and hygiene of the home have been continued with only minor maintenance items noted. EVIDENCE: All the recommendations of the last inspections carried out by the local Environmental Health and Fire Officers have been completed. From a limited tour of the home and visits to selected bedrooms, the home has continued in a satisfactory condition although the replacement carpets in the dining room and downstairs corridors installed last year are showing a disappointingly high level of staining and wear and give a poor impression of the home. All the residents spoken to were happy with their bedroom areas and particularly those with ensuite facilities and those who are wheelchair users. There were some items of maintenance noted that reduce the quality of the environment for residents, but the manager reported that these were in hand for attention: A radiator in the dining room was partially fitted to the wall. The chest of drawers in one bedroom was not fully functional. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 16 The communal areas and bedrooms of the home visited during this inspection were clean and tidy and free from odours. Residents spoken to had no complaints about the laundry service of the home and all residents observed in the home wore clean and well-presented clothing. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of residents are met by a group of staff who are selected by a robust recruitment system and who are on duty in good numbers. In the past year they have been given a good standard of training and development opportunities which is aimed to improve the standard of their work. EVIDENCE: Examination of the staff rota indicated that the number of staff on duty was to the level previously agreed, and that agency people are not used at the home to cover gaps; this is done from within the staff group itself. At the time of the inspection there was a vacancy for a full time carer post which was being advertised, but both staff and residents reported that the levels of staff on duty were satisfactory and that workloads were generally not excessive; staff have time to give individual attention or to just sit and chat, which is what residents enjoy the most. Examination of the personnel file of the most recently recruited member of care staff indicated a satisfactory system now being employed for recruiting new staff and the checks in place make sure that the right people are employed. The manager and the staff spoken to reported regular opportunities for staff development and training and most of the key areas have been covered, including moving and handling, fire safety and issues around the protection of vulnerable adults. Additionally all staff have undertaken an extensive programme in relation to understanding and working with people who have Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 18 dementia. The content of the revised induction given to new staff is provided by a training agency; it has only been used a small number of new staff so its’ effectiveness had not been assessed yet. Examination of staffing records indicated that the 50 target for achievement in the National Vocational Qualification training has now been achieved and nearly all staff have completed or are now enrolled on this. The levels of staff activity in this area is designed to improve the quality of their work and all those spoken to showed a strong commitment to working in professional and committed ways. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 19 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, 36and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in administration and management of the home have continued to be made to the benefit of staff and residents, and the safety of everyone is maintained within the working and living environments. EVIDENCE: The home continues to be operated on a day-to-day basis by the registered manager with the very ‘hands on’ support of the proprietor and recently by the appointment of a deputy manager. Between them they now cover the management of the home over the full 7 days per week. Both managers have a wide range of experience in the management of care homes and the new deputy has also been a registered manager herself, and residents will benefit from the application of that experience. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 20 As part of the process for monitoring the quality of the services provided at the home, a number of questionnaires to survey the views of residents and relatives have been used with an ongoing programme of sampling two or three every month. Additionally, the Annual Plan for the home has been reviewed and a new one prepared, which indicates an increasingly professional approach of the home’s management to organising its future progress. Examination of other records and self audits by the manager indicated a satisfactory system for the management of resident spending money, and that standards of Health and Safety activity are good. From discussion with staff it was evident that daily involvement of both the registered manager and proprietor in the running of the home offers staff good levels of informal support and help with problems as they may arise. A formal system to meet with staff on a 1-to-1 basis has been revived but this is irregular for most staff and does not meet the target required by law and reduces the opportunity to further monitor their work. Staff reported that morale was good within their team and residents and visitors alike reflected this in their comments; the overall impression of life and work at the home is a positive and happy one. ‘You can talk very confidentially with them; they are friends as well as managers’. ‘It’s a very supportive environment here and the happiness of the staff reflects on the residents’ ‘Generally the home is well run with no major concerns’. ‘It’s a very well run place and she seems much happier here and to have settled well’. ‘I had a problem and the manager sorted it out straight away. Everybody is so friendly and relaxed’. Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 21 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 13(4) 14(1,2) Requirement Timescale for action 31/08/07 2. OP9 13(2) 3. OP15 16(2)(i) 4. OP19 23(2) All people coming to the home must have all of their care needs examined, particularly those hazardous areas of their lives that create risks. Ways in which staff can work safely must be indicated and these aspects of people’s lives must be looked at regularly or as circumstances change so that staff are always working with up to date information. (Re-written from inspection dated 18/10/06). All medicines managed on behalf 31/05/07 of people living at the home must be dispensed from the original packaging so that the responsible staff have clear instructions to work from and they do not give out the wrong items. Arrangements for storage of 31/05/07 fresh vegetables and fruit must be reviewed so that that the quality and nutritional balance of meals is maintained. The items of maintenance listed 31/05/07 in the body of the report must be DS0000019955.V334322.R01.S.doc Version 5.2 Butterley House Page 23 attended to so that residents can fully enjoy the facilities of the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP15 OP19 OP21 OP30 Good Practice Recommendations Arrangements for storage of fresh vegetables and fruit should be reviewed so that The condition of the carpets should be improved in order to give residents a positive impression of the home. Create a domestic appearance in the toilets and bathrooms. The organisation and impact of the staff’s induction training should be assessed for its effectiveness and more closely monitored so that staff are better prepared for the work they are to carry out. The manager should develop an annual written programme planner for staff supervision to enable proper management of this activity and for the required number of individual sessions to be achieved. 5. OP36 Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Butterley House DS0000019955.V334322.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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