Inspection on 24/04/06 for Butterley House

This inspection was carried out on 24th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 19/04/07

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 24th April 2006 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.V289187.R01.S.doc Version 5.1 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.V289187.R01.S.doc Version 5.1 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 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.V289187.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Plus Five (5) Day Care Places Date of last inspection 25th January 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 rooms, 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. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 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 6 hours. 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, the manager and 6 staff working at the home during the visit. The care records of 3 people who live at the home were examined in detail and they were interviewed along with 6 others and 2 visitors who were at the home during the morning. Since the last unannounced inspection of the home on the 9 November 2005 an additional inspection visit was carried out on 25 January 2006 to further evaluate progress with requirements made previously. What the service does well: What has improved since the last inspection? The proprietor has purchased a professionally produced system for recording care documentation and records and, together with the manager, is transferring all existing records in relation to residents into this new format. This will improve the quality of care practice by giving staff a more efficient mechanism to plan and review the care and support being given. Maintenance of the home’s environment has continued and all the requirements of the Environmental Health and Fire Officers have been carried out. The fitting of new carpets for the dining room and corridors has been planned and should be carried out soon. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 6 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. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 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.V289187.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users receive written information before coming to the home and are able to make decisions in advance about any permanent move. This includes a contract, which formally sets out the responsibilities and liabilities of all parties. The system for the assessment of needs has been improved and documentation modernised so that people can be reassured that the home will meet their needs. EVIDENCE: The home’s Statement of Purpose and Service User’s Guide have now been incorporated into a single document that fully complies with the law and is given to new residents and their representatives, confirmed by those spoken to. This will give them a clear picture of the home’s operation. A new the contract of residence has been prepared and this will particularly useful for people paying for their own stay at the home, as it will make the rights and responsibilities of all parties clear and explicit. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 9 The service user files examined contain a range of information that had been prepared at the time of admission and these have been improved so that specific care needs are looked at and areas of particular concern and risk highlighted. These include general assessments in relation to nutritional and moving and handling needs as well as specific assessments related to, for example, Parkinson’s disease and skin breakdown. Since the last inspection the proprietor has purchased a professionally produced document system that incorporates all of these assessments into an easily accessible format that should improve efficiency of recording and give staff a clearer idea of how they should support people living at the home. The programme of transferring information into this system has recently started and will be more fully evaluated at the next visit. The home does not provide an intermediate care service so Standard 6 does not apply. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The care of all residents, including health care, is planned and given in ways that respect individuality and privacy. The administration of medicines at the home requires some improvements to ensure that it is safely organised. EVIDENCE: As reported above the manager is in the process of introducing a new system of documentation for recording resident care, and this should eliminate the problems identified at previous inspections and improve the efficiency of the way that staff work. The staff spoken to who had looked at the files already updated commented that the layout of personal plans was easy to understand and a considerable improvement on the old ones. From discussion and examination of care records the health needs of residents are attended to and a number of specific areas are looked at during and after the admission period to the home. These include Parkinson’s disease, diabetes, mobility problems and falls, diet and nutrition, mental health and Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 11 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. The latter was visiting residents during the morning of the inspection. One resident spoken to described 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. 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 this to be 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. Some issues requiring attendance at the last visit had been dealt with by the manager but further work is needed to ensure complete safety and proper administration: A number of handwritten records were not signed or dated by the person writing the instruction. Patterns of non-administration were noted that indicated the timing of medicines needed reviewing, particularly in regards to night medicines when the resident was asleep. A number of instances of medicines being missed, lost or accidentally destroyed had not been fully recorded. There were no recordings of the temperature of the medicines refrigerator. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents at the home enjoy a life that they find satisfying with good contacts maintained with family and friends. Arrangements in the kitchen have continued to improve, and the quality of meals produced by the home’s kitchen staff is much appreciated. EVIDENCE: From discussion with residents, staff and management and examining records, reasonably active lifestyles are encouraged, and the appointment of an activities coordinator for two ½ days a week should see further improvements. Residents have also recently been able to air their views about activities and events at a residents meeting and this will be a way of making sure that this 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. Contact with families is encouraged through an ‘open door’ policy, and good numbers have been seen at the home during recent 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.V289187.R01.S.doc Version 5.1 Page 13 During a visit made to the kitchen and from discussion with the new cook 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. Arrangements for the afternoon tea have been improved following the residents’ meeting (mentioned above) and everybody spoken to was positive about the standard of meals served at the home. ‘ The meals are good with lots of home baking’ ‘I like most of the main meals and there’s always variety and choice’. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff and management of the home encourage residents to speak out about the care they receive and any concerns are dealt with promptly and satisfactorily. The management also makes sure that residents are protected from harm by the systems in place and by a programme of staff training and awareness raising. 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. A relative who had complained about arrangements in her father’s bedroom in the past also supported this. 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. ‘Staff are always helpful and tell me what’s going on. They like to know if I approve’. Good standards in relation to training staff about the abuse of vulnerable people have been continued and a senior member of staff, having completed a Social Services training course to become an approved trainer, now supports this. She will be responsible for regular updates for staff and general awareness raising, although there have been no instances or reports of any untoward incidents at the home recently. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Good standards of maintenance, cleanliness and hygiene of the home have been continued. The replacement of carpets is planned to take place in the near future. EVIDENCE: All the recommendations of the inspections carried out by the local Environmental Health and Fire Officers have been completed. Arrangements have been made for the replacement of all the carpets in the dining room and downstairs corridors and this major investment in the home was due to be completed soon after this inspection. 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.V289187.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not specifically looked at this inspection, other than to note that NVQ training for care staff was ongoing and the targets should be achieved by this summer and that the application form for employment now includes a comprehensive health questionnaire which will give an improved view of the candidate’s suitability to work at the home. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is well managed by 2 experienced people but formal arrangements to support and monitor staff activities are not in place. 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. Between them they now cover the management of the home over the full 7 days per week. Whilst the latter has completed the Registered managers award (RMA) at NVQ level 4 the former has not; this is required by the law but further discussions will be made to agree a suitable outcome. Both managers have a wide range of experience in the management of care homes and residents will benefit from the application of that experience. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 18 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. ‘The managers and seniors give lots of help on a day-to-day basis’. However more formal arrangements are not in place to meet with staff on a 1-to-1 basis and the opportunity to further support staff and monitor their work is being missed. Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 X X X Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 20 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 14 Requirement The registered person must introduce the new documentation that records the assessments of all resident needs at the point of admission to the home. (New timescale agreed to allow completion). The registered person must introduce the new documentation that records the care plans of residents and how their needs are being met, including identified risks. They must be kept updated and regularly reviewed and must show the involvement of service users/relatives. (New timescale agreed to allow completion). Handwritten instructions for the administration of medicines on the daily record sheets must be dated and signed by a responsible person. The manager must review the need for any medicines that are not being administered, with the DS0000019955.V289187.R01.S.doc Timescale for action 31/08/06 2. OP7 15(2) 31/08/06 3. OP9 13(2) 31/08/06 4. OP9 13(2) 31/08/06 Butterley House Version 5.1 Page 21 5. 6. OP9 OP9 13(2) 13(2) 7. OP19 16(2) 8. OP28 18(1) relevant medical practitioner. The record of temperatures of the medicines refrigerator must be maintained. Instances of medicines being missed, lost or accidentally destroyed must be fully recorded. The registered person must replace the carpet in the dining room and the adjoining corridors. (Previous timescale of 31/03/06 not met). The registered person must ensure that 50 of care staff achieve a minimum of NVQ level 2 by the due date. (Previous timescale of 31/12/05 not met) The registered person must reintroduce a system of formal supervision meetings for staff support and monitoring. 31/08/06 31/08/06 30/06/06 30/06/06 9. OP36 18(2) 30/08/06 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 OP12 Good Practice Recommendations The registered person should continue to review the arrangements for activities and social life at the home and consult with residents and their representatives about their wishes in this area of the home’s operation. Create a domestic appearance in the toilets and bathrooms. The home’s management should include discussions with staff and relatives within the annual planning process. 2. 3. OP21 OP33 Butterley House DS0000019955.V289187.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 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.V289187.R01.S.doc Version 5.1 Page 23 - 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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