Inspection on 25/06/07 for The Burnham Nursing and Residential Home

This inspection was carried out on 25th June 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

The Burnham Nursing and... 27/12/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Burnham Nursing and Residential Home 19 Oxford Street Burnham-on-sea Somerset TA8 1LG Lead Inspector Shelagh Laver Unannounced Inspection 09:30 25th June 2007 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 The Burnham Nursing and Residential Home DS0000069138.V339163.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. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Burnham Nursing and Residential Home Address 19 Oxford Street Burnham-on-sea Somerset TA8 1LG 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) 01278 781757 danielja@bupa.com ANS Homes Limited Mrs Jacqueline Ann Daniells Care Home 80 Category(ies) of Old age, not falling within any other category registration, with number (80), Physical disability (80) of places The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (N) to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE)-maximum 11 Physical Disability (Code PD)-maximum of 5 The maximum number of service users who can be accommodated is 76. 11 persons with dementia to be accommodated on the Kingfisher wing only. May accommodate up to 5 persons from the age of 30 years who have nursing needs by way of physical disability. 2. 3. 4. Date of last inspection This is the first inspection for this registration. Brief Description of the Service: This established home has been re-registered since 31/12/06. The Burnham Nursing and Residential Centre is a large care home owned by BUPA. The registered manager is Mrs Jackie Daniells. The home is located in a converted school and chapel forming a three-storey building. The home is divided into three units. Two are for people requiring nursing care, Sandpiper/Kingfisher and Nightingale. In April 2007 the Kingfisher unit was registered to provide care for 11 people with dementia. A senior nursing sister manages each unit. A residential manager manages the top floor; the Rookery with provides personal care only. Each floor has its own dining room and sitting room. The seafront is within walking distance for more mobile residents. All rooms have en-suite facilities of toilets and hand basins. 57 rooms also have a bath or shower. There are two activities co-ordinators who organise a weekly programme of social events. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 5 Fee range The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This is the first Key Inspection of the service following its new registration on 31/12/06. This inspection consisted of two visits. On 25/06/07 two inspectors visited for six and a half hours. Particular attention was paid to the Dementia Care Unit (Kingfisher) registered on 4/04/07. In total there were 70 service users in the home. There were 9 people in the Kingfisher unit, 7 who had a primary diagnosis of dementia. The inspectors discussed the Annual Quality Assurance Assessment document submitted prior to inspection and requested to view documents that verified the statements made in it. On the 2/07/07 two regulation inspectors and the pharmacy inspector made a further visit. While the focus of the inspection was the parts of the home not previously reviewed in depth, an up-date on the previously required action taken to change practice on the dementia care unit was reviewed. Comment cards were sent to people in the home and their relatives. Fifteen replies were received. Staff were also sent questionnaires. Ten responses were received. Following the departure of the Lead Nurse (RMN) on the Kingfisher Unit and the concerns regarding care practice there, the home is not currently admitting people with a primary diagnosis of dementia. On 28/06/07 the Commission received complaints from staff recently recruited to the home. The investigations surrounding the complaint have resulted in requirements relating to the protection of staff and residents in the home. What the service does well: Service users who returned comment cards to CSCI confirmed that they always (11) or usually (4) received the care and support they needed. All comment cards recorded that people felt staff listened to and acted upon what was said to them. Comment cards stated that 8 people felt staff were always available when they were needed and 7 said they were usually available. Responses confirmed that medical support was always or usually available. The inspectors spoke to relatives and people in the home during the inspection who were pleased with the care provided and found staff to be kind and caring. Relatives spoken to during the course of the inspection talked of the kindness of staff and the good care provided to their relatives. One comment was “My family and I have nothing but praise for the care, support and attention given by all the staff to myself and my family.” The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 7 People seen in the general nursing and residential areas appeared clean and comfortable. There was evidence of sufficient specialised equipment in the home. Staff spoken to were positive and helpful and were observed interacting with people in ways that promoted dignity and well-being. There are regular review meetings with relatives and service users. What has improved since the last inspection? What they could do better: The concerns about the home focus on the following areas: The registration of the eleven-bedded dementia unit on 4/04/07 was made subject to appropriately trained staffing. The Registration report states “Staffing for the unit will be separate once registration is in place. Registration is dependent on employment of a Registered Mental Nurse to manage the unit. It is also dependent on allocated care staff and registered nurses being trained in dementia care awareness.” The inspection of the unit on 25/06/07 showed that although an RMN had been appointed he had recently resigned. The commission had not been made aware of this. The practices in the unit on that day demonstrated a lack of specialist knowledge of the care of people with dementia. At the second visit the nurse in charge of the unit was a bank nurse with no recent training of dementia care. Care staff spoken to were kind but demonstrated little awareness of the needs of people with dementia. Currently staffing for the unit is included in the general staffing rota so it was not possible to see who was working on the unit on a day–to-day basis. The manager agreed dementia care was not her area of expertise and yet did not seem able to acknowledge the need for a team of trained staff. The local mental heath team has also raised staffing issues and concerns regarding the inadequate care of one servcie user. Again the registered manager seemed not to recognise the importance of the specialist skills needed to care for people in this unit. The registered manager addressed health and safety issues in the dementia unit, such as the storage of dental cleaning tablets disposable gloves and hand washing materials seen on 25/06/07 immediately. Care plans were reviewed and up-dated on the unit between the two inspection visits. There remain concerns about the levels of staff skill on what is intended to be a specialist unit. The home has agreed not to admit further people to the unit until suitable recruitment and training has been undertaken. The arrangement, observed during inspection, where four people without dementia were sleeping in the unit but came across to another dining room The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 8 and sitting room during the day, was most unsatisfactory. In addition these people were spending long periods of time in wheelchairs. During the course of the inspection a concern was received from recently appointed overseas staff about their conditions of employment. Subsequent investigations showed that people without an appropriate POVA and CRB checks were accommodated in registered bedrooms adjacent to service users. These people were free to enter and leave the building at will and this resulted in at least one late entry to the home. In addition these staff were not provided with adequate facilities so had to have access to service users showering and bathing provision. The policies and procedures relating to staff induction and management of overseas recruitment must be amended in order to ensure that other staff and people in the home are protected at all times. The induction period for new oversees staff should also be reviewed to provide a managed positive experience. The AQAA stated that there is a “BUPA Care Homes Personal Best” scheme in place. This was not the case. The AQAA states, “We have provided a private secluded and secure garden for the enjoyment of residents in the newly created dementia unit.” This is not in place and work has not yet commenced. Attention should be paid to the management of personnel records. It is not easy to track all training undertaken. Appraisals and supervisions need up dating. 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. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 9 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 The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 5 6. Quality in this outcome area is adequate. The assessment and admission procedures for the nursing and residential units are sound however people have been admitted to the Kingfisher unit when their needs could not be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Service User guide. There is a welcome pack in each room. A pre-admission assessment is carried out on potential people for nursing and residential care placements. Those observed in care plans were undertaken thoroughly by appropriately qualified people and included visits to hospital and additional information where needed. People and their relatives can visit the home prior to admission. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 11 There is currently no one qualified to assess people with dementia care placements. There are people in the Kingfisher unit whose needs were not fully met during the inspection period. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 11 Quality in this outcome area is adequate. The health and personal care in the nursing and residential units is good however there is a need to improve care in the Kingfisher unit. People are placed at risk through some of the medicine recording practices in use at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Eight care plans were examined over the two days of the inspection, sampling plans for all areas of the home. Those on the nursing and residential units showed evidence of clear planning and evaluation. They showed individual needs and overall gave clear instructions for care. There was a need for an up-date on the assessment of pressure damage risk as in some plans the assessment of Waterlow scores appeared low. Staff were clear about their responsibilities with regard to monitoring fluid and turn charts. There was evidence that some wounds had The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 13 been good and managed effectively. There was evidence that people accessed services from other healthcare professionals. One care plan showed care of a person at the end of life. There was evidence of attention to pain relief and the involvement of family in the home. In two care plans there was evidence of weight loss clearly recorded but no plan of action to be taken to try and correct this. On the first day of the inspection examples of poor care were observed on the Kingfisher unit. People were observed to be agitated and seemed to spend long periods of time alone. Where people had behavioural problems there was no evidence of understanding of these or plans for effective management. People spent many hours in wheelchairs without care plans to prevent pressure damage. Overall the plans were reflective of the poor level of understanding of dementia care at the time of the inspection. In some care plans the BUPA “map of life” designed to give “greater insight into residents previous lives and help staff implement activities” had not been completed. The home is implementing a new system of care planning called “Quest” in the autumn and training had commenced. The pharmacy inspector undertook a medication inspection on the second day of the inspection. We found that the home have clear records for the administration of anti -coagulant medication. They also have clear records for the application of creams and ointments and for the administration of nutritional supplements. We found that the use of abbreviations in the dose of insulin was not in accordance with current good practice guidance and had the potential to place people at risk of being given an inappropriate dose. We found that for one service user medication had run out, although we did find evidence to demonstrate that the home was making efforts to obtain further supply. We found that for some analgesic liquid medicine it was not possible to determine the date of expiry. We found that both tablet controlled and diet controlled diabetics were having regular blood glucose monitoring performed. However there was no reference to this in the care plans for these people and also no agreed diabetic care plan. We also found that many of the dressings in the first aid boxes were date expired. We found that although the temperature of the medication fridges is well controlled and monitored, it was not possible to see how well controlled the temperature of the first floor medicines storage areas was. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. The home tries to be flexible and attempts to provide a service that is as individual as possible. The food in the home is of satisfactory quality, well presented and meets the dietary needs of people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some people in the home are frail and poorly. People were seen resting comfortably in their beds. People spoken to described a variety of ways in which they spent their day. Some preferred to stay in their rooms others were in the communal rooms. An inspector observed an art group and heard about the other activities that included musical activity with instruments and bingo. Bazaars and coffee mornings are held to fund raise. Once a month outside entertainers are booked. There are a few trips out including to an animal sanctuary. There is The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 15 some opportunity for 1:1 contact that enables personal needs such as letters to be read. There is an active Christian community in the home and there is a morning service in a dedicated room. Other services are held monthly. Most people were satisfied with the food. The menu has been extended in order to give a wider choice. There is a Nite Bite menu advertised so that people can have a snack between supper and breakfast. Some people wanted more fresh vegetables. On the Kingfisher unit meals are brought already plated up. It was not clear how people made a choice and the inspectors were concerned about the temperature of meals served. At the end of the second day of inspection it was sad to watch one person struggling to maintain independence and eat her supper. She was seated in a lounge chair with a table far too high to have been of assistance. Planning and consideration would have enabled this clearly independent lady to maintain her dignity and enjoy her supper. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is poor. The implementation of recruitment policies does not protect service users from potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an Overseas Recruitment Policy that states, “Accommodation for the first month will be sourced by the Home manager. This could potentially be within the Care Home, B&B, with a staff member or shared accommodation.” Accommodation in the home on this occasion for three staff was in registered bedrooms on the ground floor and top floor of the building. The staff were able to come and go as they chose and on at least one occasion entered the home late at night. As they were waiting for POVA and CRB checks to be returned they were unable to work and there was no clear plan of training in place. The company policy makes it clear that it is the Home Manager who is responsible for the safe implementation of this policy. There were no complaints recorded. The home should be aware that it is good practice to record issues raised by families that are addressed by the management. There was evidence of compliments received from relatives pleased with care their families had received. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 17 Comment cards indicated that people knew who to talk to if unhappy and how to make a complaint. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is adequate. The layout of the home enables people to live in a safe well-maintained and comfortable environment. There is a need to develop appropriate outside spaces and to review the use of one communal room. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is large and there is a 5-year rolling programme of planned works. Substantial maintenance work has been undertaken on the roof and windows. The home is clean and well maintained. Communal areas are decorated in a homely manner. Bedrooms have en-suite facilities and bathrooms were clean and well equipped. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 19 During the inspection people were observed in the lounge on the Sandpiper unit. Some people spent a long time in wheelchairs. This is a difficult room to use as one end has poor natural light and no outlook. It is important to ensure peoples’ comfort is regularly reviewed and that adequate staff input is available. Further enhancement of the Dementia Care Unit is required to meet with upto-date good practice recommendations in dementia care. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is adequate. There are policies and procedures in place to ensure recruitment protects service users but there is insufficient evidence to confirm these are always followed. Induction and training is taking place however record keeping should be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are comprehensive human resources policies and procedures to ensure effective recruitment and staff management. In the six staff files examined there were parts of the recruitment process not recorded. For example in one file there was no evidence of occupation after 1988. Interview records not signed or dated and are sparse. The manager had discussed issues at length with at least one employee but there were no records. There was no record of supervision meetings for the RMN employed to run the dementia unit and no evidence that goals had been set or monitored. One applicant had no experience and a reference that might indicate The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 21 unsuitability for care but there were no notes of why the appointment had been made. It was difficult to track appraisals and supervisions. The last appraisal in one file was December 05 and in another no record could be found. No areas on Induction records for two newly appointed staff had been signed off by a senior staff member yet the staff were part of the minimum staffing levels for the next day. One of these staff had no previous care experience, the other had not worked in care of a number of years. Staff spoken to were able to describe recent training courses that they had been on. Nurses had undertaken appropriate skills courses such as syringe drivers and catheterisation. Staff had undertaken in-house fire training. There is a spreadsheet that records training but this is in progress of being fully developed. Although the home is large and has many staff it is important that accurate records are kept of all training. Current records show fire lectures and National Vocational Qualifications at a glance. It was more difficult to find out who had undertaken POVA training. 43 of permanent and bank care staff have NVQ 2 or above. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 22 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 32 33 34 35 36 37 38 Quality in this outcome area is adequate. The manager is qualified and experienced. The home has a system of planned maintenance and health and safety monitoring. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is Jackie Daniels who has been at the home for twelve years and holds the Registered Managers award. At this inspection there was evidence that some areas of the home needed more direct management to ensure positive safe outcomes for people in the home. There are several ways in which the home seeks the views of the residents. Quarterly meetings are held where people can express their views and recorded minutes can be acted on. The manager has informal review meetings The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 23 with families. Notes of meetings are kept and signed by all parties. There is an annual quality assurance questionnaire. There is planned servicing and health and safety management by designated staff members. The staff team are supported by company staff with monitoring and advice. Records of peoples’ finances are recorded and kept safely. Records are held safely by administration staff. During the first day of the inspection a number of health and safety issues were identified on the Kingfisher unit. Disposable gloves, denture cleaning tablets, plastic bags and creams were stored on open shelves. They were removed immediately and stored safely by the manager. A comprehensive environmental risk assessment is required for this area. The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 3 3 2 3 3 The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 25 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 OP27 Regulation 18(1) Requirement The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home as are appropriate for the health and welfare of service users. (This applies to staff working on the Kingfisher Unit.) The registered person shall ensure that at all times a suitably qualified registered nurse is working at the care home. (This applies to the Kingfisher unit.) The manager must ensure that home recruitment policies are followed and that practice protects service users. The registered manager must ensure that at all times service users are protected from possible abuse. Specifically by the management of people who have access to the home. The registered person must ensure that proper provision is made for the health and welfare of service users. (This applies DS0000069138.V339163.R01.S.doc Timescale for action 01/09/07 2. OP27 18(3) 01/09/07 3. OP29 19(1) 01/09/07 3. OP18 13(6) 01/09/07 4. OP8 12(1) 01/09/07 The Burnham Nursing and Residential Home Version 5.2 Page 26 5. OP9 13(2) 6. OP9 13(2) particularly to people on the Kingfisher unit.) Hand written entries on the 13/08/07 medicine administration record charts must be clear and unambiguous to ensure that people are not given an incorrect dose. For all people having their blood 13/09/07 sugar monitored there must be a care plan in place to indicate the range being looked for and the actions to be taken if outside this range 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 OP36 OP15 Good Practice Recommendations The manager should ensure appraisals and supervisions are up-to-date and clearly recorded. The registered manager should ensure that staff are aware of the ways in which people can be assisted to eat their meals with dignity and independence. There should be a review of the way in people use the Sandpiper lounge including length of time spent in unadapted wheelchairs and staff time. There should be a training up-date for staff on the assessment of risk and prevention of pressure damage, the management of weight loss and the psychological care of people. This training should be clearly linked to expected outcomes for people. It is recommended that the home develop a system for the monitoring of expiry dates for all medicinal products. OP12 OP8 3. OP9 The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 The Burnham Nursing and Residential Home DS0000069138.V339163.R01.S.doc Version 5.2 Page 28 - 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. 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