Care Home: Burkitt Nursing Home

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What the care home does well The preadmission process ensures people`s needs are fully assessed prior to moving into the home, so that staff have information to enable them to meet needs. In the survey forms that people returned to us they told us that care needs were met. Comments from people living in the home included: "Good care", "They care for my needs". Meals are enjoyed and care is taken to prepare food to meet individual needs and preferences. Any complaints or concerns are taken seriously with clear records kept. The premises are kept clean. Trained and competent staff are provided and we received several positive comments about the current staff: "I never have to worry about my mother`s welfare as she is so well cared for by the staff." "I feel the staff always do the best they can." "The care staff are always friendly and make me laugh." A system is in place to monitor the quality of care and, overall, the home is run in the best interests of the people living there. What has improved since the last inspection? A Care Plan is in now place for people as soon as they are admitted to the home and there are also detailed risk assessments so that staff have directions to meet each person`s specific needs. Meal arrangements have improved and kitchen staff have details of people`s individual needs, including diabetic diets, supplements, allergies and favourite foods. After the last inspection visit we required that the damaged wooden tray tables be removed as they posed a risk of infection. On this visit we found none of these in the lounge as they had been replaced with nesting tables. People were pleased with the new flooring that had been laid in the reception hall. Outside there was a garden area and some people had been helping to plant flowers and herbs in the new raised bed. What the care home could do better: They should make sure action plans are included to meet communication needs for all people who live in the home and, where appropriate, specify how hearing aids are to be monitored. An additional activities worker would help to enable a more flexible and comprehensive activities programme to meet individual needs and preferences. Following this inspection the manager sent confirmation about a revised procedure put in place that stated that qualified nurses need to ensure shifts are not left uncovered. There were plans for an on call system to make sure a staff member is available to cover absences at short notice. This should help to ensure there are always enough staff to meet people`s needs. Key inspection report Care homes for older people Name: Address: Burkitt Nursing Home 41-47 Melton Road West Bridgford Nottingham NG2 7NE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Meryl Bailey     Date: 2 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Burkitt Nursing Home 41-47 Melton Road West Bridgford Nottingham NG2 7NE 01159814046 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr David Hetherington Messenger care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Mr David Hetherington Messenger is registered to provide personal and nursing care and accommodation at Burkitt Care Home for service users of both sexes whose primary needs fall within the following categories :- Old Age, not falling within any other category (OP) 55 One named service user shall be accommodated at Burkitt Care Home within category Physical Disability (PD). One named service user under the category PD named in the variation application number V38564 dated 8th February 2007 can be accommodated at Burkitt Care Home. One named sevice user under the age of 65 years, named in variation application number V39491 dated 7th March 2007, can be accommodated at the Burkitt Care Home. The maximum number of service users to be accommodated within Burkitt Care Home is 55 Date of last inspection 0 7 1 0 2 0 0 8 0 Over 65 55 Care Homes for Older People Page 4 of 24 Brief description of the care home The Burkitt is a care home registered to provide both nursing and personal care. The home is a converted and extended detached property, with bedrooms on the ground, first and second floor. There are 2 passenger lifts, which facilitate access to the upper floors. 11 bedrooms have en-suite toilet facilities. Some rooms were previously shared, but now provide spacious single accommodation. There is a large lounge and small dining area on the ground floor and further sitting areas around the building. The home is situated in West Bridgford and is convenient for public transport into Nottingham City. The centre of West Bridgford is also close by which offers facilities such as shops, cafes, a library and public houses. There is an enclosed garden to the rear of the property. The weekly accommodation charges range from £345 to £550 per week. Further information about the home and a copy of the last inspection report is available at the home. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people and their views on the service provided. This process considers the providers capacity to meet regulatory requirements and minimum standards of practice and it focuses on aspects of service provision that need further development. We reviewed all of the information we have received about the home since the last report of our key inspection in October 2008. We used questionnaires to allow people who live in the home, their relatives and staff to make comments anonymously. We did the inspection visit with one inspector. It was unannounced and took place on one day during the daytime. One method of inspection we used is called case tracking which involves us choosing a sample of people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We looked at five peoples records. A tour of the premises included communal areas in use, bathrooms and some bedrooms. We also looked at recruitment Care Homes for Older People Page 6 of 24 records to find out if checks were carried out before new staff started working at the home and other records to see if staff were appropriately supervised and supported. We have taken account of all the information we have received about the home since the last inspection. This includes the Annual Quality Assurance Assessment (AQAA), which the registered manager is required to complete to identify from their own quality monitoring what the service does well at and what they need to improve on. The AQAA form was returned before the site visit and was used to plan the site visit and to support judgements made in this report. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: They should make sure action plans are included to meet communication needs for all people who live in the home and, where appropriate, specify how hearing aids are to be monitored. An additional activities worker would help to enable a more flexible and comprehensive activities programme to meet individual needs and preferences. Following this inspection the manager sent confirmation about a revised procedure put in place that stated that qualified nurses need to ensure shifts are not left uncovered. There were plans for an on call system to make sure a staff member is available to cover absences at short notice. This should help to ensure there are always enough Care Homes for Older People Page 8 of 24 staff to meet peoples needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The preadmission process ensures peoples needs are fully assessed prior to moving into the home, so that staff have information to enable them to meet needs. Evidence: The Service User Guide was available in reception. A new person confirmed that sufficient information was given before moving in. We looked at the files of five people altogether and each had a full assessment of needs. Information was detailed including previous history and identified needs and risks. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are well met and people receive their medication safely. Evidence: We looked at the care plans for five people. They seemed to be sufficient in detail and comprehensively covering all identified needs. However, during inspection we noticed that one person had problems with a hearing aid that was not working. When alerted to this one of the staff immediately replaced the battery. This person still depended on lipreading. We found nothing about communication or hearing aid care in the care plans for this person. Otherwise the files gave clear records of regular health checks with monitoring as needed for pulse rates, blood pressure and weights blood sugar levels on one. There were detailed risk assessments related to: pressure sores, nutrition, falls, manual handling, medication, and infections. All care plans had been regularly reviewed on at least a monthly basis. One person had recently moved into the home and the care plan was in place with sufficient information for staff to meet care needs. Staff had recorded daily notes of the care given and we saw charts of care and attention given to people looked after in bed. One person told us that staff knock Care Homes for Older People Page 12 of 24 Evidence: before they come into the room and give regular attention to prevent pressure sores. A pressure relieving mattress was also in place. There were also records of all visits from doctors and other health professionals. We observed a nurse administering medication at lunchtime and she was following appropriate procedures in handling and recording what she gave to people. She kept the medication secure at all times. The manager was aware of gaps in recording one of the medicines due to her own monitoring of the Medicine Administration Record Sheets. She assured us that action is taken if nurses have not completed these in full. In the survey forms that people returned to us they told us that care needs were met. Comments from people living in the home included: Good care, They care for my needs and one relative told us the home, treats residents according to their physical and emotional requirements as individuals. There were no negative comments about the care given. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy the activities that are provided, but would benefit from further attention to their social needs. Meals are enjoyed and care is taken to prepare food to meet individual needs and preferences. Evidence: The activities worker was present for four hours on day of inspection and this covered the lunchtime period, which meant the time spent providing activities with people was limited. She told us she was only available to work for twelve hours each week. The manager told that more hours were available, but no one else had been recruited. We observed a group word game, which people enjoyed and one person told us about regular card games. The activities worker told us about food tasting for Harvest Festival week and plans for a bonfire night party. There were records of activities that people had taken part in. In completed surveys some people told us they enjoyed the activities, but others said more were needed. Some staff and relatives also commented about activities, for example, I think the home could be better by taking the residents out more. and I would like to see more activities and trips out for the residents. The activities worker told us that it was intended to develop social histories to better establish peoples interests and social needs. Care Homes for Older People Page 14 of 24 Evidence: Lunch was salad or meat stew potatoes and green beans. Three care staff were helping with the meals whilst the nurse administered medication. One group said they had been waiting at the dining table from 11.35 to 12.15 for their lunch, but they thoroughly enjoyed the food. The cook on duty had details of peoples individual needs and preferences and she was developing the file for this to make sure it was complete for everyone. It included diabetic diets, supplements, allergies, favourite foods. There were hazard analysis sheets to clarify what action was needed, for example food to be cut up. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that any complaints or concerns taken seriously and people are safeguarded from abuse. Evidence: Some people living in the home were not aware of how to make a formal complaint, but they told us they would raise concerns if they needed to with senior staff at the home. Relatives were aware of the complaints procedure and we saw a copy in the reception hall. There were records of complaints received and investigated. Of the three complaints received during the past twelve months, one was upheld. There have been concerns raised with the Commission about staffing levels and this is detailed in the staffing section of this report. We saw records of staff training in Safeguarding Adults and this had been carried out since the last inspection. We also saw records of thorough checks carried out before staff started work at the home. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are fit for the purposes of meeting the needs of people living there. Evidence: We made a tour of the communal areas and a sample of bedrooms. All areas appeared clean and adequately maintained. 27 people were currently accommodated in bedrooms on three floors. Two passenger lifts were available and in good working order. The maintenance book showed that maintenance problems had been dealt with within a week. After the last inspection visit we required that the damaged wooden tray tables be removed as they posed a risk of infection. On this visit we found none of these in the lounge as they had been replaced with nesting tables. People were pleased with the new flooring that had been laid in the reception hall. There were domestic staff working every day and cleaning was ongoing during the inspection. Outside there was a garden area and some people had been helping to plant flowers and herbs in the new raised bed. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Trained and competent staff are provided to meet peoples needs efficiently. Evidence: Since the last inspection the Commission had received anonymous information on three occasions about there not being sufficient staff on duty and this was found to be due to staff sickness at short notice. On the day of this inspection there were 27 people currently living in the home and 14 of those had nursing needs. The planned staffing rota showed one nurse available at all times with four carers in the mornings and three carers in the afternoons. There was one nurse and two carers each night. The working rota for the day of inspection had been changed to cover staff sickness. We monitored staff response times to call alarms and these were two to three minutes. People told us that they never waited long when they used the alarms. The recorded rota for Thursday 24 September 2009 showed there were just three care staff working in the morning and two in the afternoon. Also, on Friday 25 September 2009 and on Sunday 27 September 2009 there were only two care staff in the afternoon, but there was always one nurse on duty. The manager told us that that it was difficult to get staff to cover, though there was a procedure for nurses to try. Following this inspection the manager sent confirmation about a revised clear procedure put in place that stated It is the responsibility of the Qualified Nurses to ensure that all shifts are covered for the week ahead. Qualified staff need to ensure shifts are not left uncovered any more than two days ahead of shortage. And also An Care Homes for Older People Page 18 of 24 Evidence: on call system is in place and a staff member is placed on reserve for a week to cover sickness or absences. This should help to ensure there are always enough staff to meet peoples needs. There were positive comments about the staff in the survey forms that were returned. These included: I never have to worry about my mothers welfare as she is so well cared for by the staff. I feel the staff always do the best they can. The care staff are always friendly and make me laugh. Records of staff on duty all included evidence that two references were received and checks had been carried out through the Criminal Records Bureau prior to people commencing work. There were records of regular staff supervision meetings and Promoting Dignity and Respect was always included in the supervision agenda. There was clear evidence of nursing and care qualifications and confirmation as appropriate of permission granted to stay in the United Kingdom. Training records and certificates showed that since the last inspection staff had been trained in Safeguarding Adults, Health and Safety, Food Hygiene, Infection Control and Fire evacuation procedures. Some had been trained to Level 2 in the Managing and Safe Handling of Medicines. Most of the care staff had completed the National Vocational Qualification at level 2 in Care and some also had achieved level 3. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management procedures have developed so that the home is run in the best interests of people living there. Evidence: The manager is a registered nurse and registered with the Commission. She was present during the inspection. She had returned to us the Annual Quality Assurance Assessment in September, when we asked for it. This was comprehensively completed and gave us the information to help in planning the inspection visit and completing this report. We saw copies of quality questionnaires in reception and regular Residents meetings were held. As a result of listening to people who live in the home and their families, the manager told us they have improved communication with families when there are changes in peoples health. They have also improved the garden and menus. A senior manager visited the home on behalf of the provider on a monthly basis and we have received records of the last two visits. These show a thorough assessment being made on each visit. Care Homes for Older People Page 20 of 24 Evidence: We looked at arrangements for money held for people and found this was secure and signatures of two people were always recorded to confirm all transactions were accurate. There was a receipt book. There were records of regular temperature testing and all servicing of equipment was up to date. Also, staffing records showed that all safe working training was given to staff as needed. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Include action plans to meet Communication needs for all people who live in the home and, where appropriate, specify how hearing aids are to be monitored. Recruit a further activities worker to enable a more flexible and comprehensive activities programme to meet individual needs and preferences. 2 12 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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