Care Home: Burnham Lodge Nursing Home

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What the care home does well Burnham Lodge is a small nursing home in a quiet location. The home offers nursing care and support to older people in a homely environment. There is a committed staff team some of whom have worked at the home for a number of years. Visitors to the home again expressed their satisfaction with the service at the home. Regular visitors spend time in the communal areas and contribute to the experience of people living at the home by being present in the lounge. Staff are polite and helpful and all observed interactions were friendly and caring. The service has good relationships with the community health care professionals. What has improved since the last inspection? There has been significant investment in the premises. New windows have been installed throughout the home and a conservatory is being built to increase the amount of communal space available to people living at the home giving them a choice of where to sit. There has been redecoration and recarpeting of the lounge, which has greatly improved the presentation of the room. The plumbing has received attention in line with the requirements made by the Health and Safety Executive improvement notices. Hot surfaces have been guarded or altered and the Legionella risks in the pipe work and with hot water temperatures have been addressed. The bed rails have been adjusted and the homes maintenance staff are now conversant with the safety checks required. A chart with photographs was developed after the HSE inspection to show clearly how the bed rails should be fitted. Since the random inspection by the CSCI pharmacist oxygen has been moved to safer storage. The medications trolley has been changed and is stored safely in a cooler place. Fire safety on the stairwell has also been addressed since this inspection. Meetings have been held with people in residence, their relatives and the management of the home. This has improved the communication between all parties and has provided the opportunity for Mr Lingajothy to express his commitment to the provision of an improving and good service. The manager designate has made links within the health care community and with organisations to access information and training opportunities for staff. Training to update skills and for developing new skills has been planned and is underway for the registered nurses and care staff. Mandatory training plans are in place and a fire training lecture was held during the inspection day. Staff had an opportunity for hands on experience with the use and discharge of fire extinguishers. Attention has been given to the care plans to improve the monitoring of wound care. What the care home could do better: The recording onto a communal record of bowel actions is to be discouraged, this is not person centred or dignified. A request to change this was discussed with the inspection feedback and an email to the commission post inspection from the manager designate, confirmed that this would be addressed. Record keeping must be contemporaneous and accurate. Entries onto any nursing records must not be filled in retrospectively without regard for the accuracy of the entry. One example of poor practice was brought to the attention of the manager designate to investigate. Opportunities for activities have improved but must continue in order to develop a good standard of social care at all times and that reaches all people in residence. The goal must be for a meaningful social care programme that is tailored to meet the needs of all the individuals in residence. Staff must continue to update and achieve to a higher baseline of nursing skills. This will allow the service to deliver good standards of skilled nursing care at all times and the staff to achieve their individual continuing professional development as registered nurses. CARE HOMES FOR OLDER PEOPLE Burnham Lodge Nursing Home 147 Berrow Road Burnham-on-Sea Somerset TA8 2PN Lead Inspector Barbara Ludlow Key Unannounced Inspection 19th March 2009 10:20 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 Burnham Lodge Nursing Home DS0000064241.V374552.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. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burnham Lodge Nursing Home Address 147 Berrow Road Burnham-on-Sea Somerset TA8 2PN 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 783230 01278 781249 burnhamlodge@btinternet.com Elderly Medicare Limited Manager application for registration in progress Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Burnham Lodge Nursing Home DS0000064241.V374552.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- Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 23. 17th September 2008 Date of last inspection Brief Description of the Service: Burnham Lodge Care Home can be accessed down a long drive fronting onto the Berrow Road in Burnham-on-Sea. The service provides nursing care for older persons. The accommodation is homely and comfortable. The communal space is limited at present; on the ground floor there is a lounge and a small sitting area with a dining table for people to take meals. There are 17 bedrooms, 13 single bedrooms of which 6 have en-suite facilities and 4 double bedrooms, 1 of which has an en-suite facility. Access to the first floor is via a passenger lift that can take a wheelchair. The home has a large rear garden where a summerhouse is located. A conservatory for the house overlooking this garden is under construction. Meals are offered to suit the individual. There is registered nurse manager whose Registration with CSCI is in progress. A registered nurse is on duty over the 24 hours supported by care and ancillary staff who are experienced in caring for older persons. The fees at the last key inspection in 2008 were £620 - £655 per week (less free nursing care of £101 and privately funded people with higher rate attendance allowance have a further reduction of £67). Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This inspection was the second key inspection in the inspection cycle for 2008/09 due to the poor rating awarded to the service in September 2008. Since this time there have been two random inspection visits by CSCI, one was lead by the CSCI regional pharmacy inspector. There has been regulatory input from the Health and Safety Executive with follow up to monitor the improvements that were required. Surveys were distributed in September and six were returned. Eleven relatives were seen at the last key inspection. No surveys were distributed at this key inspection and five relatives were seen. The Annual Quality Assurance Assessment (AQAA) was completed in October 2008. This key inspection takes into account all information gathered and random inspection findings since the last inspection visit. This inspection found the home to be clean and fresh, there was a warm ambient temperature and no unpleasant odour was detected. Staff were all friendly and welcoming and the people living at the service and their visitors were seen and spoken with during the day. A tour of the premises was made and daily life was observed for people living at the home. The home was calm yet there was building work at the rear of the home to begin the conservatory extension. Visiting professionals were seen and spoken with. The inspection was well received. The manager, whose application for registration with the commission is in progress, was available throughout the day to support the inspection process. Lunch and tea meal times were observed; the food looked and smelled appetising. People asked said the food was ‘good’ and ‘very good’. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 6 Records were sampled and care plans were seen during the afternoon. The medication administration records were examined. The home owner, Mr Lingajothy came to the home during the late afternoon. Some time was given to discussion about the increased communal space and the development of the service. Mr Lingajothy has invested in considerable improvements to the home since the last key inspection. This inspection was positive and feedback was given to the Manager designate in the early evening at the conclusion to the inspection. What the service does well: What has improved since the last inspection? There has been significant investment in the premises. New windows have been installed throughout the home and a conservatory is being built to increase the amount of communal space available to people living at the home giving them a choice of where to sit. There has been redecoration and recarpeting of the lounge, which has greatly improved the presentation of the room. The plumbing has received attention in line with the requirements made by the Health and Safety Executive improvement notices. Hot surfaces have been guarded or altered and the Legionella risks in the pipe work and with hot water temperatures have been addressed. The bed rails have been adjusted and the homes maintenance staff are now conversant with the safety checks required. A chart with photographs was developed after the HSE inspection to show clearly how the bed rails should be fitted. Since the random inspection by the CSCI pharmacist oxygen has been moved to safer storage. The medications trolley has been changed and is stored safely Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 7 in a cooler place. Fire safety on the stairwell has also been addressed since this inspection. Meetings have been held with people in residence, their relatives and the management of the home. This has improved the communication between all parties and has provided the opportunity for Mr Lingajothy to express his commitment to the provision of an improving and good service. The manager designate has made links within the health care community and with organisations to access information and training opportunities for staff. Training to update skills and for developing new skills has been planned and is underway for the registered nurses and care staff. Mandatory training plans are in place and a fire training lecture was held during the inspection day. Staff had an opportunity for hands on experience with the use and discharge of fire extinguishers. Attention has been given to the care plans to improve the monitoring of wound care. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 8 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 Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Information about the service is available for prospective people enquiring at the home. Pre admission assessments are undertaken to ensure that care needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans that were sampled were checked for pre-admission assessment and these were seen to be in place. Visits to the home are welcomed and the first month from admission is considered to be a trial period. Contracts were sampled and were up to date. Two inventory lists were seen in the care plans sampled; neither was dated. Personal belongings and clothing change from admission over time. It is helpful Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 10 therefore to maintain accurate records of personal items from admission to the home with checks to update at intervals during a stay at the home. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. Care plans are in place and people are receiving a good quality nursing care service. Medication is appropriately stored and safely managed. People are treated in a dignified way and respectfully at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Daily life was observed at the home from mid morning to early evening. Throughout the day people were treated with kindness at all interactions with staff. Staff were helpful, polite and had respectful relationships with people and their families. Five care plans were sampled. The care plans contained personal and family information and details of the next of kin contact. Daily records were made and Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 12 risk assessments were in place for pressure sore risk, manual handling, nutritional risk, weight and bed rail risk, all were up to date and recorded. It was noticed that in the office a list is kept of weights and of bowel movements, it is not ideal to have communal records and this was discussed with the manager. A more dignified approach to individual record keeping within the care plan for each person is required. The single assessment process and reviews (SAP) from social services were seen on file. These documents had been obtained when people were assessed for admission. One visitor confirmed their involvement with the assessment and subsequent reviews. Visits from community health care professionals when made are recorded. The community nurse was seen when she called to give clinical supervision to the registered nurses with a clinical procedure. This was being undertaken after practical and observational tuition to ensure safe practice of a new nursing skill. The home has a link nurse who has received training from the specialist continence nurse advisor and now provides the link ‘in house’ for continence management and staff updating. Vision call attends the home to carry out regular eye tests if required. At the last inspection in September 2008 evidence was seen of recent annual optical checks and dental checks and these had been recorded. The store cupboard for nursing equipment and dressings was safely locked. The homes chiropodist visits regularly and people are seen every four or five months. Some people with chronic health conditions such as diabetes receive free chiropody care. The improvement with wound care mapping has been maintained since the last inspection. The home reported that there were no people suffering from pressure sores. One person was pleased to inform the inspector that their leg had recently healed. One body map with an entry was undated making it difficult to judge the relevance in time of the entry; another was seen that was clearly dated. The storage of medication was seen, there have been changes since the CSCI pharmacist inspection, the trolley is now stored in an office and in a cooler position. The main store was seen at the pharmacy inspection, the medication fridge is kept here and this is monitored daily and is maintained within a safe temperature range which is recorded. The medication administration records (MAR) were examined. These were found to be appropriately completed and neatly presented. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 13 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 good. Families and friends are welcome to visit at any time. The activity range and availability has improved. Appetising meals are served and drinks and snacks are available throughout the day. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At this inspection there were fifteen people in residence and one person attending for day care. Everyone was seen during the day. Time was spent in the lounge areas and people and their visiting relatives were spoken with. Daily life at the home was observed. Visitors are made very welcome and they seemed to be relaxed and comfortable with staff and staff were heard to be polite and helpful in all interactions. Regular meetings have been arranged for relatives since the last key inspection. The meetings are supported by the home owner Mr Lingajothy and the manager designate. The last meeting was held on 25/02/09 and was Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 14 supported by seven relatives. The agenda has covered menus and outings and there has been an open and good level of feedback. Lunchtime was observed, the portions served were plentiful and the main meal looked and smelled appetising. The menu is displayed each day on the white board in the main lounge, today it was minced lamb casserole, cauliflower and mashed potatoes. Dessert was banana and custard or ice cream. Alternatives to the main meal of the day are available on request. Drinks were served at lunch time and were available at all times. Jugs of fruit squash are kept in lounge, hot drinks were served mid morning and afternoon. A hot drinks and snacks trolley was reintroduced after the last inspection visit; this ensures that all people in residence have refreshments and snacks offered to them during the evening. The supper trolley was seen at 19:50pm when staff were serving hot drinks in the lounge. No concerns were raised about the food or the catering and people asked all said the food was “good” and “very good”. The home has a schedule for future trips out, this was advertised on the notice board, the manager said that it is anticipated that up to four or five people will be able to go on a trip out at any one time. Regular social activities have commenced. The AQAA indicated that more regular motivational activities are used by staff each day. People are encouraged to spend their time where and how they chose. The home has limited communal space; one person said they are looking forward to the conservatory being built, as this will offer them an alternative place to sit each day. The AQAA indicated that the manager hopes that the garden will be used more during the next twelve months. The care plans had social care recorded for two people this was infrequent. This also indicated that all activities have been communal and not one to one, which would have been the level required for the two people case tracked. Social care must be geared to meet the individual’s needs and add value to their home life each day, the range of social care and recording of social care, needs further management attention. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 15 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 good. People are protected from abuse by the home’s policies, procedures and safe practice. People and relatives asked said they would speak to the manager or the nurse in change if they had any concerns or complaints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff have been safely recruited. The AQAA indicated that checks are made to ensure that staff are only employed when they have been checked against the protection of vulnerable adults list and safe recruitment practice has been followed. Records sampled at this inspection confirmed this good recruitment practice. One person was working with supervision as their preliminary Protection of Vulnerable Adults check (PoVA) only had been returned. The supervisor was not formally recorded on the duty rota but was agreed at each handover. A more formalised record should be made each day. The home has a complaints policy and procedure for staff to follow in the event of a complaint, concern or safeguarding issues coming to their attention. Staff have received abuse awareness training. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 16 There have been no complaints made to the commission since the last inspection. The home has received one complaint since the last inspection and this was investigated within 28 days and was not upheld. The AQAA confirmed that all staff have been informed about the whistleblowing policy. People are protected from harm by the policies, procedures in place and appropriate referral to Social Services where anyone has required support under the Somerset Safeguarding guidance. People, their visitors and staff confirmed that they would know who to speak with if they had any complaints or concerns about the care or welfare of people at the home. The manager has arranged for staff and relatives of people living at the home to have access to information leaflets about the Mental Capacity Act, Deprivation of Liberty Standards. Training has also been sourced for the manager and senior staff to attend about this new legislation. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 17 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): 19,26 Quality in this outcome area is adequate. The service provides a homely but restricted environment. The internal environment has been suitably adapted but the layout and communal space have limitations. The home is kept clean, tidy and fresh smelling. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was made, both lounge areas were seen and all accommodation; this included toilet and bathing facilities, laundry facilities, a sample of bedrooms, the offices, kitchen and staff accommodation. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 18 There are seventeen bedrooms these include potentially four as double bedrooms. The double rooms have only mobile screens to separate the bed space for privacy. The home has two bathrooms. One is an assisted bathroom with a Parker style bath is on the ground floor; this room also provides access to the linen store and access to the conservatory staff room. The other bathroom is on the first floor. The shower facility is also on the first floor. The home has aids and equipment to meet the needs of people in residence. This includes patient hoists, pressure relieving equipment, assisted bathing facilities and wheelchairs. The home had a Health and Safety improvement notice issued for bed rails that did not meet the safety guidelines. There were adjustments made to achieve safe bed rails and the improvement notice was lifted on 3rd March 2008. Other environmental Health and Safety Executive improvement notices were found to be met at this time. The restricting mechanisms on the home newly fitted windows need to be altered by the window installer, this matter is in hand and the Health and Safety Executive are aware of this situation. Pressure relieving equipment was seen to be in use as required. Bedrooms can be personalised and many contained personal possessions such as photographs, soft furnishings and personal furniture and television sets. Hand washing facilities are available for staff throughout the home and this includes the provision of liquid soap and paper towels. Alcohol gel is available for staff to use. Other resources are available to aid infection control such as gloves and aprons. Waste bins require foot operated flip top lids for best practice. Two bins with broken lids were brought to the managers’ attention at this inspection visit. Industrial style laundry equipment is accessed via the ground floor bathroom and is situated off the back conservatory. At previous inspections it has been stated that: Due to the geography of the internal fittings staff have to access the laundry and their staff room via the kitchen or the assisted bathroom. The registered person is encouraged to review this situation as part of a redevelopment of the home. This comment remains valid. Since the last key inspection the floor of the laundry has been recovered and ‘tank’ fitted making it fully washable and more hygienic. The home has limited communal space which is being enhanced with the construction of a new conservatory leading out from the small lounge / dining room. The presentation of the communal areas is institutional due to the limited opportunity for arrangement of the furniture. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 19 There has been some redecoration since the last inspection this has included the main lounge. This work was admired by the people living at the service who are pleased to have the room brightened up. There has been a great deal of work to improve the health and safety of the plumbing. Hot pipes have been lagged and a radiator removed. Dead end pipes have been removed and fail safe valves fitted where required. New boilers have also been installed. Other work has included the refitting of carpets and re-carpeting the kitchen step for safety and cleanliness. The fire safety of the internal staircase has been addressed. This staircase has been cleared of clothing stored or hung here and oxygen cylinders that were stored here. The staircase is now safe and has been redecorated and re-carpeted. The small lounge / dining room remain unchanged. This will be altered when the home’s new conservatory is built but will remain as a communal area. The exterior has been tidied up and shrubs and flowers have been planted. The home has new windows installed throughout, much improving the appearance, the draught proofing and subsequent warmth of the home. The home has two maintenance staff to maintain and improve the premises and grounds. The home has a large lawned garden; this provides a pleasant outlook from the rooms at the rear of the house. Burnham Lodge Nursing Home DS0000064241.V374552.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): 27,28,29,30 Quality in this outcome area is good. There is a stable, skill mixed staff team. Recruitment practice ensures new staff are safely recruited to work at the home. Relevant training is made available for staff to work safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At this unannounced inspection visit the registered nurse and three care staff were on duty to care for sixteen people. The manager who is also a registered nurse was also on duty. The wider staff team included the cook, domestic and two maintenance staff. Duty rotas were seen, these confirmed that there is a minimum of three care staff and the registered nurse each day and two care staff and a registered nurse each night. There were no concerns raised about staffing numbers at this inspection. Staff were polite and helpful, the home had a calm atmosphere and people looked well cared for. Staff were observed during the day, all interactions were positive and helpful. One relative spoke with the duty nurse and received a professional, friendly response and the assistance that was required. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 21 The staff are well regarded by people and visitors to the home, one person said of the staff that they are “lovely and kind”. The manager was described as “very good” and was praised as someone “you can talk to”. Fire training was in progress during the afternoon of the inspection visit. This had been arranged to take place at the handover and fourteen staff attended the first of two sessions booked with an outside trainer. This included practical training for staff with the safe use of fire extinguishers. The AQAA indicated that six of the ten care staff holds a National Vocational Qualification (NVQ) in care. We also read that there have been three staff that have left the employment here in the past twelve months. Forty shifts have been covered by agency or relief staff in last three months. Two new staff have been recruited since the last key inspection. Their records were sampled. These demonstrated good recruitment practice. One staff had not received a full CRB only their PoVA check. Although working with supervision within the staff team a record of the supervisee needs to be recorded on each shift. This is a requirement at this inspection. Staff training has been expanded and the manager has sourced training through the Somerset Skills for Care organisation for care homes and nurse skills training via the Primary Care Trust. At this inspection the local community nurse called to oversee a nursing procedure carried out by the homes staff to ensure their practical skill competency. The home has good support from the local health care professionals. The staff group seem to get along well together and there was a sense of team working to improve the standard of service delivery and the outcomes for people living at the home. Burnham Lodge Nursing Home DS0000064241.V374552.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): 31,33,35,38 Quality in this outcome area is good. Management systems are in place to protect the interests of service users. Quality Assurance has been undertaken and used to make changes for service improvements and the best outcomes for people living at the home. Staff supervision has been implemented. The home is well and safely maintained. This judgement has been made using available evidence including a visit to this service. Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home has a manager who has applied for registration with the commission. The home owner is taking an active interest in the home and visits regularly to support the management and oversee improvements that are being made at the home. Progress has been made with quality assurance since the last key inspection. Mr Lingajothy has attended staff and residents meetings and the views and feedback from relatives and people living at the home has been listened to. Changes have been made to improve the home and the activities. Monthly regulation 26 visits are undertaken and recorded. It has been reported that Small amounts of money are held for people who live at the home. The receipts for any purchases or expenditure are kept and are linked to invoice numbers on the computer system. Any money belonging to people in residence is held in a special residents trust bank account. No change to this system was reported. Cash held for people was checked and three accounts were seen for people living at the home and the account for the ‘residents extra’ fund. This was all satisfactory. Accounts for fees were not examined. At the last key inspection ledger and computerised accounts were seen, four contracts and invoices were made available for inspection purposes and all were satisfactory. All management records have restricted access and are securely stored at the home. Maintenance records for fire safety and equipment servicing were not seen at this inspection. At the last key inspection in September all were up to date. The AQAA indicated all servicing and maintenance due dates. The home has also complied with all the improvement notices served by the Health and Safety Executive (HSE) for environmental safety improvements. Policies and procedures are in place as reviewed in January 2009. Staff supervision records were checked and Supervision is cascaded through the senior staff team. Records for months of December, February and March were in place demonstrating supervision for all staff. These records are stored securely. Burnham Lodge Nursing Home DS0000064241.V374552.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 X X 3 Burnham Lodge Nursing Home DS0000064241.V374552.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 OP12 Regulation 16(2)(m) and (n) Requirement The choice and availability of social activities should be part of daily life for all the people living at the home. Attention must be given to the range of social care to ensure people are not excluded from regular social contact. Foot operated flip top bins must be available for staff hand wash waste in bedrooms, to reduce the risk of cross infection. Rusted catheter bag stands must be replaced to allow thorough cleansing, reducing any risk of cross infection. Timescale for action 24/05/09 2 OP26 13(3) 24/05/09 3 OP26 13(3) 24/05/09 Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 26 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 OP8 Good Practice Recommendations People should be more involved with their care planning and the reviews of their care. Care records should evidence their decision-making and choices. Advice should be taken with regard to the safety of having an uncovered low ceiling light fitting in the laundry, close to the washing machines. The communal space should be increased to provide at least the minimum level for the maximum registered number of people living at the home. (This will be achieved when the new conservatory is completed) 2 OP19 3 OP19 Burnham Lodge Nursing Home DS0000064241.V374552.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Burnham Lodge Nursing Home DS0000064241.V374552.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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