Care Home: Burrell Mead

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What the care home does well What has improved since the last inspection? Since the last inspection there has been improvements in the medication practices making it safer for people. The manager has also undertaken a review of the service involving residents in surveys to find out what they think about the home and the care received. Generally records were signed and dated and the manager has taken on board the need to fully record complaints and the investigations that take place. We recommended that the home obtain copies if Local Authority Inter-Agency Guidelines on adult protection from all authorities who arrange placements in the home to ensure correct procedures are followed. These have now been obtained. There has also been some redecoration of the bungalow completed to ensure it is decorated to a good standard. The carpet in the hallway has also been replaced. What the care home could do better: There are still a few areas that must be addressed to ensure individuals` needs are more fully met and to ensure the safety and well-being of people. The development of care plans continues and this inspection has shown there has been further improvement. However, there are gaps in areas, particularly around healthcare needs that would place people at risk if it were left to "word of mouth" alone to provide the care. Staff must also understand individualneeds around management of finances and their everyday social needs to ensure the residents have the support they require to live the life they wish. Medication practices have improved significantly since the last inspection with good records in place. Further improvement around self-medication practices must be made to enable people who wish to retain independence to do so safely. Whilst the staff have been trained in a number of areas they must be provided with regular moving and handling training as determined by a risk assessment. This is also true of first aid training, the type of which must also be determined by the needs of the home and the residents being cared for. Implementation of a quality assurance system that includes regular audit of the systems in place would ensure the continued good care and health, safety and well-being of those living in the home. We would also recommend that the manager looks to producing information in other formats to ensure all people living there are given the opportunity to understand the information provided. CARE HOMES FOR OLDER PEOPLE Burrell Mead Burrell Mead 47 & 49 Beckenham Road West Wickham Kent BR4 0QS Lead Inspector Wendy Owen Unannounced Inspection 3rd July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Burrell Mead DS0000006939.V366487.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. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burrell Mead Address Burrell Mead 47 & 49 Beckenham Road West Wickham Kent BR4 0QS 020 8776 0455 020 8776 0858 info@burrellmead.co.uk 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) Westwood Housing Association Limited Mrs June Parke Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Burrell Mead DS0000006939.V366487.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 Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 22 6th September 2007 Date of last inspection Brief Description of the Service: Burrell Mead is owned by Westwood Housing Association (founded by West Croydon Baptist Church) and is run on a Christian ethos. The Home is located in a residential area of West Wickham, close to the town centre and public transport links. It provides 24-hour care to twenty-one older service users of either sex. Accommodation is provided in two buildings, one of which is a bungalow and provides accommodation for six service users, who are more active. The main house is set over two floors and provides accommodation for sixteen service users. The Home has twenty- one single rooms, two of which are en-suite. There are six toilets and three bathrooms and one shower room. It is set in its own grounds with attractive gardens which are accessible to service users by a ramp. There is limited off road parking. There have been recent changes to the environment that includes enlarging the kitchen and storage area, the provision of a managers office, a new bathroom and two single rooms with en-suite facilities. A manager, deputy manager, care and ancillary staff provide care and support to the people living there. The current scale of charges range from £480-£580 dependent on whether it is Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 5 for permanent or short stay care and for single en-suite. The fees include accommodation, food and staffing. The charges do not include toiletries, clothing or personal expenditure such as hairdressing or chiropody. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 2 star. This means the people who use this service experience good outcomes. This unannounced inspection took place over one and a half days. The visit included a brief tour of the main building and grounds, viewing of records and discussions with a group of residents, members of staff, the manager and Provider. We also sent out a number of surveys and the following were returned; one from a person living there; five from staff and three from relatives. This report also includes information provided by the annual quality assurance assessment (AQAA) and from the random inspection that took place in January 2008. We discussed how people would like to be referred to in the report and agreement was reached with the use of resident and people who used the service. What the service does well: Burrell Mead provides a good standard of care to the people living in the home. All of the people who gave us with feedback were very positive about the way they were cared for and supported. They felt it offered a warm, comfortable and homely environment to live in. “Top notch” and “excellent” were two of the words used to describe the home. “I can now call this my home,” said one person spoken to and one relative wrote “They look after X well.” Staff understand individuals’ needs and are trained and experienced to meet basic personal and health care needs. According to a relative “Burrell Mead has particularly caring staff” and find that “it is a very caring place. Staff are patient and kind.” They are good at promoting independence and enabling people to make everyday choices and decisions with many residents liking the fact that “they (staff) don’t take over”. Staff are valued and this shows in the standard of care provided with a manager who is kind and sensitive, leads by example and wishes to provide a good service. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 7 People are able to follow their spiritual and religious needs to the degree they wish. The quality of the food is also very good with praise being given to the kitchen staff. “The meals are excellent. There are always two choices for every meal” wrote one resident. People felt that they are listened to and concerns raised are dealt with efficiently and without a fuss. The standard of décor and furnishings is of a good standard too. It is clean homely and very comfortable “The home is spotless and comfortable” as well as having a personal and homely touch. There are efficient and effective systems in place for the recruitment of new staff and ensuring the health and safety of people living and working in the home. What has improved since the last inspection? What they could do better: There are still a few areas that must be addressed to ensure individuals’ needs are more fully met and to ensure the safety and well-being of people. The development of care plans continues and this inspection has shown there has been further improvement. However, there are gaps in areas, particularly around healthcare needs that would place people at risk if it were left to “word of mouth” alone to provide the care. Staff must also understand individual Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 8 needs around management of finances and their everyday social needs to ensure the residents have the support they require to live the life they wish. Medication practices have improved significantly since the last inspection with good records in place. Further improvement around self-medication practices must be made to enable people who wish to retain independence to do so safely. Whilst the staff have been trained in a number of areas they must be provided with regular moving and handling training as determined by a risk assessment. This is also true of first aid training, the type of which must also be determined by the needs of the home and the residents being cared for. Implementation of a quality assurance system that includes regular audit of the systems in place would ensure the continued good care and health, safety and well-being of those living in the home. We would also recommend that the manager looks to producing information in other formats to ensure all people living there are given the opportunity to understand the information provided. 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. Burrell Mead DS0000006939.V366487.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 Burrell Mead DS0000006939.V366487.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): 1,2,3,5 & 6 is not applicable. People who use this service receive good quality care in this outcome area. This judgement has been made using available evidence including a visit to this service. People have the information are able to visit the home to decide if it is right for them and staff are provided with this information to ensure they provide the care and support each person requires. EVIDENCE: A Service Users Guide (Resident’s Brochure) and Statement of Purpose have been developed with a copy of the “Guide” kept in the individuals’ room. People spoken to were aware of information provided by the home, although not all had taken the opportunity to read it. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 11 These documents are in written format and therefore not suitable if the person has a visual impairment or other disability. The manager should investigate how this information could be provided in a format, other than in writing. There is an admission process that begins with an initial inquiry and prospective users of the service are then provided with an up-to-date information pack with brochure, aims and objectives, Residents User Guide, sample of a weekly menu and application forms with information on what it is like to live at Burrell Mead and the current tariff. Prospective residents and their family are invited to view the home and staff will answer any enquiries they have. People often spend time meeting staff and residents and getting to know what its like to live in the home. The opportunity is also taken to undertake an assessment of the individuals’ needs as well as deciding if the home is right for them. One resident who is fairly new to the home told us that they had visited the home first and had discussed their needs with someone. Another person confirmed that they had the opportunity to speak to someone about their needs. The terms and conditions or contract allows the resident a month to decide if the home is right for them and for staff in the home to determine if they can meet their needs. We viewed three individuals’ files to determine if assessments had been completed and other information provided. These were found to contain an initial enquiry form, details of the individuals and an assessment of capabilities as well as contracts or terms and conditions, if placed by the local authority. Where arrangements have been made by the Local Authority, placement agreements are provided and maintained by the home, although there is often a delay in receipt of these. Burrell Mead DS0000006939.V366487.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 People who use this service receive good quality care in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in the home are treated with respect and dignity and provided with a good standard of care that meets their expectations and their health and personal care needs. Medication practices are more robust now ensuring the individuals health and well-being. EVIDENCE: Discussions during the group meeting with seven residents showed that they are very happy with the care provided. Words used to describe the care were Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 13 “top notch” and “excellent”. There are two people who have been living there for many years with others also having lived there for sometime. “We only have to ask and it’s done!” said another about staff. In the main people were aware that they had care plans detailing the care provided and were in some way involved in telling staff how they wished to be cared for. They all felt that staff knew about their needs and what support they required. It is clear that some are more independent than others and that this independence is respected and promoted ensuring the person is kept as safe as possible. One person told us “they don’t take over, we can do little things for ourselves.” Another told us, “I look after myself”. It is evident from these discussions that self-care is promoted and of individual choice. Observations showed people to be dressed according to the weather conditions and looking well groomed. When asked about bathing we were told that they had a bath weekly although this could be more if they wished. “I really enjoy my bath” one person told us. All agreed that staff respect their privacy and their time spent alone and that they choose how they wish to spend their days. Some residents spend their day in their room reading etc whilst some enjoy the company of others in the lounges. Personal care is something which is done with the dignity of the person in mind and in the way in which they choose. The “routine” maintained in individuals’ rooms help staff with this. A brief tour around the home showed residents to be well presented, well dressed well and well groomed. When asked about clothing and laundry all were keen to tell us that they had their own clothes and staff looked after them well with few laundry errors. We viewed the care plans of three residents. These showed some good information particularly about their individual needs and how they wished to be cared for. Routines of the day have also been developed and a summary of the care plan is maintained in each person’s rooms in a discreet location. “My life before you knew me” is a record of the individual’s life up until they moved to the home. This gives staff a good idea about the person their history and experiences and provides the staff with another side to residents lives as to what they see now. It also provides staff with the opportunity to talk to people about their lives. Those care plans viewed were variable and the manager admitted that this is an area that they have great difficulty with but a lot of effort goes in to try and Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 14 make them person-centred and comprehensive. It is clear that the plans viewed did contain a good deal of information that help staff care for the individual rather than be a universal approach, particularly for those who had less complex needs. The care plans were appropriate in these cases, although some gaps were evident. Where, in the case of one viewed, the needs were a little more complicated with some health and clinical issues the care plan was less well documented about the person’s needs. For example: the lack of records regarding diabetic needs and the need to ensure complete records in respect of pressure sores. It is apparent that the individual is receiving the appropriate care from the District Nurse but the lack of records and, in particular, actions required by staff may result in deterioration of health. For example: the risk assessment details a high risk of pressure sores and although a care plan has been developed about the pressure sore and how the DN is involved as well as the equipment used there is little information about the need for fluids and food or monitoring skin conditions, especially where the individual may be incontinent. This is also true of the need for good diabetic care. Apart from the dietary needs there is also a need to ensure good foot and eye care to maintain good health. With the expected appointment of a nurse as deputy manager it is hoped that the overseeing of clinical care may improve, although the manager was made aware that clinical practice must still be obtained from outside professionals due to the registration of the home. There are still gaps in care plans, including more about the social, leisure needs of individuals as well as ensuring healthcare needs are addressed. However, this is balanced with some good information that ensures individual and specific needs are addressed. It is positive to note that attention to detail includes how people like to be dressed as well as their faith and spiritual needs. We found that two of the three care plans had been signed by the person and when discussed with a group of residents a number informed us that they were aware of their care plans. Risk assessments have been developed for pressure care, nutrition, falls and moving and handling and, generally, where risks had been identified this had been addressed in the care plan. We discussed how health needs are met and we were told that the GP visits every two weeks and “in between” if someone needed to see her. We were also told of visits by the chiropodist and optician. One person said they preferred to use a local optician and visits the GP independently. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 15 We also noted that the District Nurse attends regularly where there is a need, particularly where someone has a pressure sore. During the last two inspections there were issues around the medication practices. The random inspection in January 2008 resulted in an immediate requirement in respect of these practices. A compliance visit by the Pharmacy Inspector in February found that the issues had been addressed and improvements made. We found that the improvements have continued and practices were of a good standard. The staff have had an opportunity to use the new “Boots” system and whilst there are still some issues, the change has meant easier monitoring and recording. Records were generally complete and photographs in place for each resident. Hand transcriptions had been counter-signed and medication coming into the home had with a couple of exceptions been recorded in. The home has now obtained a controlled drugs (CD) book that meets with the Regulations and CDs are kept in a suitable cupboard that ensures security. Improvements could be made by ensuring there is consistency in medication carried forward each month and that, where the medication, particularly creams, states “as directed”, there is clear instruction for staff to follow. Where most improvement could be made is when people wish to administer their medication. There must be a full assessment that not only details the person’s competency but also the monitoring and which aspects of selfmedication they wish to remain in control of. This has been completed in parts but there are gaps in the information and records. This may present risks to the individual if there is not enough guidance for staff. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 16 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 People who use this service receive good quality care in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in the home are able to choose how they wish to spend their days and enjoy some activities that stimulate them. Visitors are welcome and resident are encouraged to keep in contact with family and friends Meals provided are varied and nutritious providing people with a healthy diet. EVIDENCE: We spoke to a number of residents and also received written comments about the home. We found residents are able to make choices about their daily Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 17 routine with a daily routine record for each resident. People are able to make choices how they spend their day with a number preferring to stay in their rooms reading, listening to the TV or music sometimes joining others for the exercise sessions etc. Some are able to go out independently and do as they wish whilst others prefer company and spend their time in the lounge or conservatory chatting, watching TV or listening to music. There are some activities on offer with a schedule on display in the hallway notice board and in a Newsletter called “The Bugle” produced monthly. This is an area which previous inspections had stated could be improved. The feedback from people living there shows that the activities suit their needs. Although for some, they would like to go out a little more. However, staffing does not enable this to happen and therefore people are reliant on family members. This is difficult if family members are not around for whatever reason. The manager should again consider the staffing levels and people’s wishes in this area and try and accommodate them to some extent or look at ways in which this could be done such as use of volunteers or locating day clubs. Residents’ birthdays are celebrated with a special cake and a special tea of their choice and people notified of these in the newsletter. The home is run on a Christian ethos and people can attend Churches of their choice or services in the home. There are also bible readings held by residents. Visitors are welcome at anytime either chatting in the lounge/conservatory or in the privacy of their rooms. Refreshments are offered and staff also spend time talking to relatives. It is clear from discussions and observations that individuals can look after their personal affairs, if they wish, have personal belongings in their rooms to make it their own and make decisions about their lives. They and the manager spoke about informal discussions about their wishes and choices etc although this is rarely put on a more formal standing by having regular formal meetings. The quality of food is good has been consistently of a good standard and enjoyed by residents. Meals are generally taken in the dining room or they are able to be served elsewhere if they prefer. They have a choice of food and are offered three meals a day, plus snacks at any time. There is a choice of food at each meal and staff provide help as needed and “no one is hurried” the manager wrote in the AQAA. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 18 “The meals are excellent. There are always two choices for every meal,” wrote one resident. During discussions at this visit the residents only good things to say once again about the quality of the food provided. It is clear that they are provided with varied, nutritious meals that are ample in quantity. The manager and staff are also aware of the value to individuals of drinking plenty of fluids throughout the day. We were told by the people we spoke to that there is tea, coffee and cold drinks provided day and evening as well as snacks and biscuits so they “don’t go hungry”. The tables are well presented and set with tablecloths, condiments and tablemats with each resident having their own serviette ring. Meals are a social affair with residents chatting away over a good meal and staff assisting where required. As well as recording individuals food preferences the staff are also aware of ensuring religious requirements are acted upon. An example of this is where “Roman Catholics ……. like fish on Fridays……...” (Recorded in the AQAA) Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 19 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): 16,17 & 18 People who use this service receive good quality care in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in the home feel they are listened to and any concerns acted upon and dealt with. There are adult protection procedures in place that enable staff to ensure vulnerable people are protected. EVIDENCE: The home has a Complaints Procedure which specifies how complaints are made, who will deal with them and that they will be responded to within a maximum of 28 days. This information is in the Residents User Guide which is given to each person. A copy of the procedure is on display in the main hallway and when asked the question (in the survey) staff were able to tell us how they would respond if a complaint is made. The home maintains a log of “minor complaints” and compliments as well as recording the more serious issues in a more formal manner. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 20 It is clear from the feedback that people living in the home and relatives feel that there is an open and inclusive approach and that any concerns are listened to and dealt with “without any fuss”. The manager continues to ensure residents are involved in the electoral process as well as supporting people to make decisions about they wish to manage their lives including taking responsibility for management of monies etc. People were very complimentary about the manager and her approach to managing the home as well as taking on board issues or concerns. During discussions with residents we were told by one person, “You’ve only got to say and its done.” The AQAA records no formal complaints over the last twelve months and this was confirmed by viewing the complaints register. We discussed the differences between what, appears minor and more serious issues and the need to record fully the actions taken to investigate and address the “complaints”. The adult protection and whistle-blowing procedures are also available to staff with many having gained further knowledge through completion of the NVQ in Care. One member of staff spoken to had a clear understanding and knowledge of what they would do if they were concerned of possible abusive situations occurring. They were also aware of what other agencies they could contact if they felt they were not able to report it to the manager. However, they pointed out that they could approach the manager who took concerns seriously. Whilst staff view a video to give them guidance in this area we recommend staff undertake more formal training, particularly around the role of social services in the safeguarding of people. The manager is also aware of her role in ensuring allegations are passed to the person in social services responsible for co-ordinating investigations. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 21 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): 19,20,21,23,24,25 & 26 People who use this service receive good quality care in this outcome area. This judgement has been made using available evidence including a visit to this service. Burrell Mead provides people living there with a homely and comfortable environment that is safe, clean and well-maintained. EVIDENCE: Burrell Mead provides individuals with a warm and comfortable environment that is well maintained. The feedback from people living there and the relatives that provided feedback told us that they felt the home is clean with no odours. “The home is spotless and comfortable” wrote one person. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 22 The manager stated in the AQAA that, “There is a program of regular maintenance and renewal with records kept. The grounds are tidy and well kept.” This was found to be an accurate reflection of our findings on the day. The grounds were well maintained with summer bedding plants and garden furniture placed for the benefit of the residents. Communal and private rooms were decorated to a good standard and done so in a homely way. Since the last inspection there have been some improvements, including repainting rooms in the bungalow, full redecoration of the hallway and new carpet in the bungalow entrance and two new chairs purchased for the main lounge area. Individual rooms are also clean, fresh and comfortable with personal possessions giving each room an individual feel. Most residents are mobile to a great degree and therefore areas of the home are accessible with the first floor accessed by a lift. Those living in the bungalow need to be fully mobile due to the step at the entrance and from some of the patio doors. The manager and Provider should look at the home to ensure any potential hazards such as steps, particularly to the outside of the home, allow for better access. Baths are fitted with bath hoist and are checked regularly to ensure safety and there are a number of grab and handrails around the home to assist people. Staff have had infection control training and the laundry is fitted with equipment, including a washing machine with a sluice facility. The AQAA also told us that new paper towel dispensers have been put in each toilet and the laundry instead of fabric towelling. A recent visit by the Environmental Health Office gave the home a four star rating for their kitchen. These systems and practices ensure the risk of infection to vulnerable people are reduced Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 23 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 People who use this service receive good quality care in this outcome area. This judgement has been made using available evidence including a visit to this service. The staff are trained and competent to provide a good quality of care to the people living there with adequate numbers of staff to meet their needs. Vulnerable people are protected by sound recruitment practices. EVIDENCE: We received feedback from five staff who were very positive about the home, the training and the quality of care provided. Staff feel valued and part of the organisations. This can be seen from comments received from staff including “Our place still has that personal touch …..” “I wouldn’t want to work anywhere else.” The home has a mix of qualified/unqualified staff ranging from senior care assistants, care assistants, domestics and cook and kitchen staff. During the day the home is generally staffed by three care staff in the morning with additional management support. However, there have been problems Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 24 with covering some days of the week and therefore the required level has not always been met. The manager is addressing this with a recruitment campaign already underway. However, currently agency staff have been used to try and cover the shortfalls. There has also been a higher than usual use of agency staff. The manager ensures they use the same agency and wherever possible staff who have been in the home before. They also ensure that the people they have working there have had the required checks completed to ensure the safety of those living in the home. Some form of induction for agency staff must be provided to ensure they have the basic understanding of the home and the residents they are to care for. Staff are generally well trained. One person wrote of Burrell Mead “It provides a good quality of care. Trained staff and experienced staff and loyal staff.” All the staff are over 18 and 11 staff have N.V.Q 2,3 or 4. This means that over 63 of staff are trained in N.V.Q 2 or above. Most of the staff have been working in the home for over three years with a number for several years longer. All staff have received induction training and continue to have ongoing training such as manual handling, infection control, fire safety, food hygiene, first aid. They are also encouraged to pursue extra training, e.g. Dementia Care. On inspecting the recruitment procedures we found that there have been no new staff employed since the last key inspection. The AQAA states that all new staff are employed with the checks required by the Regulations. We discussed the recruitment practices with one of the administrators, as they are very involved in this. They had a sound understanding of the checks required to ensure the safety of people living there and have good organisational and administrative skills. We discussed the employment of a deputy manager and they appear to be ensuring the checks are made prior to commencement of employment. However, this aspect will need to be monitored more fully at the next inspection. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 25 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): 31,32,33,35, 36 & 38 People who use this service receive good quality care in this outcome area. This judgement has been made using available evidence including a visit to this service. The home is well managed and ensures the safety and well-being of those living there. It is run with taking people’s views into consideration in an open and inclusive manner. EVIDENCE: The manager has over 25 years in Senior Management in the care sector with N.V.Q level 4 and Registered Managers Award. She has taken periodic Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 26 training such as First Aid, Moving and Handling and she is familiar with the conditions and diseases of old age. The feedback from people living in the home, relatives and staff were all positive about the way in which the home is run and how much the manager listens to individuals to try and improve the care. It is clear that she is open and approachable and values the staff in her charge knowing that she leads by example and staff look to her for advice and guidance. To improve the service feedback is sought through the opinions of the residents and relations. Recently a residents survey was sent out and completed. A summary of the outcome was reported in the “Bugle” for all to read. This process could be made more formal with other stakeholders included and a formal report detailing the conclusion with any actions taken. This was discussed with the manager who agreed that future reviews would be along these lines. This will ensure continued improvements are made. Members of the Board of Trustees also visit the home each month and discuss the care provided with staff and residents and reports on these are completed and maintained by the manager. These show individuals are happy with the care provided and, where in the few instances, improvements either for individuals or all residents are suggested, these are taken seriously and implemented where possible. There are other informal and formal systems for monitoring of the care provided, although the formal quality assurance system has yet to be implemented. Introduction of a more formal system with regular monitoring of all areas would ensure the good care provided continues. Care is also monitored through the regular formal and informal supervision of staff. The formal process includes discussions with staff about their personal development and training needs to ensure they have the skills required to provide a good standard of care. Surveys received back from staff and from staff spoken to on the day confirm that the formal meetings take place every six weeks when able. The home is responsible for management of some residents’ personal allowances. Where this is the case the care plan should detail the individuals’ needs and the role the home is taken to ensure safe management of personal monies. There are however, good, transparent systems in place with records of monies and receipts for any transactions on residents’ behalf. Some residents continue to be responsible for this area themselves, enabling decisions and choices as well as continued independence. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 27 The manager ensures ongoing safe working practices through arranging regular servicing of equipment and systems, and the training of staff in core areas. The organisation of these and other administrative tasks have improved since the employment of two part-time administrators. A sample of the servicing of equipment and systems was undertaken and found to be in order and in line with the details supplied in the AQAA. There is a need to ensure all staff receive regular moving and handling training (or as determined by a moving and handling risk assessment) as currently some of the night staff have not had training for some time. From the training records it is clear that there is always a member of staff on duty with some form of first aid training. The manager was made aware of the need to complete a risk assessment on the first aid training required by staff, taking into consideration the needs of people in the home, the size and what actions the home takes in emergencies. Some training including infection control and adult protection are provided via a DVD or video. This is adequate for initial training but staff would benefit from more formal and in depth training. Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 28 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 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X 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 3 18 3 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 3 Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 14 Requirement Care plans must include information about the health, personal, social, financial and spiritual needs of the individual. Where individuals are self medicating there must be a risk assessment in place that ensures the safety and wellbeing of that person. The manager must produce a moving and handling assessment that determines the training required for the staff in the home. Training including updates must be provided to staff inline with the risk assessment to ensure the safety of the residents. The manager must produce a first aid assessment that determines the training required for the staff in the home to ensure appropriate action is taken in the event of an emergency. The manager must implement a system for auditing the quality of care provided to ensure the care is continuously improved and DS0000006939.V366487.R01.S.doc Timescale for action 01/09/08 2 OP8 13 01/08/08 3 OP38 13 01/09/08 4 OP38 13 01/09/08 5 OP33 25 01/11/08 Burrell Mead Version 5.2 Page 30 6 OP30 18 that people remain safe and well. Agency induction must be 01/08/08 provided with induction during their first visit to the home to ensure they are safe to provide care to people living there. 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. Refer to Standard OP1 OP12 Good Practice Recommendations Information such as the Service Users Guide, Statement of Purpose and complaints procedures should be provided in other formats. The manager should review the activities arranged to include a range of activities in the community. The Providers should consider employing a laundry assistant to undertake laundry tasks within the home. Residents’ meetings should be arranged for residents to have their say in how the home is run. 3. OP27 4. OP14 Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Burrell Mead DS0000006939.V366487.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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