Care Home: Burrow House

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What the care home does well What has improved since the last inspection? Following a recommendation from the last inspection, staff now ensure that creams and lotions are labelled as to when they have been opened. This helps to protect people from being administered products where the date may have expired. The staff team have worked hard to ensure more activities are offered throughout the week and that meet the needs and wishes of the people who live at Burrow House. What the care home could do better: Some aspects of medication management could be improved, to promote safer systems. This relates to ensuring staff use the blister pack system as it is intended, so that a clear audit trail is available for all medications. Medications that are prescribed as needed (PRN) should have clear guidelines for staff as to when the medication should be considered. This should be included in their plan of care so that staff have a clear understanding of if and when a PRN medication should be used. Staff supervisions should, where possible be planned so staff have time to prepare for them. CARE HOMES FOR OLDER PEOPLE Burrow House Burrow House Highfield Road Ilfracombe North Devon EX34 9JP Lead Inspector Jo Walsh Unannounced Inspection 14th August 2008 09:15 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 Burrow House DS0000033415.V370196.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. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burrow House Address Burrow House Highfield Road Ilfracombe North Devon EX34 9JP 01271 863685 01271 866035 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) http/www.devon.gov.uk Devon County Council Manager post vacant Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26), of places Physical disability over 65 years of age (26) Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 Brief Description of the Service: Burrow House is a detached, purpose built residential care home. It is situated on three floors with all areas being accessible to residents through the use of stairs or passenger lift The home has several lounge and dining areas, affording a variety of recreational areas for residents. It also offers accommodation to people requiring respite care and a day centre on the premises allows residents, on occasion, to participate in activities alongside day care service users. The home itself is well maintained. The fee charged for accommodation is £556.74 with additional fees levied for items such as newspapers, magazines, hairdressing and chiropody. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place during a weekday in August and lasted for approximately seven hours. During this time people who live at the home were asked for their views and care practice was observed throughout the day. Time was also spent talking to staff members and looking at some key documents including plans of care, assessments completed in respect of individuals needs, staff records, medication records, staff training and records relating to monies held on behalf of individuals. The manager was available for most of the inspection process. Surveys were sent to a sample of people who live at the home, staff and to local general practitioners. Their views are included throughout the report and have helped to inform the inspection process. Prior to the inspection the home were asked to complete an Annual Quality Assurance Assessment (AQAA), which provides us with information about how the home maintains a safe environment, what staff training has been implemented and how they monitor their quality of care and support. What the service does well: Although Burrow House is dated, the building is purpose built and provides people with a very clean, warm and homely environment. Staff have clearly worked hard to ensure that communal areas are made homely and welcoming, and the ancillary staff are commended for the high standard of cleanliness. People who live at Burrow House said • There is nothing that could improve this service, its perfect • Staff are first class, I like them all, can’t say enough to say how good they are • I am very happy with the caring I receive, the room and all the services. • Staff are wonderful and we are all very upset that the council have plans to have the place taken over by someone else, then knocked down. People who live at Burrow House gave very positive comments either by discussion or surveys, about the food. One said ‘’ the food is always very good with plenty of choice and variety.’’ Another person commented in their survey Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 6 ‘’ we do not always get what we have chosen, but the food is very good.’’ The home offers a good range and several choices are available for each meal. Special diets are catered for and individual likes and dislikes are taken into consideration. The staff team are experienced and have a good understanding of individuals’ needs and wishes. They were seen to provide support in a caring and respectful way and work hard to ensure that people are able to make choices about how and where they spend their time. Good systems are in place to ensure the views of the people who live at the home are listened to and acted upon to review and improve the quality of care and support. What has improved since the last inspection? What they could do better: Some aspects of medication management could be improved, to promote safer systems. This relates to ensuring staff use the blister pack system as it is intended, so that a clear audit trail is available for all medications. Medications that are prescribed as needed (PRN) should have clear guidelines for staff as to when the medication should be considered. This should be included in their plan of care so that staff have a clear understanding of if and when a PRN medication should be used. Staff supervisions should, where possible be planned so staff have time to prepare for them. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 7 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. Burrow House DS0000033415.V370196.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 Burrow House DS0000033415.V370196.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): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential new people benefit from a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: Assessment information for three people was looked at during this inspection. Details include what needs the individual has in terms of personal and health care and includes and identified risks. There is also a copy of the local authority assessment and care plan, which helps inform the home’s own assessment. The home offers interim care, but not intermediate care. Care is provided in separate wing, that has it’s own kitchen area. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ care is well planned so that staff has good information to ensure that personal, health and social needs are met. EVIDENCE: People who live at Burrow House said • There is nothing that could improve this service, its perfect • Staff are first class, I like them all, can’t say enough to say how good they are • I am very happy with the caring I receive, the room and all the services. Staff are wonderful and we are all very upset that the council have plans to have the place taken over by someone else, then knocked down. Three plan of care were looked at in some detail. The plans clearly set out individuals’ needs and how these should be addressed. For each area of personal, health and social needs, a care plan format had been developed and these are reviewed regularly. Plans could be made more person centred by including preferred daily routines for individuals. This would enable all staff to Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 11 have a good understanding of how each person prefers their care and support to be delivered. Plans of care and daily record clearly show how individual health care is monitored and followed up, one persons weight was being closely monitored and detailed records kept on what they had eaten, as this person had lost a significant amount of weight. This issue was discussed with the manager and assistant officer in charge who confirmed that this was an area they were closely monitoring. Records also showed when GP and district nurse advice and visits had been sought. Two GP surveys returned gave very positive feedback about the home, ticking only positive outcomes for all questions asked. Individuals who wish to self medicate are risk assessed and this is reviewed on a regular basis to ensure that they can continue to safely administer their own medications. Locked storage is made available for individuals who wish to self medicate. The medication storage, administration and records were all looked at during the inspection. All medicines are appropriately kept locked with a separate cabinet for controlled drugs and a locked fridge for any medications that need to be stored at a cooler temperature. When checking the blister packs, it was noted that one person’s medication had been administered out of sequence. It was explained that the medications was a mild pain killer, and was the same for morning, lunch and tea, so rather that use all three blister packs they only used one throughout the day. We discussed the fact that this could potentially lead to an error, as it was unclear from the blister pack at a glance, whether the medication had been administered for any given day. It was agreed that the home should use the blister packs as they are intended, as this provides a visual and easily audited system and trail for all medications administered. It was also noted that one persons nighttime PRN (as needed) nighttime sedation was being given almost every night. If the frequency becomes regular, this should be reviewed with the GP, to decide if this medication is suitable to be given as a nightly medication instead of PRN. Also it is recommended that where individuals are on as needed (PRN) medications that their plans of care include clear instructions to staff as to if and when the medication should be considered. People spoken to and those who returned surveys confirmed that privacy and dignity is upheld. Care practice was observed at different times during the day, and staff were always kind and respectful in the way they delivered care and spoke to individuals. One person was asked what drink they would like, and did not respond. The carer came back with a tea and a coffee and made both drinks available to the person so that they could choose which they preferred. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-14 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Burrow House have a range of activities that suits their needs and are supported to exercise choice and control over their lives. EVIDENCE: Since the last inspection the staff group have worked hard to ensure that there are planned activities on offer throughout the week. People who live at Burrow house told us • One day a week we go out for a ride, last time we went to Hidden Valley for a coffee • Staff get us involved in playing games, we have been trying to think of a name for some new budgies that someone is getting. • The hairdresser comes in a few times a week. • We have art sessions, games like scrabble and watching DVD’s as a group. The staff try hard to think of things for us to do. A monthly newsletter on the dinning room tables keep people informed of any planned activities and staff said that they also try to incorporate some additional activities, such as getting people out for walks if the weather is good. On the day of the inspection one carer had brought in a DVD ‘’Miss Potter’’ for people to watch that afternoon. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 13 People spoken to confirmed that they are able to have visitors at any time and that they are made welcome with refreshments. The home say in their AQAA that they try to maintain contact with wider community through events such as coffee mornings, social gatherings in the community. They are currently planning a BBQ for individuals their family and friends for the bank holiday weekend. People spoken to confirmed that routines are flexible and individuals are able to choose when to get up and go to bed, where they spend their days and what they wish to do. One person said they liked to go out and about in the loacl community and that they just needed to tell staff when they were going out, but that they could leave whenever they wished. One person said ‘’ It is just like your own home here, we are treated really well and can please ourselves what we do. You couldn’t wish for better.’’ Staff confirmed that they assist people where possible to make choices and decisions about their lives, and individuals opinions were listened to via keyworker sessions, meetings and in everyday discussions with people. Staff were observed to offer individuals choices about what they ate and actvities they could join in. The home offers a good balanced diet that gives individuals a choice and range of different meals. The main meal is served at luch time and everone spoken to and those who returned surveys were complimentary about the food. One said ‘’ the food is always very good with plenty of choice and variety.’’ Another person commented in their survey ‘’ we do not always get what we have chosen, but the food is very good.’’ The home offers a good range and several choices are available for each meal. Special diets are catered for and individual likes and dislikes are taken into consideration. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Burrow House can be confident that their concerns will be listened to and acted upon. EVIDENCE: People who live at the home who were spoken to during the inspection said they could make any concerns known to staff and most were confident that they would be dealt with. Most said they had no reason to make a complaint. The home keep a record of any complaints and have only dealt with one since the last inspection. They ensure that all actions are recorded so that it is clear how they have responded to a complaint. In addition the also actively seek feedback form individual using the service and their family members, by sending a letter four times a year inviting feedback. They are also looking to introduce a feedback system for each stay in respite. Three staff spoken to were able to say what may constitute abuse and what should be done if they suspect abuse is happening. All said they had received training in this and would be confident to report any issues of concern. We looked at staff files and were satisfied that appropriate checks were being completed to ensure that people who work in the home are suitable to work with vulnerable adults. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 15 Good systems are in place to ensure that individuals’ finances are protected. A clear audit trail ensures individuals’ monies are fully protected. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. The home is suitable for its stated purpose and people can be assured that the environment will be clean, homely and well maintained. EVIDENCE: Although the building is dated, it is purpose built and provides people with an environment that is suited for the needs of the frail elderly. The staff have clearly worked hard to ensure that communal areas are made welcoming and homely, with touches such as matching head rest covers, cushions, flowers and pictures. The home is kept clean to a high standard and there are no unpleasant odours present. Information from the home sent to the commission prior to the inspection shows that checks are made on all equipment and health and safety is reviewed and monitored via risk assessments and regular checks. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 17 The home has a separate laundry, which is well organised and ensures that dirty and clean linen are stored separately. The home has good infection control procedures in place and practice was observed to show that staff followed this. Aprons, gloves hand wash etc is available throughout the home. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 18 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): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff group are experienced, well trained and supported to ensure the needs of the people who live at the home are well met. EVIDENCE: The home has sufficient carer and ancillary staff to ensure that care and support needs are met and the home is kept clean. Staff spoken during the inspection and those who returned surveys said that they had good opportunities for training. One staff member said ‘’ I have always been supported by relevant training and support to do my job.’’ The manager confirmed that all core training is offered and induction training ensures individuals have time and support to understand the basic principles of care practices as well as the specific policies and procedures that relates to Burrow House. Only 5 of the 27 staff have or are working towards NVQ 2 (National Vocational Qualifications) in care. The national recommendation is that 50 should have achieved this or be working towards an NVQ. A sample of staff files were looked at (3) and relevant checks and references had been taken up to ensure that individuals were suitable to work with vulnerable adults. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the people who live there. EVIDENCE: The manager is not yet registered with the commission, but is in the process of completing her application. She previously ran the day service, which is attached to Burrow House, and is qualified and experienced to manage the service. The home has regular meeting with the people who live there and these are recorded so everyone can see what has been discussed. The home use surveys to help them to include the views of the people who live there when they review the quality of care and support provided. This is externally quantified and a report is produced hat clearly shows the results Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 20 from the survey. This information is then used to help improve the quality of care and support provided. Staff spoken to and those who returned surveys said that they could talk to the manager and that their opinion was listened to. Two staff members mentioned that fact that they were not always given notice of supervision sessions. This is where a senior person spends time discussion an individual’s role, training needs and how they are doing. Senior staff should ensure that some notice is given to staff so that they can prepare and therefore get more from regular planned supervision sessions. The home gave good information in their annual self-assessment, to show how they maintain a safe environment. They health and safety issues are addressed via training for staff and regular checks and audits on equipment and facilities. All new staff has an induction programme to ensure that they understand working safely. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 21 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 X 3 3 X 3 Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP9 OP9 Good Practice Recommendations Blister pack system should be used as it is intended so that a clear audit trail is available for all medications Where PRN (as needed) medications are prescribed, clear instructions should be available to staff as to how, when and why PRN should be considered. Reasons why it is administered should be clearly recorded on each occasion. Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 23 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 Burrow House DS0000033415.V370196.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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