Care Home: Burrows House

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What the care home does well The home is managed well and in the best interests of its residents. The home makes sure its staff team have the skills and experience to meet the needs of the residents. Comprehensive pre-admission assessments are carried out so people referred for placement can be assured Burrows House can meet their needs. The home makes sure prospective residents and their families have the necessary information to decide whether Burrows House is right for them.Burrows HouseDS0000006942.V375178.R01.S.docVersion 5.2Residents are treated with respect and their dignity is maintained. The home makes sure their health and personal care needs are met. The administration of medicines is being managed well. The home offers residents a very good programme of social activities. It supports residents to keep in contact with their family and friends, and to make personal choices about their life in the home. The home provides its residents with a balanced, nutritious and varied diet. The home is kept clean and properly maintained, and residents continue to benefit from environmental improvements. The home has good arrangements in place to manage complaints and to safeguard its residents. What has improved since the last inspection? It was evident that management and staff have worked together effectively to improve standards in the home. Previously, there were shortfalls in the standards for health and personal care, daily life and social activities, and for staffing but the home is now meeting these in full. Feedback from residents and their representatives shows they are satisfied with the quality of care provided. Feedback from staff shows they are satisfied with their working conditions, and with the training and support they receive. Much effort has been made to address the requirements and recommendations made at our last key inspection. This has included making improvements to: the provision and documenting of social activities; the frequency of reviewing residents` care plans; medicines storage; laundry facilities; residents` mealtimes; environmental orientation; recruitment practices; and staff training in caring for people with dementia. What the care home could do better: In general, the home promotes health and safety well but there are some specific matters to address so that all parts of the home to which residents have access are free from potential hazards. These matters include always keeping cleaning products stored safely and making sure residents are not put at risk from the boiling water machine. They also need to carry out regular checks for legionella. Care plans are reviewed regularly but more detailed and evaluative comment in all reviews would show clearly the outcomes for residents from the care delivered.Burrows HouseDS0000006942.V375178.R01.S.docVersion 5.2The manager and staff team are working on finding solutions to the effective storage of creams and recording of their administration, as they know this is an area to improve. Key inspection report CARE HOMES FOR OLDER PEOPLE Burrows House 12 Derwent Road Penge London SE20 8SW Lead Inspector David Lacey Unannounced Inspection 10:00 5 and 8th May 2009 th DS0000006942.V375178.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burrows House Address 12 Derwent Road Penge London SE20 8SW 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) 020 8778 2625 020 8659 6240 Servite Houses Limited Care Home 54 Category(ies) of Dementia (22), Old age, not falling within any registration, with number other category (32) of places Burrows House DS0000006942.V375178.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 - Code PC to service users of the following gender: whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 32) 2. Dementia - Code DE (maximum number of places: 22) The maximum number of service users who can be accommodated is: 54 07/11/08 Date of last inspection Brief Description of the Service: This home is provided by Servite Houses, which has a number of facilities throughout London and the South East. The home is purpose built over two floors. Individual bedrooms and communal space are provided on both floors. The kitchen and laundry are on the ground floor. The home is separated into seven units. Each wing has two units, with its own kitchen, dining and sitting area. There are separate units for older, frail residents and for residents suffering with dementia. Staff are normally allocated to specific units. All policies and procedures are generated centrally with amendments made to reflect the local situation. The head office coordinates recruitment of new staff. The kitchen is operated through an external contract agreement. The fees for this home range from £400-£650 per week (this information provided to CQC May 2009). Burrows House DS0000006942.V375178.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 two stars, which means that people using the service receive a good service. This key inspection included an unannounced visit to the care home, which took place over two days. To gain the views of people living in the home, the inspector spoke with residents and with relatives visiting the home. The inspector met with the home’s interim manager and with members of the home’s staff. The inspector tracked the care of four residents and observed practice. This included spending time carrying out a structured observation of the care being given to a small group of people living in the homes dementia unit. Documentation such as care plans and records of care provided, staff recruitment files, and policies and procedures were sampled for inspection. The home’s compliance with previous requirements was reviewed. The care home had provided us with its annual quality assurance assessment (AQAA) when we asked for it. This self-assessment document focuses on how outcomes are being met for residents and also gives us some numerical information. Information from the home’s AQAA has been used to inform the inspection process. Since the last key inspection, we carried out a random inspection of the home and have used findings from that visit in planning this present key inspection. Before the visit took place, we surveyed a sample of the home’s residents, its staff members and visiting professionals. We received responses from seven residents, six staff members and three health professionals. These responses have been taken into account. What the service does well: The home is managed well and in the best interests of its residents. The home makes sure its staff team have the skills and experience to meet the needs of the residents. Comprehensive pre-admission assessments are carried out so people referred for placement can be assured Burrows House can meet their needs. The home makes sure prospective residents and their families have the necessary information to decide whether Burrows House is right for them. Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 6 Residents are treated with respect and their dignity is maintained. The home makes sure their health and personal care needs are met. The administration of medicines is being managed well. The home offers residents a very good programme of social activities. It supports residents to keep in contact with their family and friends, and to make personal choices about their life in the home. The home provides its residents with a balanced, nutritious and varied diet. The home is kept clean and properly maintained, and residents continue to benefit from environmental improvements. The home has good arrangements in place to manage complaints and to safeguard its residents. What has improved since the last inspection? What they could do better: In general, the home promotes health and safety well but there are some specific matters to address so that all parts of the home to which residents have access are free from potential hazards. These matters include always keeping cleaning products stored safely and making sure residents are not put at risk from the boiling water machine. They also need to carry out regular checks for legionella. Care plans are reviewed regularly but more detailed and evaluative comment in all reviews would show clearly the outcomes for residents from the care delivered. Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 7 The manager and staff team are working on finding solutions to the effective storage of creams and recording of their administration, as they know this is an area to improve. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Burrows House DS0000006942.V375178.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 Burrows House DS0000006942.V375178.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and/or their representatives are offered the information they need to decide whether to move into the home, and are encouraged to visit the home first. Prospective residents can be assured their needs will be assessed before they move in to make sure the home can meet them. Residents receive contracts/statements of terms and conditions. Burrows House does not offer intermediate care, thus standard 6 does not apply. EVIDENCE: The home has produced a statement of purpose and a service user guide, which is made available to residents and their representatives. Copies are readily available in the home. The guide had been amended so its sections are Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 10 arranged alphabetically for easier reference. Six of the residents responding to our survey stated they had received enough information about the home before moving in so they could decide if it was the right place for them. One respondent did not answer this question. From discussions, it was evident people are encouraged to visit the home to have a look around and meet residents and staff before they decide to move in. Three residents who responded to our survey stated they had received a contract, and four people did not answer this survey question. It was evident at the inspection visit that each of the four residents whose care was examined in detail had received contracts, with the terms and conditions of their stay. Residents whose care was tracked during the inspection visit had been admitted to the home based on the outcome of a pre-admission assessment. The assessment format covered all areas of need and care records seen included pre-admission assessments and some included care manager assessments. Burrows House DS0000006942.V375178.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a care plan, prepared to show how that person’s needs are to be met and kept under regular review. The home makes sure residents’ health and personal care needs are met. Medicine administration is being managed well. Residents are treated with respect and their dignity is maintained. EVIDENCE: The care records of four residents were sampled for inspection. The records included pre-admission assessments and care plans. Care plans had been drawn up from the assessments of the residents’ needs, showing how these were to be addressed. As we had previously recommended, staff members’ entries in care documentation had been signed and dated, for accountability Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 12 and to enable effective audit. Since our last inspection, the home had started to use electronic care plans that are printed out to residents’ files. The electronic care plan for ‘communication’ printed out on one resident’s file had the name of a different resident who was referred to as being hard of hearing. This was raised with the manager who confirmed this was an error and undertook to rectify it immediately. The manager was aware of the need to make sure any care plans copied electronically are done so accurately. The four plans seen had been reviewed regularly, which met a requirement from our last inspection. The care plan reviews for two of the residents were more detailed and evaluative of the care given than those for the other two residents, which did not offer evaluative comments but repeated use of the statements “As per care plan” and “Follow care plan” (see recommendations). The supporting risk assessments that were seen on file were up to date, although there was no specific risk assessment for one resident who had chosen to propel her wheelchair by using her feet and thus was not using footplates. This was raised with the manager who undertook to ensure this specific omission was rectified. Five of the six staff members responding to our survey confirmed they are always given up to date information about residents’ needs, for example in the care plan. One staff member stated s/he was sometimes given this information. Written comments from staff included, “We have regular handover and care plan review”, and “Every staff is asked to read service users care plan before supporting them to help know how to support them”. Commenting on what the home does well, three staff members mentioned recent improvements to the recording of care plans, as did a staff member interviewed during the inspection visit. Five of the seven residents who responded to our survey stated they always receive the care and support they need. Two residents stated this is usually the case. A resident commented, “I have never had better treatment than what I get here”. Relatives visiting the home told the inspector they were very pleased with the care given, and that staff members are kind and helpful. Data analysis from the inspector’s structured observation of a small group of residents on the dementia unit indicated this care setting was supportive, with residents showing mostly positive mood states. The structured observation time was divided into 12 five-minute timeframes. Positive mood states were seen in 91 of these timeframes, with passive mood states seen in 5 of them. Residents sleeping formed the remaining 4 of timeframes. Each of the health professionals who responded to our survey stated individuals’ health care needs are always met by the home. One stated, “I have two patients at Burrows House whose needs are met”. Another commented that from her/his perspective, “all health care needs are met”. Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 13 Commenting on what the home does well, a health professional stated, “They have managed to care for my patient who was quite agitated and responded to him in a caring manner, I was impressed with their positive attitude”. The home maintains good links with the local older person’s mental health service and had recently changed its GP support arrangements. Six of the residents who responded to our survey stated they always receive the medical support they need, with one stating this is usually the case. Part of a medicine round was observed and the practice when giving residents their medication was carried out safely. Ordering, receipt and disposal of medicines were satisfactory. Storage of medicines was satisfactory, and our previous requirement to monitor the temperature of the medicines room was being met, and staff were making sure the room is kept within safe levels for the effective storage of medication. One resident was taking a controlled drug (CD), which was being stored properly and recorded in the home’s CD register. The inspector suggested the residents’ photos on medication records also have the dates they are taken recorded. This is because people’s appearance can change over time or sometimes when they are unwell, and the deputy manager took action to make sure this is done. The manager carries out monthly medication audits, which were seen on file. Issues that the manager and her team have been trying to address are those concerning the storage of external creams and the recording of their administration. For example, it became evident during the inspection that, at the morning medicine round, seniors ask carers if they have administered a cream and the senior records this on behalf of the carer, as the carer will invariably be busy with residents. At other times, carers record the administration of creams themselves. Creams were seen in residents’ rooms on open display rather than in a lockable drawer. The manager and her team are aware this is potentially hazardous, given there are people with confusion who are independently mobile. A recommendation has been made to support the staff team’s effort to find workable solutions to these matters (see recommendations). The provider’s Charter of Rights for Residents was displayed on all the units and in the main hall. The home’s statement of purpose makes it clear that this Charter sets out a framework within which services are provided. The stated principles of practice are based on privacy, dignity, independence, respect, choice, rights and fulfilment. All residents seen during the inspection visit were dressed appropriately and well groomed, with hair clean and combed. Residents spoken with were satisfied with the way staff provided care and interacted with them. Care plans seen included residents’ preferences, and it was evident people’s choices were being accommodated whenever practicable. Staff members were seen to knock on bedroom doors before entering and respond to residents’ requests for assistance in a polite, timely and helpful manner. All the health professionals who responded to our survey stated the Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 14 home always respects individuals’ privacy and dignity. One commented that, “During my visits to residents, carers maintain privacy and dignity and appear to treat residents with respect”. Another stated, “The new manager ensures that all residents are treated with dignity and respect. Residents are clearly treated as individuals. Nothing seems to be any trouble”. Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Very good arrangements are now in place to provide residents with social activities. Residents’ contact with family and friends is supported well. Where possible residents are enabled to make personal choices about their life in the home. A balanced, nutritious and varied diet is provided to residents. EVIDENCE: It was evident the home had made considerable effort to improve its activities programme, to the benefit of all residents. The provision of planned activities for residents was very good, consisting of a variety of activities that were appropriate for the capabilities and interests of individual residents, and which are designed to be changed for different times of the year. One full time activity coordinator is employed, who was very motivated and had a good understanding of the value of activities for older people, including those with confusion. Observation of an activities session showed the coordinator is skilled Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 16 in delivering this service and is able to draw on support from other staff members. The arrangements for recording of activities had been improved, taking into account our previous recommendations in this respect. Five of the residents who responded to our survey stated there are always activities arranged by the home that they can take part in. One resident said this is usually the case and another stated that there are sometimes such activities available. In relation to activities, a resident commented that, “there has recently been very considerable improvement”. Another stated, “I like the singing activity”. A relative commenting on behalf of a resident stated, “Mum really enjoys all the activities and actively participates”. A resident who was borrowing large-print books from the home’s library told the inspector, “I love reading and I can see the print in these easily”. The home has an open visiting policy and people said they could visit when they liked and could spend all day in the home if they wished. Relatives were seen interacting with the manager, staff and residents, and they appeared relaxed and comfortable in the home. None of the residents spoken with raised any concerns about visiting arrangements but said they enjoyed and welcomed family visits. Care records seen included residents’ choices and preferences. Residents spoken with knew staff members and the manager, and said staff helped them choose clothes for the day, decide where in the home they wanted to spend their day, what meal to have and whether to join in organised activities. Residents may get up and go to bed when we want. Some residents did not have the capacity to make certain decisions and care plans seen showed how their needs were to be met. The health professionals responding to our survey all stated the home always supports its residents to live the life they choose. One commented, “This is very much the residents’ home. Activities are now provided on a regular basis. Relatives are also now involved and during recent months invited to a meeting to discuss the running and improvements of the service delivery”. Another professional stated, “My patient is encouraged to listen to music that he enjoys and they have engaged with him in a person centred way”. It was evident during the inspection visit that residents are supported to exercise choice and control over their lives. For example, a resident having lunch on one of the dementia units was not actually living on that unit. A carer said the resident had wandered into the unit’s dining room and made it clear she wanted her lunch there “so we just let her do that”. All of the residents who responded to our survey stated they always like the meals that are provided. One commented that the meals “are varied and appetising”. Another resident stated the meals are “lovely”. The menu on each day of the inspection visit was displayed. The choice and variety of food was good and the menu looked well balanced. Residents had access to fluids in their rooms, and had tea and biscuits served between meals. Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 17 The structured observation of a small group of residents on the dementia unit was continued during lunch served in the dining room. Residents had the choice of meal they preferred, and a resident who changed her mind when she saw what she had chosen was offered an alternative choice of food. The tables were laid with clean linen cloths, place mats and cutlery, and napkins were provided. Condiments were on each table for residents to help themselves as they wished. It was evident the home had addressed our previous recommendation to make sure each person can eat their food without difficulty, and that as far as possible meal times are enjoyable occasions for all residents. Staff wore blue aprons while serving the meal, and gave sensitive and unhurried assistance to residents as they needed. For example, a carer gave a resident his food, explained what it was, offered assistance but also tried to encourage him to maintain independence by feeding himself. When he finished eating his pudding independently, the carer said “well done” and the resident looked pleased. Another carer gave gentle encouragement to a resident who was reluctant to feed herself, and with this support the resident did so. Another resident said she did not want to finish her meal and, after checking with her that she did not want any more, a carer took the resident’s plate away. The resident sat down to watch TV and was offered a banana to eat while she did so. The manager and the chef showed the inspector their plans for ‘finger food’ (food that does not require cutlery to be used) to be offered on the dementia unit. Their focus was on providing meals with a high nutritional content that residents would enjoy. This plan is to be welcomed as it is designed to benefit some of the residents with confusion who might prefer to eat in this way. Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives may be assured that good arrangements are in place to manage complaints and to safeguard residents. EVIDENCE: A complaints policy and procedure was provided and there is a system in place to record complaints made about the service. A suggestion box has been placed in the home’s reception area so that people may make written comments without necessarily having to give their names. The home’s AQAA stated six complaints had been received by the home over the past year, five of which had been upheld and all of which had been resolved within the appropriate timescale. Records seen were satisfactory and showed how complaints had been managed. All the residents who responded to our survey confirmed they knew how to make a complaint and residents knew who to speak to if they were not happy. Two relatives stated they or other family members would raise any issues as needed on behalf of their relatives who live in the home. One commented, “We Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 19 as a family will bring up any problems we’d like sorting and the staff and manager are very helpful”. All of the six staff members responding to our survey stated they knew what to do if someone raised concerns about the home. One stated, “I will talk to my line manager who in turn meets with the home manager to discuss ways for improvement. The new manager takes concerns about service users seriously”. Each of the health professionals responding to our survey confirmed the home had always responded appropriately if they or a person using the service had raised concerns about care. One stated, “I am able to contact the manager to discuss my patient’s care”. Another commented there had been “improvement over recent months. Everything raised has been sorted out professionally and quickly”. Staff receive training in safeguarding and those spoken with during the inspection showed appropriate understanding of safeguarding adults and understood their reporting responsibilities if they witness or suspect abuse of residents The home was using the provider’s corporate safeguarding and whistleblowing policy and procedures, dated April 2007. The AQAA stated five safeguarding referrals had been made over the past year, all of which had been investigated and about which the commission had been made aware. The provider has followed the appropriate safeguarding procedures and has attended meetings or provided information to external agencies as required. In September 2008, the local authority (Bromley) had put a temporary embargo on placements at Burrows House, following allegations received. This embargo is no longer in place. Follow up reports about the home in January 2009 from the Bromley safeguarding care manager and contracts compliance officer were both satisfactory and noted improvements. . Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to benefit from environmental improvements to the home. More has been done to help residents suffering with confusion to find their way around. EVIDENCE: The home was clean, tidy and communal areas were free from odour. The décor looked clean, well decorated and some rooms had pictures on the walls. A resident who spoke with the inspector said that what she likes about the home is that it is always very clean and does not smell. Of the residents who Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 21 responded to our survey, five confirmed the home is always fresh and clean. Two residents stated this is usually the case. The home’s garden was well kept, with plenty of seating available and is used by residents and their visitors to enjoy the fresh air and surroundings, and by some residents as part of gardening activities that the home now offers. The home had acknowledged our previous recommendation to add to the natural shade available during the warmer weather. The provider intends to offer more services to people with dementia, so more is being done to make it as easy as possible for residents with confusion to find their way around the home. This follows our previous recommendation to improve the home’s environmental orientation facilities for people with dementia so they reflect best practice. Two residents who smoke may do so in their rooms only. The manager confirmed that risk assessments for the individuals and the premises were in place, together with appropriate insurance cover. Staff make sure the two rooms are ventilated as much as possible. Potential hazards to residents’ health and safety were identified in dementia unit kitchenettes. There were cleaning and dishwashing products in unlocked kitchenette cupboards, and a machine for constant boiling water sited on a worktop. These matters are commented on under standard 38. Improvements to the laundry facilities were about to take place, to create separate wet and dry rooms and to install an Otex system. There was a clear action plan in place for these improvements, which have been designed to benefit residents by improving the home’s arrangements for infection control. The laundry was running well on the day of our visit, with all machines working. It was evident the home had addressed our previous requirement about the handling of residents’ clothes. Commenting on what the home could do better, three staff members responding to our survey suggested that installing telephone lines on each unit would improve the communication links within the home, including enabling residents to receive calls on their units. The provider may wish to consult with residents, relatives and staff about this. Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team had the skills and experience to meet the needs of the residents. Staff members are supported well and receive training that is relevant to their work in the home. Appropriate staffing levels are maintained and the home operates robust staff recruitment procedures that support and protect residents. EVIDENCE: The staff team comprised of a manager and a deputy manager, team leaders and care assistants, domestic and ancillary staff. Discussions and staff rosters seen during the inspection showed appropriate staffing levels were being maintained. Care staff work either in the dementia units or the units for older people, only moving between units in an emergency. The manager confirmed there were no permanent care staff vacancies at the present time. Vacant shifts are covered by bank staff or, occasionally, agency staff who already know the home. The use of agency staff had decreased significantly since our last inspection, which benefits residents as they are now seldom cared for by staff members who do not know them. A staff member interviewed said there Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 23 had been a lot of agency staff when she first started work in the home but there are very few now. Three of the residents we surveyed told us that staff members are always available when they need them, and four stated this is usually the case. All of the residents who responded to our survey stated the staff listen and act on what they say. Five of the six staff members responding to our survey stated there are always enough staff to meet residents’ individual needs, with one staff member stating this is sometimes the case. One staff member wrote, “There is no problem with staffing, there are permanent and relief staff. Also, recruitment is still in progress”. A relative commented that, “In the past there was a fair degree of turnover resulting in a loss of continuity, our impression is that this is no longer the case”. The structured observation of a group of residents on the dementia unit included staff interaction with residents. The observation time was divided into 12 five-minute timeframes. Residents experienced engagement with staff in 62 of these timeframes, and the observation data suggested that whenever there was some interaction by a member of staff this usually had a positive outcome for the individual resident. Seventy-nine per cent of staff interactions with the group of residents being observed were positive and 21 were neutral, such as simply exchanging information. No negative staff interactions were seen. Staff members were prompt in responding to the group of residents being observed and were using a person-centred approach to meeting their needs. Recruitment files for three staff members were inspected and found to comply with regulations. All staff members responding to our survey confirmed their employer had carried out checks, such as CRB and references, before they started work in the home. Our previous requirement about staff recruitment records had been met. Induction for new staff comprises a four-day Servite awareness programme carried out away from the home, which contributes towards Skills for Care induction. Five of the six staff members responding to our survey stated their induction had covered very well what they needed to know to do the job when they started. One staff member stated induction had mostly covered what s/he had needed to know. A staff member commenting on the induction programme stated, “You end up knowing what you are supposed to know so you can meet the service users’ needs”. All the staff members responding to our survey confirmed they were being given training that is relevant to their role, that helps them understand and meet individual residents’ needs, and that keeps them up to date with new ways of working. One commented, “I am very pleased with the training I’ve Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 24 attended so far. These training courses have helped a lot in developing my knowledge and enhance the skills I need as a carer. For example, equality and diversity, NVQ2, NVQ3 in progress, health and safety, care planning, activities, to mention but a few”. Another staff member commented that training had helped to give better care to people with dementia. Commenting on what the home does well, a staff member stated, “The service always organises training for staff pertaining to their job role”. The AQAA confirmed the provider’s commitment to NVQ training, stating that 73 of permanent care staff had achieved NVQ 2 awards or above. Our previous requirement about dementia training for staff had been addressed. The staff members responding to our survey felt they had the right support, experience and knowledge to meet the different needs of the residents. One commented s/he had completed a training course on equality and diversity that had helped in this respect. Health professionals responding to our survey confirmed care staff have the right skills and experience to support people’s health and social care needs. One professional noted the home had increased its provision of relevant training for staff and stated that, “this is visibly evident in watching how carers provide appropriate care to individual residents”. Burrows House DS0000006942.V375178.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was being managed well and in the best interests of its residents. Residents have access to appropriate support with their personal finances. Staff members receive regular supervision. Systems are in place to ensure people’s health, safety and welfare are promoted and protected, though some specific improvements are needed in the way these are operated. EVIDENCE: Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 26 An interim manager has been in post at Burrows House since November 2008, until a new permanent manager is appointed to run the home. The interim manager has skills and experience in managing care homes for older people, including people with dementia. Management and staff presented as a cohesive team who work together to meet the needs of the residents, and to both maintain and also raise standards of care. Feedback we received about management was positive. For example, a health professional commented that her/his dealings with the interim manager showed the manager has the right skills and experience to support people’s social and health care needs. Another told us, “The manager also offered a great deal of support to the wife of my patient”. Two of the health professionals responding to our survey stated the home always seeks advice and acts on it to manage and improve individuals’ health care needs. One stated this is usually the case. One professional commented that, “Communication between manager and carers appears to have greatly improved”, and observed this has had a “significant improvement with residents’ health care needs”. The professional also commented that following discussions the interim manager had always taken appropriate action. Another visiting professional commented that, “The atmosphere at Burrows house has improved greatly in recent months. Care staff seem motivated and keen to fulfil their duties. Clients’ care appears improved”. Five of the six staff members responding to our survey stated the ways in which information about residents is passed between staff, including the manager, always work well, with one stating this is usually the case. Staff members commented this is achieved through handovers between each shift and written daily notes. One wrote, “Any issue beyond the capability of staff on the unit is passed on immediately to duty head or line manager”. As mentioned in the Environment section of this report, staff members suggested the practicalities of communication within the home could be improved by installing telephone lines on each unit. The home had systems in place to monitor and improve the standard of care provided. This included residents, relatives and staff meetings, audits and satisfaction surveys. The most recent user satisfaction survey had been carried out in 2008. The results for Burrows House were displayed, together with an action plan drawn up for 2009 from the results of the survey. Monthly reports of the provider’s monitoring visits were on file and available for inspection, together with action plans drawn up from the visits. It was evident residents and staff had been consulted during these visits. The home has the facility to store residents’ personal money safely if they require, and lockable facilities are provided for valuables in residents’ bedrooms. Money was being stored securely and up to date records were maintained. The money held is checked weekly by two people who sign to confirm they have completed this check. Records are kept of any money Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 27 received by staff for safekeeping and also for money spent such as on hairdressing and chiropody fees. The three residents’ financial records checked at random were found to be correct. The deputy manager explained that each resident has their own personal allowance envelope. Monies held are topped up by residents’ families or, if there is no family and the provider is not the appointee, the home invoices the placing local authority. Servite Housing’s finance department is the appointee for some residents but the deputy manager confirmed no staff members working at the home fulfil this function. There were effective arrangements in place for the supervision of staff members. Supervision records were seen on the three staff files sampled. Five of the six staff members responding to our survey stated the manager meets with them regularly to give support and discuss how they are working. One staff member stated the manager often does this. A staff member commented, “We have regular staff meetings, supervision and appraisal”. Staff members spoken with during the inspection visit said they are being supported well and are supervised regularly. From the information provided and records inspected, attention was being given to providing a safe environment for residents and others. A maintenance technician attends to day-to-day repairs and regular in-house safety checks. A random sample of safety records showed nearly all were up to date and within the appropriate timeframes. The exception was that the most recent evidence of a check for legionella was three years previously, which was brought to the manager’s attention as an up to date check is needed (see requirements). As noted in the Environment section above, potential hazards to residents were found in the form of various COSHH cleaning products in unlocked cupboards in the dementia units’ kitchenettes (see requirements). Also potentially hazardous for confused but independently mobile residents was the constant boiling water machine with tap, sited on a worktop in the unit D/E kitchenette. The home will need to make sure an appropriate balance is maintained between enabling residents’ independence and ensuring their safety, particularly as it intends increasing its provision for people with dementia (see requirements). The kitchen was not inspected on this occasion but records seen showed the last environmental health inspection had given the home a 5-star ‘excellent’ rating for food hygiene. It was understood our previous requirement about food temperatures had been addressed, with the kitchen staff checking temperatures before the food leaves the kitchen. Staff on one unit said the temperature is checked again on its arrival on the unit but staff on another unit said food is just checked before it leaves the kitchen and is then kept on the unit in an electric hot trolley which is plugged into the mains. It is good practice to make sure the last meals served also meet required food safety temperatures (see recommendations). Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 28 Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 29 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 3 8 3 9 3 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 3 3 X 3 3 X 2 Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 30 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 OP38 Regulation 13 Requirement The registered person must ensure the home has an up to date check for Legionella carried out by a competent person. This is to ensure the health and safety of residents. The registered person must ensure cleaning products kept in the dementia units are always stored safely. This is because these products are potentially harmful to residents. The registered person must ensure the risks to residents from the boiling water machine with tap in the unit D/E kitchenette are identified and so far as possible eliminated. This is because boiling water from the tap may scald vulnerable residents. Timescale for action 31/07/09 2 OP38 13 30/06/09 3 OP38 13 30/06/09 Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 31 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 OP7 Good Practice Recommendations The registered person should ensure all care plan reviews include evaluative comment, rather than just repeated use of statements such as, “as per care plan” and “follow care plan”. This will help to show the outcomes from the care delivered. The registered person should support the manager and her team in finding workable solutions to the safe and effective storage of creams and recording of their administration. The registered person should ensure staff members check the last meals served from a hot trolley meet required food safety temperatures. 2 3 OP9 OP38 Burrows House DS0000006942.V375178.R01.S.doc Version 5.2 Page 32 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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