Care Home: The Burnham Nursing and Residential Home

Similar services:

• The Vicarage
• Fairfields Country Rest Home
• 7 Hyde Road
• 5 Seafield Road
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home

What the care home does well People living at the home and their relatives made many positive comments about the care given at the Burnham Nursing Home. One relative said, "The care here is wonderful. Staff are polite and kind." A person who lived in the home said, "I have been here three months. I am very well looked. The food is fine. My room is pleasant." People said that their privacy was respected. "People always knock." The kindness of all staff was commented on. One person praised the kindness of cleaning staff and the importance of a "friendly face" when they were lonely. One person said of staff "Nothing is too much trouble." People felt that there were staff they could rely on to sort out any issues. The home management is structured and efficient. There was a prompt response to any concerns raised through the inspection process and in response to complaints. There is a comprehensive structured care planning system in place and evidence that people receive good levels of support for personal and health care. There is an interesting menu with variety and choice. Most people are pleased with the food available. People commented on the efficient laundry service. Overall the home is clean and well maintained. Rooms were seen to be personalised and comfortable. The recruitment procedure is structured and well documented. There is a comprehensive induction programme for new staff commencing work at the home that is based on the Skills for Care portfolio with additional training. What has improved since the last inspection? There have been concerns expressed about the staffing levels in the home. The staffing levels in the home should be monitored continually by the home and varied according to occupancy and dependency levels. Issues raised at the last key inspection have been addressed. Additional rubbish bins have been purchased. Staff undertaking interviews have received training. A "grumbles" book has been introduced on each floor to encourage people to raise issues informally as well as the formal complaints procedure. Formal complaints have been fully investigated and recorded. The exterior of the home and grounds have improved since the last key inspection. The grounds including the pathways have received attention. The front garden was tidy and attractive. The home won a prize for Burnham in Bloom. Bedrooms have been redecorated on a rota basis. Corridor carpets have been replaced. The manager discussed the commitment of the company top continuing to redecorate and up-grade the home. What the care home could do better: Overall care in the home was reported to be good however there were some observations that caused concern. One person was seen to be in an unadapted wheelchair in the communal sitting room from 9:55 when the inspectors arrived until 17:00 hrs when the inspectors left. Her care plan stated that she liked her own company and had an assessment that indicated she had a high risk of pressure damage. (The Waterlow Assessment recorded was noted as 14 when it was more like 16.) It was noted in the care plan that there was already some sign of pressure damage (skin redness) and antibiotics had been prescribed for a urine infection. This person looked tired and weary and her experience on this particular day did not reflect her care needs or care plan. It can be difficult to balance the care people need with their continued wish to be independent. This is particularly the case in a large nursing home where many people are very ill and staff can be very busy. None the less the words of one person reflected the feelings of others. "We are birds in a gilded cage. We are looked after but not allowed to go out."Attention should be made to the serving of meals away from the main dining room to ensure that they are really hot. Whenever possible people should sit in arm chairs not general wheelchairs when taking part in activities. The AQAA states that 22 of the 47 care staff have NVQ 2 or above and efforts are being made to improve this number. CARE HOMES FOR OLDER PEOPLE The Burnham Nursing and Residential Home 19 Oxford Street Burnham-on-sea Somerset TA8 1LG Lead Inspector Shelagh Laver Unannounced Inspection 24th February 2009 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 The Burnham Nursing and Residential Home DS0000069138.V374471.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. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Burnham Nursing and Residential Home Address 19 Oxford Street Burnham-on-sea Somerset TA8 1LG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01278 781757 01278 794861 danielja@bupa.com www.bupa.co.uk BUPA Care Homes (ANS) Ltd Mrs Jacqueline Ann Daniells Care Home 76 Category(ies) of Dementia (11), Old age, not falling within any registration, with number other category (76), Physical disability (5) of places The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) - maximum of 11 Physical disability (Code PD) - maximum of 5 The maximum number of service users who can be accommodated is 76. May accommodate up to 11 persons with dementia on the `Kingfisher` wing only. May accommodate up to 5 persons from the age of 30 years who have nursing needs by way of a physical disability. 27th December 2007 2. 3. 4. Date of last inspection Brief Description of the Service: The Burnham Nursing and Residential Centre is a large established care home that has been registered as BUPA owned since December 2006. The registered nurse manager for the whole service is Mrs Jackie Daniells. The home is located in a converted school and chapel forming a three-storey building. The home is divided into four units, Sandpiper, Nightingale, Kingfisher, which is on two floors, and The Rookery. Two units are for people requiring general nursing care these are Sandpiper and Nightingale. In April 2007 the Kingfisher unit was registered to provide nursing care for 11 people with dementia. A senior nursing sister manages each unit. On the top floor, The Rookery is a residential care unit with a residential unit manager. Each floor has its own dining room and sitting room. All rooms have en-suite facilities of toilets and hand basins. 57 rooms also have a bath or shower. The seafront is within walking distance for more mobile residents. There are two activities co-ordinators who organise a weekly programme of social events. Fees: Social service rate £389, privately funded personal care £660 per week. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 5 Nursing care, social service rate £504, privately funded care £770 with the Free Nursing Care element refunded. These rates were given at the date of this inspection. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. Two inspectors from CSCI undertook this Key Unannounced Inspection on one day over a period of six hours. There were 55 people living at the home with, unusually, seventeen empty rooms. This was a positive inspection visit where people were overall satisfied with the care they receive. Prior to the visit to the home the Annual Quality Assurance Assessment (AQAA) had been completed and returned to CSCI. This gives information about the achievements of the home in the previous year and plans for the next twelve months. The manager wrote of the home “We deliver a very high standard of care to all residents whilst maintaining a light-hearted and homely environment. We endeavour to alleviate their fears of moving into care by presenting a friendly, whilst still professional manner.” We received a copy of the homes’ 2008 Resident Satisfaction Survey that had sampled the views of 35 people in the home and reviewed key aspects of the service. A tour of the premises was made and people living and working at the service spoke to us. We observed daily life and saw care plans for those individuals whose care was case tracked. Medications management, staff recruitment and maintenance records were all sampled. The manager Mrs Jackie Daniell’s was available during the inspection and gave all assistance. Mrs Daniell’s retires in April this year after fourteen years as manager of the home. The inspectors would like to thank all who contributed to the inspection process for their time and valuable feedback. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? There have been concerns expressed about the staffing levels in the home. The staffing levels in the home should be monitored continually by the home and varied according to occupancy and dependency levels. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 8 Issues raised at the last key inspection have been addressed. Additional rubbish bins have been purchased. Staff undertaking interviews have received training. A “grumbles” book has been introduced on each floor to encourage people to raise issues informally as well as the formal complaints procedure. Formal complaints have been fully investigated and recorded. The exterior of the home and grounds have improved since the last key inspection. The grounds including the pathways have received attention. The front garden was tidy and attractive. The home won a prize for Burnham in Bloom. Bedrooms have been redecorated on a rota basis. Corridor carpets have been replaced. The manager discussed the commitment of the company top continuing to redecorate and up-grade the home. What they could do better: Overall care in the home was reported to be good however there were some observations that caused concern. One person was seen to be in an unadapted wheelchair in the communal sitting room from 9:55 when the inspectors arrived until 17:00 hrs when the inspectors left. Her care plan stated that she liked her own company and had an assessment that indicated she had a high risk of pressure damage. (The Waterlow Assessment recorded was noted as 14 when it was more like 16.) It was noted in the care plan that there was already some sign of pressure damage (skin redness) and antibiotics had been prescribed for a urine infection. This person looked tired and weary and her experience on this particular day did not reflect her care needs or care plan. It can be difficult to balance the care people need with their continued wish to be independent. This is particularly the case in a large nursing home where many people are very ill and staff can be very busy. None the less the words of one person reflected the feelings of others. “We are birds in a gilded cage. We are looked after but not allowed to go out.” The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 9 Attention should be made to the serving of meals away from the main dining room to ensure that they are really hot. Whenever possible people should sit in arm chairs not general wheelchairs when taking part in activities. The AQAA states that 22 of the 47 care staff have NVQ 2 or above and efforts are being made to improve this number. 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. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 10 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 The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 11 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 3 5 6 Quality in this outcome area is this outcome area is good. People receive a pre admission assessment to ensure their care needs can be met at the home. People admitted to the Kingfisher Dementia care unit are seen and assessed pre admission by the Registered Mental Health Nurse employed to oversee the care on this unit. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Service User guide. An up-dated version was seen at inspection. The statement of purpose makes references to the “BUPA philosophy of care located in the manager’s office.” Unfortunately several people were asked about this but knew nothing of it. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 12 There is a welcome pack in each room. A pre-admission assessment is carried out on potential people for nursing and residential care placements. Those observed in care plans were undertaken thoroughly by appropriately qualified people and included visits to hospital and additional information where needed. People and their relatives can visit the home prior to admission. One person said that her social worker had suggested the home after which she had made a visit. Another said, “I made the choice to come here. It is quite pleasant. Very peaceful.” At this inspection two recent admissions were case tracked. Staff had made assessments from the home. Single assessment process forms were on file from the community professionals involved with the assessment of the person prior to their admission to the home. As the home is registered for nursing, residential and dementia care there is flexibility for people. One person was living on the residential floor while his wife was nursed on the floor below. Following appropriate in-house assessment people can receive alternative care if their needs change within the home. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 13 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. Comprehensive care plans have been introduced for all people at the home. Health care needs are met. Medications are safely managed. There is evidence that people living in the home are treated with care and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People in the home looked relaxed and well cared for. During the inspection frail people were seen to be resting in bed. Beds were adjustable and appropriate pressure relief equipment was seen. Beds were clean and fresh and people were seen to have received personal care and be resting until late in the morning. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 14 There were records of people’s drinks, food and changes of position. Observation of one member of staff showed that after giving out morning drinks all frail people were assisted and the amount taken was recorded. The home has a new care panning system called Quest. This aims to be a person centred methodology and staff have received training to do this in a person centred way. The manager said this is now fully implemented. Care plans were sampled and the evidence was that the system is very detailed and staff have adopted a person centred approach to writing and preparing care plans. The Personal Best training aims to make staff aware of the need for person centred care planning. Good practise was seen around night care planning. There were references to personal preferences and choices. Risk assessments had been completed for nutritional assessment; pressure sore risk and falls risk assessment. We asked about any people with pressure damage in the home. The manager said there were none. We discussed people who had been admitted to the home with pressure damage. The home had informed us when this had occurred. We were able to see from care plans that one person who had lost weight in hospital had been appropriately assessed and action had been taken. The person had been weighed weekly and a careful food diary had been kept. Whilst the system is sound there was some evidence there is still room for improvement in implementation. In one “grumble book” requests were made for improvements in care for one person but this had not been transferred to the care plan. Another person had complained about a health problem that had either not been picked up or had not been recorded. One person was seen to be in an unadapted wheelchair in the communal sitting room from 9:55 when the inspectors arrived until 17:00 hrs when the inspectors left. Her care plan stated that she liked her own company and had an assessment that indicated she had a high risk of pressure damage. (The Waterlow Assessment recorded was noted as 14 when it was more like 16.) It was noted in the care plan that there was already some sign of pressure damage (skin redness) and antibiotics had been prescribed for urine infections. This person looked tired and weary and her experience on this particular day did not reflect her care needs or care plan. In the dementia care unit some Life Story books were not completed. Staff said that this was because people had few relatives to offer information. People are supported in attending hospital appointments and can be accompanied by staff if families are not available. People with diabetes see the The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 15 specialist nurse but one care plan needed to be clearer with regard to the units of insulin to be given. Medications were monitored on one unit (Sandpiper) and seen to be accurate and conforming to best practice. The homes’ deputy manger and the regional manager audit medication records. Staff receive training up-dates each year. The home’s Resident Survey indicated that 100 of respondents felt that staff were respectful. They said that staff knew their needs and provided an excellent or good quality of care. People spoken to confirmed that their privacy was respected. “The girls are very good. They don’t pry and always discreet.” Staff confirmed that they receive training and have management support with their work. The Burnham Nursing and Residential Home DS0000069138.V374471.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): Quality in this outcome area is good. People can spend their time as they choose. Visitors are made welcome at any times. There is dedicated activities staff and there is a range of social activities in the home. Choices in daily living are supported. Meals are well presented and look appetising. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People confirmed that they could spend their time as they choose; some people chose to spend time in their rooms with the television, books or the radio for company. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 17 Visitors are made welcome and two were seen and spoken with during the day. There is a range of social activities held at the home this includes music crafts and trips out. The home has formed a choir called the Jackdaws. There were some innovative ideas for example the “Food Cruise” gave people the opportunity to sample different menus and is linked to activities. Various entertainers are booked including pianists and singers. There are opportunities for religious worship, this is supported and there is a small chapel at the home. Independent lifestyle is supported and care plans demonstrated attention to support people’s choices and preferences in daily living. Daily life in the dementia care wing was observed. On the ground floor a small group of people had been enjoying a poetry reading session. People were seen in their rooms sleeping in bed or watching television from their chair. Notice boards display the day, the date, the staff on duty and these were up to date. The menu is displayed at the home but is not on the tables, this may help to remind people what they have ordered as picture menus are not available yet. We observed the afternoon activity , which was music. People came to the communal lounge to play instruments and listen to the keyboard being played. Tea and cake is offered. Whilst some people clearly enjoyed the event, at over two hours long some people were flagging by the end. It is important that staff are aware that unadapted wheelchairs are designed for transport and that if activities are to be enjoyed consideration should be given to the seating people have. The sitting room contains many comfortable chairs and people should be offered these. Some input to menus from people in the home is encouraged through residents meetings. There were some comments that meals on the upper floors are not hot enough and this is being addressed. The main dining room was laid up smartly for lunch. The menu is clearly displayed and contains a full range of options including a cooked breakfast option. Lunch alternatives include omelettes, jacket potatoes, and salads. The menu is not clearly displayed on Rookery. At lunch time staff were seen helping people on a 1:1 basis they were seated and help was given discreetly. People said they enjoyed the food. One person praised the variety of the breakfast menu. Another said, “I love my porridge and grapefruit. There are lots of other choices but I like that.” The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 18 97 of people who participated in the Resident Satisfaction survey found the food to be good or excellent. The Burnham Nursing and Residential Home DS0000069138.V374471.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 18 Quality in this outcome area is good. The company has a complaints policy and procedure to follow, this is available to people at the home and their relatives. Complaints had been investigated and recorded thoroughly. There are policies and procedures in place to protect people in the home. Staff receive training to ensure people are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a company complaints policy and procedure that is available to people living at the home and their relatives. The monthly visit by the company to conduct a care home regulation 26 visit includes checks on the incidence and nature of any complaints received that month. There were four complaints or concerns recorded at the home and three referred to CSCI. Two random inspections have been undertaken as a result of complaints about the home. There was evidence of thorough investigation and recording of the complaints. There are letters of thanks and compliments received from relatives pleased with care their families had received. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 20 The home now has a grumble book on each floor where it is hoped that concerns can be addressed before they escalate to complaints. The local guidance “Safeguarding Adults in Somerset” was seen on each floor. There is a safe system of managing people’s finances. Computerised records are kept and checks on randomly selected accounts confirmed the records. Some people spoken to missed having their own money and being responsible for paying their own hairdresser bills for example. The Burnham Nursing and Residential Home DS0000069138.V374471.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 22 23 24 25 26 Quality in this outcome area is good. The environment is safely maintained and there is evidence of investment and improvement to the home. The exterior and grounds of the home have improved since the last inspection. There are systems in place to ensure the home is pleasant and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been suitably adapted as a nursing home with assisted bathing and toilet facilities. There is equipment for patient handling and nursing care The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 22 provision. There is a nurse call system through out the building. People confirm that staff answer the bells promptly “most of the time.” Additional and replacement equipment purchased since the last inspection included new bedpan washers and profiling beds. The home has fire alarm and fire safety equipment all of which are regularly maintained. BUPA has invested in extra equipment to improve evacuation procedures in the event of a fire. Communal areas are decorated in a homely manner. Bedrooms have en-suite facilities and bathrooms were clean and well equipped. Carpeting in corridors has been replaced The dementia garden for which the home achieved grant funding towards its development last year, has been landscaped. The home won a prize for Burnham in Bloom in 2008. Infection control is generally well managed. There are staff hand washing facilities around the home and staff have access to personal protective clothing such as gloves and disposable aprons. People responding to the Resident Satisfaction Survey were pleased with their rooms and the overall cleanliness of the home. The Burnham Nursing and Residential Home DS0000069138.V374471.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 Quality in this outcome area is good. There are policies and procedures in place for recruitment practice that will protect service users from the risk of harm. Training is taking place and this has included dementia care training and person centred care planning to improve the quality of care practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a sufficient number of staff on duty at the time of this inspection with an appropriate skill mix. On arrival a senior charge nurse was running the home and the manager had gone to a persons’ funeral. There were four registered nurses on duty, one of which was a Registered Mental Nurse. There were 8 carers on duty supported by a range of ancillary staff. Staff are based on one floor to promote continuity of care but are expected to be flexible in emergencies. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 24 A registered mental health nurse (RMN) works on the dementia care unit, full time each week. The RMN is supported by a team of regular care staff that have received dementia care training. The staffing levels have been adjusted as there are empty rooms at the moment. Some staffing issues are on going. Rookery has one member of staff at night and this is under continuous review as the dependency levels on this unit are rising. One person on Rookery said, “staff are very nice but they need more.” The dementia unit staffing is by two carers on the unit overnight with assistance from the trained nurse on the Sandpiper unit. Six staff files were examined and staff were seen and spoken with during the inspection visit. Staff were heard to be pleasant and helpful in their interactions with people who live at the home. Praise was heard for their kindness and for the care they give to people living here. One carer said, “It is nice to work here.” Care staff confirmed that they had had training and that they had support from nurses. “We are not asked to do anything we are not able to do.” Staff recruitment demonstrated safe practice with references and criminal record bureau checks being on file for all staff. Registered nurses personal identification numbers (PIN) had been checked with the nursing and midwifery council (NMC). Staff files and computer records demonstrated that mandatory training had been given. Records showed that staff are trained in Manual handling, Fire prevention, and Abuse Awareness. All staff are provided with appropriate training. Nurses spoke of the clinical up-dates they had undertaken. New staff receive a comprehensive induction based on Skills for care with additional training over nine months. There are induction booklets for health and safety, activities and dementia Care. Staff are also trained in basic infection control and the control of substances hazardous to health. (COSHH.) Meetings are held regularly for all staff and attendance is mandatory. Trained staff meet on a monthly basis, as do heads of departments. Meeting minutes were seen at the inspection. Staff supervision was recorded and it was found that staff had set objectives for their personal development under the company ‘Personal Best’ programme. It was noted that of permanent and bank care staff 22 have NVQ 2 or above. This is below the National Minimum Standard recommendation of 50 . The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 25 The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 26 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 37 38 Quality in this outcome area is good. The manager is qualified and experienced. There is a robust management structure in the home that ensures people receive a good standard of service in all areas. The home has a system of planned maintenance and health and safety monitoring that protects staff and the people who live in the home. The manager and the company have addressed all action points for improvement since the last key inspection. This judgement has been made using available evidence including a visit to this service. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager is Mrs Jackie Daniels who has been at the home for fourteen years and holds the Registered Managers Award. At this inspection the home appeared to be well managed. There is a range of BUPA systems and procedures in place. The home has a management team of heads of department co-ordinated by the home manager. Mrs Daniels continues to be closely involved with people who live in the home being ready to “fight the corner” of any person in the home who needs her help and support. There is a comprehensive range of policies and procedures that are reviewed and up-dated by the company. There are several ways in which the home seeks the views of people who live in the home. Quarterly meetings are held where people can express their views and recorded minutes can be acted on. The manager has informal review meetings with families. Notes of meetings are kept and signed by all parties. There is an annual quality assurance questionnaire which was sent to CSCI. There is planned servicing and health and safety management by designated staff members. We spoke to the full time maintenance man who explained his responsibilities for checking bed rails, water temperatures and fire equipment. A decorator and gardener are also employed by the home. The Health and Safety procedures in the home are monitored and supported by the home manager and regional teams. Maintenance is planned and recorded. Random checks undertaken at inspection confirmed this. The kitchen has received a 5 star (the highest) award from Environmental Health. A recent check by the Health and Safety Executive confirmed that the home had a high standard of health and safety compliance. There is an efficient system of office administration Records of peoples’ finances are recorded and were seen to be accurate. All records requested were quickly accessible and appropriately stored. BUPA has systems to ensure and improve the quality of care in the home and other aspects of service delivery. Monthly audits are conducted by the regional manager assessing many aspects of home life. The Burnham Nursing and Residential Home DS0000069138.V374471.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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 N/A 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 3 18 3 3 3 X 3 3 3 3 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 3 3 X 3 3 The Burnham Nursing and Residential Home DS0000069138.V374471.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 OP27 Regulation 18(1)(a) Requirement Staffing levels must be sufficient to meet the needs and safety of the people in residence. Staffing levels must continue to be monitored to take into account the layout of the building and the staff to people in residence ratio. Timescale for action 30/06/09 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. 3. Refer to Standard OP8 OP15 OP7 Good Practice Recommendations All staff should be aware of the risk to people of pressure damage when they spend too long in wheelchairs and appropriate preventive action should be taken. The manager should take action to ensure that all meals delivered to people in all units of the home are sufficiently hot. When writing and reviewing the Quest care plans staff should ask themselves what is really happening to that person and is the care that is planned actually being DS0000069138.V374471.R01.S.doc Version 5.2 Page 30 The Burnham Nursing and Residential Home delivered. The Burnham Nursing and Residential Home DS0000069138.V374471.R01.S.doc Version 5.2 Page 31 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 The Burnham Nursing and Residential Home DS0000069138.V374471.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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!