Burlington Court Care Home Service Adults

Burlington CourtCare Home Service Adults3 Stepps RoadGlasgowG33 3NQTelephone: 0141 774 7880

Inspected by: Jacqueline Young

Julia Bowditch

Type of inspection: Unannounced

Inspection completed on: 2 July 2012

ContentsPage No

Summary 31 About the service we inspected 52 How we inspected this service 73 The inspection 154 Other information 325 Summary of grades 336 Inspection and grading history 33

Service provided by:Guthrie Court Limited, a member of the Four Seasons Health Care Group

Service provider number:SP2005007863

Care service number:CS2011301476

Contact details for the inspector who inspected this service:Jacqueline YoungTelephone 0141 843 6840Email [email protected]

Inspection report continued

Burlington Court, page 2 of 34

SummaryThis report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change after this inspection following otherregulatory activity. For example, if we have to take enforcement action to make theservice improve, or if we investigate and agree with a complaint someone makesabout the service.

We gave the service these grades

Quality of Care and Support 2 Weak

Quality of Environment 3 Adequate

Quality of Staffing 3 Adequate

Quality of Management and Leadership 3 Adequate

What the service does wellAt the time of this inspection it had been eight months since the home had beenregistered under a new provider. Positive changes were noted by staff in relation tothe provider's commitment to improving the environment.

There is an understanding from management about what is needed to move thehome forward.

What the service could do betterThree recommendations and three requirements made at the last inspection havebeen repeated in this report. The recommendations relate to communication withpeople with dementia, observing staff in practice and a service development plan.The requirements are about improving the overall quality of personal plans, thequality of staff handovers and staffing arrangements in the dementia units.

The grade of 'weak' continues because of staffing at mealtimes. After our visit themanager advised us that plans were in place to introduce a 12pm to 6pm shift inunits to improve mealtime support. This is acknowledged as a positive development.



What the service has done since the last inspectionThis inspection found improvement in areas related to the majority of requirementsand recommendations made in the last inspection report. This includedparticipation, plans to improve the environment, staff meetings, staff e-learning andaddressing actions from audits.

ConclusionThis report shows the improvements made since the last inspection. However, morework is needed on improving the quality of personal plans and shift handovers. Inaddition, continued weaknesses found in relation to staffing in the dementia unitsmust be addressed by the provider as a matter of priority.

Who did this inspectionJacqueline YoungJulia Bowditch



1 About the service we inspectedThe Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, thisfunction was carried out by the Care Commission. Information in relation to all careservices is available on our website at www.scswis.com

This service registered with the Care Inspectorate on 31 October 2011.

Requirements and RecommendationsIf we are concerned about some aspect of a service, or think it could do more toimprove its service, we may make a recommendation or requirement.

- A recommendation is a statement that sets out actions the care service providershould take to improve or develop the quality of the service but where failure to do sowill not directly result in enforcement.

- A requirement is a statement which sets out what is required of a care service tocomply with the Public Services Reforms (Scotland) Act 2010 and Regulations orOrders made under the Act or a condition of registration. Where there are breaches ofthe Regulations, Orders or conditions, a requirement must be made. Requirements arelegally enforceable at the discretion of the Inspectorate.

Burlington Court Care Home is owned by Guthrie Court Limited a member of FourSeasons Health Group which owns other care services.

The home is located in the Queenslie area of Glasgow. It is at the edge of a housingestate and near the M8 motorway.

The service provides care and support to a maximum of 90 older people of whom 43have dementia care needs.

The home is purpose built and is a two storey building with the people with dementialiving on the ground floor. All bedrooms are single and have ensuite shower facilitiesand there are communal bathrooms and toilets throughout the home.

The home is divided into four units to allow for smaller group living for service usersand each area has its own sitting and dining room. A garden area is available topeople.

The aims and objectives were generic to the organisation. We discussed thatthese ought be developed to reflect support delivery that is specific to BurlingtonCourt. We will look at progress on this on the next inspection.



Based on the findings of this inspection this service has been awarded the followinggrades:

Quality of Care and Support - Grade 2 - WeakQuality of Environment - Grade 3 - AdequateQuality of Staffing - Grade 3 - AdequateQuality of Management and Leadership - Grade 3 - Adequate

This report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change following other regulatory activity. You canfind the most up-to-date grades for this service by visiting our websitewww.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of ouroffices.



2 How we inspected this service

The level of inspection we carried outIn this service we carried out a medium intensity inspection. We carry out theseinspections where we have assessed the service may need a more intense inspection.

What we did during the inspectionThis inspection was carried out by inspectors Jacqueline Young and Julia Bowditch.

The inspection visits took place over three days. We attended the Home DevelopmentCommittee on the evening of 17 May 2012. Following this we did an unannouncedvisit on 13 June, starting at 7.15am so that we could meet some night shift staff andobserve the handover of shift. We finished this visit at 2.30pm.

We did a further visit on 20 June from 9.30am to 2pm. At the end of this visitwe gave feedback to the manager and the home's external manager. Jim Frenchfrom Contracts and Commissioning (Glasgow City Council) was also present for thefeedback meeting. The inspection was concluded on 2 July 2012, following furtherinformation sent to us by the provider.

The main focus of this inspection visit was to look at progress on requirements andrecommendations made at the last inspection.

As requested by us, the service had previously sent us an annual return andcompleted a self assessment about the service.

In this inspection we gathered evidence from various sources including the relevantsections of policies, procedures, records and other documents, including:

- the self assessment the home submitted to us prior to our visit- the action plan from the last inspection detailing how requirements andrecommendations would be progressed

- aims and objectives of the service- personal planning paperwork and review records- minutes of meetings for residents, relatives and staff- staff training information- a walkround of the environment- observation of a verbal handover of information from night staff to day staff- observation of the breakfast meal in the Marshall and Douglas units.



We also spoke with the following people:

- the manager- two deputy managers- a charge nurse- three nurses- the external manager- 6 care assistants- domestic staff- 12 people who use the service- 6 relatives- a visiting GP.

We observed how staff work including their interactions with service users. We alsoexamined the environment. For example: Is the service clean? Is it set out well? Is iteasy for people to move around? Is the environment suitable for people who may beconfused?

Grading the service against quality themes and statementsWe inspect and grade elements of care that we call 'quality themes'. For example,one of the quality themes we might look at is 'Quality of care and support'. Undereach quality theme are 'quality statements' which describe what a service should bedoing well for that theme. We grade how the service performs against the qualitythemes and statements.

Details of what we found are in Section 3: The inspection

Inspection Focus Areas (IFAs)In any year we may decide on specific aspects of care to focus on during ourinspections. These are extra checks we make on top of all the normal ones we makeduring inspection. We do this to gather information about the quality of these aspectsof care on a national basis. Where we have examined an inspection focus area we willclearly identify it under the relevant quality statement.

Fire safety issuesWe do not regulate fire safety. Local fire and rescue services are responsible forchecking services. However, where significant fire safety issues become apparent, wewill alert the relevant fire and rescue services so they may consider what action totake. You can find out more about care services' responsibilities for fire safety atwww.firelawscotland.org



What the service has done to meet any requirements we made atour last inspection

The requirement1. The provider must ensure that reviews of service users' care take place 6 monthly inline with legislation.

What the service did to meet the requirementSee Quality Theme 1, Statement 1.

The requirement is: Met

The requirement2. The provider must ensure that the care plans are person centred and providedetails of service users' likes, dislikes and support they would like to receive. Serviceusers or their representative must be involved in the care planning process.


The requirement is: Not Met

The requirement3. The provider must ensure that where deficits in care planning are identified thatthe care plans are updated.



The requirement4. The provider must ensure that where appropriate service users have pain riskassessments undertaken and care plans developed.





The requirement5. The provider must ensure that all services users have a care plan which detailsmedication prescribed, administration guidance, reason for the medication, sideeffects and how often the medication should be reviewed. All service users whoreceive medication must have a review of their medication by the relevant GP orconsultant. Where service users require covert medication a care pathway in line withMental Welfare Commission guidance must be in place.



The requirement6. The provider must ensure that the two dementia units are in line with best practicefor dementia care environments. This includes appropriate signage and orientation forpeople around their environment.



The requirement7. The provider must ensure that staff have appropriate training in working withpeople with dementia, this should include providing care to people with dementia,care planning, activities, environment and managing behaviour which is challengingto the service.



The requirement8. The provider must ensure that there is the appropriate number of staff withappropriate skills in caring for people with dementia working in the two units forpeople with dementia.




The requirement is: Not Met

The requirement9. The provider must ensure that infection control practice within the home isimproved and that the following areas addressed:

• Sealing of paint in toilet/bathrooms• Lids placed on all bins• All baths and chairs to be cleaned after use• Communal bars of soap and toiletries to be removed from toilets/bathrooms.



The requirement10. The provider must ensure that all staff receive a handover of information from theprevious shift to ensure that they are aware of the support needs of service users. Atthis time the service users must be supported by staff.


The requirement11. The provider must review the management arrangements within the home toensure that there are sufficient management hours in place. As part of this a reviewof the depute managers' roles to review whether they are managers or the nurses onshift providing direct care to service users should take place.





What the service has done to meet any recommendations we madeat our last inspectionNine recommendations were made in the last inspection report. These were aboutpeople's involvement in assessing the quality of service, laundry, management of staffperformance and a service development plan.

For progress on the above recommendations, please refer to the main body of thereport.

The annual returnEvery year all care services must complete an 'annual return' form to make sure theinformation we hold is up to date. We also use annual returns to decide how we willinspect the service.Annual Return Received: Yes - Electronic.

Comments on Self AssessmentEvery year all care services must complete a 'self assessment' form telling us howtheir service is performing. We check to make sure this assessment is accurate.

All sections of the self assessment were completed. Information provided focusedmore on describing processes. In order to see what the service does to bring aboutimprovements or change for people, it would be good to provide examples of this thathave lead to positive outcomes.

The home's self assessment ought to capture ongoing involvement of people andhow this influences decisions on grades. The self assessment can be updated toreflect ongoing changes.

The service had given 'adequate' to 'good' grades to the statements we looked atduring this inspection. Our assessment of grades were mostly similar in part, apartfrom Quality Theme 1, Statement 3, where we graded it as 'weak'.

Taking the views of people using the care service into accountWe sent out 20 service user questionnaires to the home before our visit. We did notreceive any responses from these.

Prior to the inspection we met three service users when attended a homedevelopment meeting on 17 May.



During the inspection we met with a further nine service users. We also attended aresidents' meeting. Some people were not able to express their views to us due to theeffects of dementia or other cognitive impairment. For these people we observedhow they spent their time and how staff interacted with them.

Comments from people about the quality of service included:

"The building is fine, the staff are fine, the food is decent enough. I go into the gardenwhen I feel like it. We've plans to do some work on it, we're going to start a gardenproject."

"Food is very good...no complaints really."

"I don't think the food is very good, I get the same thing every morning..."

"There was entertainment last night, I suppose there could be more to do moreoften. It would be good to get out more, a lot us need help so we need to rely onstaff and family for this."

"Generally staff do a good job, although some bits could be better. I'm an old manand I wonder why they have karaoke....sometimes the activities don't make sense.The other thing that could be better is that sometimes mealtimes can be noisy,because of the noise staff make. I think the manager needs to look at this...it wouldbe good to see more of the manager."

"I get looked after, so I'm happy enough."

A resident we spoke with was not happy about a particular aspect of care. This wasshared with the manager, who met with this person during our visit.

Taking carers' views into accountWe did not receive any responses from the 30 relative questionnaires we sent to thehome prior to our visit.

Before our inspection visit we attended a home development meeting on 17 May2012, where we met with five relatives. We met another relative during our visits.

Relatives were generally satisfied with most aspects of the service. However, concernwas raised about the staffing in the dementia units.

Other concerns were raised by another family, and as these were specific to theirrelative we asked the manager to address this.



We met one of the GPs for the home during our visit who was generally positiveabout the home.



3 The inspectionWe looked at how the service performs against the following quality themes andstatements. Here are the details of what we found.

Quality Theme 1: Quality of Care and SupportGrade awarded for this theme: 2 - Weak

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the care and support provided by the service.

Service strengthsUnder this statement we focused on reviewing action taken on four recommendationsand one requirement made in the last inspection report about participation. We alsolooked at a recommendation made under this statement about laundry.

We considered the home's action plan in relation to the above recommendations andrequirement. We also looked at people's involvement in their personal plans,opportunities for people to get involved in decisions about service delivery and howstaff spoke to and interacted with people. We found that good progress had beenmade in some areas, however more work is needed in other areas. The overallperformance for this statement was found to be 'adequate'.

The requirement in the last report stated that:"The provider must ensure that reviews of service users' care take place 6 monthly inline with legislation."

We found a calendar of reviews that showed reviews were taking place on a sixmonthly basis. This was being tracked by the manager to make sure that timescaleswere monitored. Relatives that we met said that they had been invited to suchreviews.

The following three recommendations about participation had been met:

* The provider should ensure service users' meetings are an opportunity to gainfeedback from service users and an action plan should be developed following themeetings.

* The provider should take forward methods of involving service users in the quality ofstaff.



* The provider should take forward methods of involving service users in the quality ofthe service provided.

We could see that opportunities for people to get involved in the service werebecoming more established. This included monthly resident and relative meetings.Minutes of these meetings reflected action plans and associated timescales. Therewas mixed levels of recordings in relation to feedback from people in the minutes welooked at. Minutes of relatives' meetings showed more detail of feedback, and thisought to be developed further for the recordings of resident meetings.

Questionnaires were offered to people to comment on the quality of service, thatcovered all the statements that we inspect against. The six grades that we use werealso included in the questionnaire. The current analysis of these questionnaires hadbeen considered at the last inspection. Areas for improvement highlighted by peoplein questionnaires were taken forward through the newly established HomeDevelopment Committee. These questionnaire were due to be distributed to peopleagain. The next inspection will look at the findings of the questionnaires andactions to be taken as a result of what people have said.

The Home Development Committee had started since the last inspection. Weattended one of these meetings and could see that matters raised by people werebeing taken forward. For example, an issue about laundry and access to fluids wasdiscussed. The manager told people what had been done to address both matters.Decoration was also discussed, as were plans to produce a newsletter for the home totry and improve communication and encourage more feedback from people.

A recommendation had also been made about reviewing the procedure for markingservice users' clothes and the laundry arrangements to reduce the amount of clothesgoing missing. We have referred to laundry being discussed at the Home DevelopmentCommittee. Whilst, there were still issues to do with laundry we could see that theprocedure had been reviewed and was being monitored. Therefore, therecommendation was met.

Areas for improvementA recommendation was made in the previous inspection report about developingthe participation of people with dementia. For example, by use of appropriatesignage or communication tools to assist people with dementia to make choices.This recommendation had not been met. Plans were in place to introduce DementiaCare Mapping (DCM) to the home. DCM evaluates the quality of the care beingprovided from the perspective of the person with dementia. This should help inaddressing the recommendation. (See Recommendation 1)



We suggested that information in the participation strategy used by the home couldbe developed in some areas. For instance, the updating of reference to unannouncedvisits by the Care Inspectorate and opportunities for relatives, as well as residents toget involved in staff recruitment processes.

It may be helpful to people if a local participation policy was in place that explainedthe current situation and plans for the future with regards participation. We have saidthis because the participation strategy was generic to the organisation, and someinformation was not always applicable to the home.

Best practice on meaningful participation suggests that an independent person/bodyis also used when asking service users and relatives for their views on a service. Thisis highlighted in the grading criteria we and providers should use for service userengagement (see Care Inspectorate website "Guidance for providers of regulatedservices: 2011/12 Arrangements for the inspection of regulated services, AppendixGrading Criteria Scale"). The home ought to look at taking this forward.

Grade awarded for this statement: 3 - Adequate

Number of requirements: 0

Number of recommendations: 1

Recommendations

1. The provider should develop opportunities for people with dementia to make dailychoices and be involved in decisions about their care.

National Care Standards, Care Homes for Older People, Standard 8: Making Choices.



Statement 3We ensure that service user's health and wellbeing needs are met.

Service strengthsWe focused on reviewing progress on seven requirements made under thisstatement at the last inspection. Five of the seven requirements wereabout improving personal plans. The other two requirements were about stafftraining, and the number and skills of staff on shift. The grade on performance isdetailed under 'areas for improvement' for this statement.

We found that the following three requirements had been met.

"The provider must ensure that all service users have a care plan which detailsmedication prescribed, administration guidance, reason for the medication, sideeffects and how often the medication should be reviewed. All service users whoreceive medication must have a review of their medication by the relevant GP orconsultant. Where service users require covert medication a care pathway in line withMental Welfare Commission guidance must be in place."

We found that care plans for prescribed medicines had improved since our last visit.From the sample we looked at we could see the information referred to in the aboverequirement. We did suggest that some information was quite clinical, in that youwould need to have a medical background to understand some of the terminology.We suggested that this was simplified so that the person and their representativecould easily understand the medicine care plan.

The management of covert medication was captured within the care planningprocess. We highlighted that the pathway the home was using did not quite coverthe structure of the Mental Welfare Commission on covert medication. During theprocess of the inspection, the home started to use the pathway on covert medicationas made available by the Mental Welfare Commission for Scotland (Covert MedicationPathway Review, pg6: Covert Medication, 2006).

"The provider must ensure that the two dementia units are in line with best practicefor dementia care environments. This includes appropriate signage and orientation forpeople around their environment."

Since our last visit some decoration had been done in one of the dementia units. Thishad freshened up some areas, such as corridors and the lounge area. We could alsosee some environmental aspects, such as wall decorations that were more reflectiveof dementia design.



Plans were in place for the home to start work in September on obtaining the PEARLaward. Part of this would include work on the the environment in relation to meetingthe needs of people with dementia. The provider's website explains that PEARL'involves staff training in dementia care mapping, person centred care andexperiential training. Key elements in the programme are that staff recognise andrespond to the holistic needs of residents, measures to engage with residents andcreating a sensory enhancing environment'. This is a good development as this willprovide staff with a more rounded understanding of how the environment needs tobe adapted to meet the needs of people with dementia. We will follow up on this onfuture visits.

"The provider must ensure that staff have appropriate training in working with peoplewith dementia, this should include providing care to people with dementia, careplanning, activities, environment and managing behaviour which is challenging to theservice."

The above information about the PEARL award has been taken into account for thisrequirement. Based on what we have said about this, the requirement above hasbeen met. Future inspections will look at the impact on staff knowledge with regardsto supporting people with dementia. We will expect to see an evaluation that showswhat difference undertaking the PEARL award has made to staff practices andsubsequently outcomes for people with dementia.

Areas for improvementThe following three requirements were made in the last inspection report:

"The provider must ensure that the care plans are person centred and provide detailsof service users' likes, dislikes and support they would like to receive. Service users ortheir representative must be involved in the care planning process."

"The provider must ensure that where deficits in care planning are identified that thecare plans are updated."

"The provider must ensure that where appropriate service users have pain riskassessments undertaken and care plans developed."

In the sample of personal plans we looked at, we could see that some recordingswere better than others in relation to the above requirements. However, there wasstill a need for the overall quality of personal planning to improve.



At the time of our visit, the structuring of personal planning paperwork was in theprocess of being changed. We could see that this was in a transitional period,whereby information was being transferred onto different paperwork. This did nothelp in the presentation of showing a clear process of care planning from assessmentthrough to evaluation.

We discussed that personal plans need to start off with a clear introduction to whothe personal plan is written for, then move to assessment of need, then from this tocare plans, reviews and evaluations. We also highlighted that evaluations of careplans needed to improve. For example, a good evaluation of a care plan would showan analysis of the last month's support, and confirm if current staff actions wereeffective, including consideration of any associated risk assessment.

We were able to see audits carried out by the manager that identified work needed toimprove personal plans. Given changes to paperwork and associated audit process,we have made one encompassing requirement about the recordings and presentationof information in personal plans. (See Requirement 1)

On the last inspection we were concerned about the level of staff support available topeople at breakfast time. This was based on observations of the management ofbreakfast in the two dementia units. The following requirement was madeabout staffing, and staff reduction on the late shift will be repeated.

"The provider must ensure that there is the appropriate number of staff withappropriate skills in caring for people with dementia working in the two units forpeople with dementia. A review should also be undertaken of the reducing of staff onthe late shift."

During this visit we spent time again observing how the breakfast time in diningrooms was managed for people with dementia. Whilst we could see that staffmembers 'leading' the breakfast were trying their best to meet people's needs, therewere still not enough staff for this to be effective.

For example, at one point we observed seven service users in a dining room with onemember of staff. One person needed full assistance to eat and drink, and so whenthe staff member was doing this there was not anyone to oversee the other serviceusers. When this was happening we sat with two people who clearly needed staffsupervision to help them eat and drink. One person was falling asleep, and the otherperson was spilling most of the contents of a glass of milk.



Staff and relatives continued to raise issues about the level of staffing at the eveningmeal as well. In addition, we continue to be concerned about staffing numbers in thedementia units reducing in the afternoon. Our concern is supported by research intodementia care, that highlights that this is the time when people are more confusedand need support from staff. This is why we have repeated some of the requirementabout staffing. (See Requirement 2)

Based on what we have said, we cannot say that staffing adequately meets the needsof people with dementia. Therefore, the grade for this statement continues tobe 'weak'. Since our visit the manager advised us that plans were in placeto introduce a 12pm to 6pm shift in units to improve mealtime support. This is apositive development, and the provider ought to evaluate the impact of this.

In the last inspection report, reference was also made to the skills of staff caring forpeople with dementia. On this visit we found good staff interactions with people.However, this needs to be considered in ongoing management evaluations of staffpractices. Further comment is made about this under Quality Theme 3, Statement 3,of this report.

Grade awarded for this statement: 2 - WeakNumber of requirements: 2Number of recommendations: 0

Requirements1. The provider must improve the overall quality of personal plans. In order to

demonstrate this:

* information must be more person centred and show that the person and/orrepresentative has been involved

* the pathway of information must be made clearer so that the person the plan iswritten for is introduced at the beginning of the plan, followed by an assessmentof needs and goals/aspirations through to care plans and evaluation

* pain assessments must be carried out and associated care plans put in placewhen needed

* nurses as well as managers must share the responsibility of auditing the careplans that they have written

* audits must consider if the quality of information reflects a person centredapproach.



This is to comply with SSI 2011/210. Regulation 4 (1) (a) and Regulation 5 (1)(2). Requirements to make proper provision for the health and welfare of serviceusers, and to prepare the personal plan.

Timescale: within 8 weeks upon receipt of the final inspection report.

2. The provider must ensure that there are appropriate numbers of staff on shiftduring mealtimes in the Marshall and Douglas units. A review must also beundertaken to support the reasoning behind any reduction of staff numbers on thelate shift.

SSI 2011/210 Regulation 4 (1) (a) and Regulation 15 (b) (i) Staffing. Requirementsto make proper provision for the health and welfare of service users, and thatpersons working in the care service are in such numbers as are appropriate for thehealth, welfare and safety of service users.




Quality Theme 2: Quality of EnvironmentGrade awarded for this theme: 3 - Adequate

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the environment within the service.

Service strengthsThe performance under this statement was found to be 'adequate'. The evidencerelating to this has been included under Quality Theme 1, Statement 1.

Areas for improvementThe areas for improvement have been included under Quality Theme 1, Statement 1.

Grade awarded for this statement: 4 - GoodNumber of requirements: 0Number of recommendations: 0



Statement 2We make sure that the environment is safe and service users are protected.

Service strengthsWe focused on reviewing progress on two requirements made in the last inspectionreport about infection control and staff handovers. We found that the requirementmade about infection control had been met, and the other had not. Therefore, theperformance had not improved enough to change the previous grade of 'adequate'.

The following requirement was made about infection control:

"The provider must ensure that infection control practice within the home is improvedand that the following areas addressed:

- Sealing of paint in toilet/bathrooms- Lids placed on all bins- All baths and chairs to be cleaned after use- Communal bars of soap and toiletries to be removed from toilets/bathrooms."

We found general improvement in the above areas when we did a walkround of theenvironment in all units of the home.

The previous inspection report said that we would look to see if the fan in smokeroom was working properly, as it had not appeared to be working and smoke could besmelled in the hall during our last visit. We did not find this to be an issue on thisvisit. We were pleased to hear that the chairs in the smokers' room wouldbe replaced, and that the smokers' room would be decorated in July.

Areas for improvementThe air conditioning was still not working properly in the room where medication wasstored. The manager said that plans were in place to address this. We would ask thatthe provider identifies a date for resolving this matter. (See Recommendation 1)

At the last inspection we observed the verbal changeover of information from nightstaff to day staff. We were concerned that the provider had not included handovertime into staff shift times. This meant that when a handover took place, staff werenot guaranteed to be on the floor to support service users. This arrangement alsomeant that staff attendance at handovers, relied on staff goodwill to start their workearlier.



On this visit we found that time for trained staff and senior carers to have handovershad been included in their shift times. This is good, however all staff need to haveprotected time to receive and deliver handovers. This arrangement will ensure thatthe floor is adequately covered, and that the overall quality of handovers is improvedas all staff will have the time needed for effective handovers. (See Requirement 1)

Grade awarded for this statement: 3 - AdequateNumber of requirements: 1Number of recommendations: 1

Requirements1. The provider must ensure that all staff receive a handover of information from the

previous shift to ensure that they are aware of the support needs of service users.At this time the service users must be supported by staff.

This is to comply with SSI 2011/210. Regulation 4 (1) (a). A requirement to makeproper provision for the health and welfare of service users.


Recommendations1. A date for fixing the air conditioning in the room where medicines are stored

should be identified.

National Care Standards, Care Homes for Older People, Standard 4: YourEnvironment.



Quality Theme 3: Quality of StaffingGrade awarded for this theme: 3 - Adequate

Statement 1We ensure that service users and carers participate in assessing and improving thequality of staffing in the service.

Service StrengthsThe performance under this statement was found to be 'adequate'. The evidencerelating to this has been included under Quality Theme 1, Statement 1.





Statement 3We have a professional, trained and motivated workforce which operates to NationalCare Standards, legislation and best practice.

Service strengthsUnder this statement we focused on reviewing action taken on threerecommendations made in the last inspection report about staff meetings, stafflearning and observing staff in practice. We looked at evidence related to this andfound good progress in some of these areas. However, the grade of 'adequate' forthis statement will not change on this visit as there is a need to develop observationsof staff practices.

The recommendation made about regular staff meetings was found to be met on thisvisit. This is based on what staff told us and evidence of minutes of staff meetings.

A recommendation was also made about checking staff understanding and theimpact on practice following e-learning training. We could see from records related tothis that staff understanding of the training was discussed with a senior member ofstaff. Further comment on how training impacts on practice is included in the 'areasof improvement' for this statement.

Areas for improvementIn the last inspection report a recommendation was made about observing staffpractice as part of staff development. We refer to this as observational monitoring.This is very good practice in relation to managing staff performance, including theimpact of training. Some work had begun in taking this forward, but there is morework to be done before we can say that the recommendation is met.

For instance, some feedback from service users highlighted the need for managers toobserve the quality of discussions and responses by staff when working with people.Our findings about management of mealtimes is another example of staff practicesthat should be observed routinely for meaningful engagement. It would also be goodto include service users' views as part of staff observational processes. (SeeRecommendation 1)




Recommendations1. The provider should develop observation of staff practice and provide feedback to

staff as part of staff development.

National Care Standards , Care Homes for Older People, Standard 5: Managementand Staffing Arrangements.



Quality Theme 4: Quality of Management and LeadershipGrade awarded for this theme: 3 - Adequate

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the management and leadership of the service.

Service strengthsThe performance under this statement was found to be 'adequate'. The evidencerelating to this has been included under Quality Theme 1, Statement 1.





Statement 4We use quality assurance systems and processes which involve service users, carers,staff and stakeholders to assess the quality of service we provide.

Service strengthsWe focused on reviewing progress on one requirement and one recommendationmade under this statement at the previous inspection. The requirement was aboutmanagement hours, and the recommendation asked for a service developmentplan. We found 'good' performance related to these areas.

Below details the requirement:

"The provider must review the management arrangements within the home to ensurethat there are sufficient management hours in place. As part of this a review of thedepute managers' roles to review whether they are managers or the nurses on shiftproviding direct care to service users must take place."

This requirement was made because we did not feel other members of management,such as deputy managers had 'protected' and enough time to carry out theirmanagement duties. On this visit we found that both deputy managers in the homenow had a supernumerary day a week when they were not on shift as the 'nurse' toprovide direct care. This is a positive development, and the impact of this ought to bemonitored to ensure that the arrangement is effective. We will continue to look atthis on future visits.

The other areas for development highlighted under this statement at the lastinspection were found to be improving. This included participation, staff meetings andaddressing delays in actions from audits of personal plans.

Staff continued to be more positive about their work and the support given by themanager. Staff told us that the manager had helped in making systems moreorganised, and staff to be more accountable for their work. For instance, we weretold that the manager had observed a staff handover to establish what the quality ofinformation was like. From this a handover sheet had been introduced to show staffwhat the expected standard was.

One of the visiting GPs for the home, who we met, said that the home hadimproved with regards to being more organised for GP visits and pro-active regardingmedical care. In addition, we joined a staff meeting with the Care Home LiaisonNurse (CHLN). The manager had arranged this to help nurses have a betterunderstanding of the role of the CHLN, and to assist nurses in how they utilised theservice. We found this to be a very helpful meeting not just for promoting partnershipworking but also for staff development.



The CHLN was able to signpost nurses to new best practice on some health matters.This is another example of the manager supporting staff to enhance existing skillsand knowledge.

The manager recognised the areas of improvement needed to develop the home. Wecould see this from minutes of meetings we looked at, including home reviewminutes. Staff we met with were aware of the key areas of improvement for thehome. Relatives and residents had forums to express their views of the home, whichthe manager attended. We found that overall the manager was working with staff,relatives and service users to improve the service. This demonstrates an improvementin processes related to quality assurance since the last inspection.

Areas for improvementWe could see a variety of information including a business plan that related to theshort and long term objectives for developing the home. However, the informationwould be more helpful if presented in the format of a service development plan. Thiswas a recommendation in the last inspection report. A service development planwould help in monitoring and evaluating the actions taken to improve the home.When compiled the service development plan should be shared with relevantstakeholders. We reiterated the need to show ongoing participation within theservice's development plan. (See Recommendation 1)

Grade awarded for this statement: 4 - GoodNumber of requirements: 0Number of recommendations: 1

Recommendations1. A service development plan should be compiled and shared with staff, service

users, relatives and any other relevant stakeholders.

National Care Standards, Care Homes for Older People, Standard 5: Managementand Staffing Arrangements.



4 Other information

ComplaintsNo complaints have been upheld, or partially upheld, since the last inspection.

EnforcementsWe have taken no enforcement action against this care service since the lastinspection.

Additional InformationN/A

Action PlanFailure to submit an appropriate action plan within the required timescale, includingany agreed extension, where requirements and recommendations have been made,will result in SCSWIS re-grading the Quality Statement within the Management andLeadership Theme as unsatisfactory (1). This will result in the Quality Theme forManagement and Leadership being re-graded as Unsatisfactory (1).



5 Summary of grades

Quality of Care and Support - 2 - Weak

Statement 1 3 - Adequate

Statement 3 2 - Weak

Quality of Environment - 3 - Adequate

Statement 1 4 - Good


Quality of Staffing - 3 - Adequate



Quality of Management and Leadership - 3 - Adequate


Statement 4 4 - Good

6 Inspection and grading history

Date Type Gradings

7 Mar 2012 Unannounced Care and support 2 - WeakEnvironment 3 - AdequateStaffing 3 - AdequateManagement and Leadership 3 - Adequate

All inspections and grades before 1 April 2011 are those reported by the formerregulator of care services, the Care Commission.



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This inspection report is published by the Care Inspectorate. You can get more copiesof this report and others by downloading it from our website:www.careinspectorate.com or by telephoning 0845 600 9527.

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Documents

Burlington Court Care Home Service Adults