Inspection on 24/08/09 for Birchwood Care Home

This is the latest available inspection report for this service, carried out on 24th August 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Birchwood Care Home Birchwood Road Newbury Berkshire RG14 2PP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Yvonne Souden     Date: 2 4 0 8 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 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. 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 Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Birchwood Care Home Birchwood Road Newbury Berkshire RG14 2PP 0163533967 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.burroughs@careuk.com Care UK Community Partnerships Ltd Name of registered manager (if applicable) Miss Debra Winwood Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 60. The registered person may provide the following category of service only:Care home providing nursing - (N) Care home providing personal care - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE(E)) Date of last inspection Brief description of the care home Birchwood has been purpose built to meet the needs of people with physical and or mental frailty, and is separated into three units over three floors. Each unit has its own staff team, and has a comfortably furnished lounge, dining room and assisted bathroom; there are rooms outside of the units that are used for meetings and activities. Residents have a single room and private bathroom within the unit that they live. The home is situated in Newbury close to public transport and local amenities. Care Homes for Older People Page 4 of 24 Over 65 0 60 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Date of last key inspection 26 September 2007. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The manager completed an Annual Quality Assurance Assessment (AQAA), which is a legal document provided, by the commission. The AQAA was used by the manager and provider to review their service and inform the commission of their findings. The AQAA was used as part of the evidence to inform this report. Other evidence used to inform the report included a 7 hour site visit to the service by one inspector. This enabled the inspector to observe care practices and speak to people who use the service, staff and management of the home. The Care Quality Commission received completed questionnaires from people who use the service and their relatives, staff and from health and social care professionals who have regular contact with the people who live in the home; their views of the service provided have been used to inform the report. Care Homes for Older People Page 5 of 24 Other evidence used to inform this report was documentation viewed by the inspector during the site visit. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: Birchwood Care Home meets the personal, health and social care needs of the people who live there, but the service should ensure documents that monitor a residents weight, food and fluid intake are used to their full potential to monitor and identify any change that should be referred to health care professionals, and or to update the persons care plan. This is to make sure the persons nutritional and health care needs are fully monitored and met. The manager should review staff working times through formal one to one meetings. This is to make sure staff are not too tired to safeguard the people who use the service. The manager should ensure staff receive an opportunity to have regular one to one meetings with their manager. This is to support staff within their development needs and to be confident that staff are able to meet the needs of the residents. The manager should ensure employment history dates include the full date of the persons last employment, not just the year. This is to identify any gaps in the persons employment history and have those gaps explained to protect the people who use the service. Care Homes for Older People Page 7 of 24 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. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Birchwood Care Home ensures information about the service provided is available to those people who use the service and to people visiting the home. People who want to live in the home have their needs fully assessed and are assured these will be met prior to admission. Evidence: The home has produced a Statement of Purpose & Welcome Pack. The information supplied in these documents is in easy read English and is sufficiently detailed to enable a potential resident or purchaser of services to feel confident about what services are on offer at the home. Residents and their relatives said within surveys sent by the commission that they had received enough information from the service to help them decide if the home was the place for them. A social care professional said within a survey sent by the commission that the service does well by providing thorough assessments and identifying needs. Care Homes for Older People Page 10 of 24 Evidence: The documentation for four residents was examined. Assessments within those files show that a detailed pre-admission assessment was undertaken by the home, and that a full assessment of need by the funding authority had taken place prior to the residents admission. Both assessments were used by the service to consider carefully the needs of the prospective resident before agreeing admission. Following admission the use of clinical tools to assess and review the residents nutrition, communication, mobility, risk of falls, continence and mental state are undertaken by qualified staff, and are used along with initial assessments of need to inform the residents care plan. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear information is in place to enable staff to meet the health and personal care needs of the people who use the service. People who use the service have their health and personal care needs met by a caring and respectful staff team. Evidence: The manager said within their Annual Quality Assurance Assessment (AQAA) that Residents receive effective personal and healthcare support using a person centred approach based upon rights of dignity, equality, fairness, autonomy and respect. A resident said within a survey sent by the commission that the home is, friendly, caring and understands patients needs. We looked at the records of four residents. All had detailed care plans in place that are reviewed regularly with involvement of the resident and or their relative or advocate. Care plans covered each personal and health care need and how to meet those needs, including risk assessments, for example, falls, manual handling, nutritional screening Care Homes for Older People Page 12 of 24 Evidence: and regular monitoring of residents weight. A summary of the care plan had been developed for quick reference of the residents individual needs. The records are stored on the Saturn computer system and computer terminals are available to all staff to update as necessary. Up to date written copies of residents care plans are available to residents and securely stored to ensure clients confidentiality. Social care professionals said within surveys sent by the commission that residents social and health care needs are monitored, reviewed and met by the care service. Health and social care records kept by the home show that health and social care professionals visit residents within the home regularly, for example, GP, district nurse, dietician and chiropodist. Staff were observed going into the rooms of those residents who remained in bed to offer assistance and to meet the persons personal care needs. Pressure care equipment used in the prevention of pressure ulcers developing was in use, for example pressure care mattresses and cushions, and there was evidence in the files that body maps, measurements & photographs are used when necessary to evidence healing and treatment of wounds. The home is reviewing the safety triggers they use that result in the use of individual client food and fluid monitoring. Staff spoke to residents as individuals in a manner that was sensitive, caring and respectful towards them, and provided personal care in a discreet and sensitive manner. A relative said that, All staff are amazing, friendly and very helpful. Another relative said, With some staff there are language problems. Residents sometimes can not understand and become confused. Telephone calls to families can be very difficult to interpret particularly when there has been a medical situation. A new care said, I understand English very well, but have difficulty speaking English, but I am attending studies to improve. Training records viewed show that staff have accessed training through the local authority on effective communication and English Language. Staff receive training and refresher training to keep abreast of good practice within the administration of residents medication. From examination of the medication administration system and discussion with senior staff and nurses it is clear that the home follows best practice guidance in relation to medication needs. The administration and storage system used for medication are effective and disposal systems are safe. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are given the opportunity to participate within the activities and lifestyle they prefer, and are encouraged to maintain contact with their family and friends. Good menu planning by the service ensures people have a choice, and have their nutritional needs met. Evidence: Residents said within surveys sent by the commission that the home arranges activities that they can take part in, one comment was, the home provides everything that is required to enable me to live comfortably and have a good quality life. The service employs a full time activity organiser who was observed to have patience and understanding of the residents needs and spoke of various activities provided within the home, for example, art and craft, and guess the song, a game that was observed to be enjoyed by some of the residents on the day of the inspection. A weekly activity schedule was in place that included daily tasks with care staff, for example making beds and preparing breakfast. Residents were observed to access other floors with assistance from staff. A resident said, I often come up to this floor to visit my friend. Pictures were on the walls Care Homes for Older People Page 14 of 24 Evidence: throughout the home that residents had made that added to the homely atmosphere of the home, and there were photographs of residents enjoying activities and days out within the community. The most recent photographs for residents to see were of their garden party that raised 420 pounds for the residents welfare. Local church leaders visit the home to provide spiritual support and guidance. The service has added some colour to the corridor walls on each floor and added memory boards by the residents bedroom doors for residents to put pictures or objects that are important to them that help them to distinguish areas. Each floor has suitably equipped dining rooms where most of the residents eat their meals. We observed residents having lunch in a very relaxed and happy atmosphere. Staff were helpful and friendly towards the residents assisting where needed, and meals were nicely presented. Picture menus have been developed and menus offer choice; residents who have specialist dietary needs have those needs met. A resident said, we are well cared for and well fed. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and staff within the home listen to the people who use the service and their representatives. Complaints are taken seriously, and action is taken to protect the people who use the service from abuse. Evidence: Residents said within a survey sent by the Commission that they know how to make a complaint and that there is someone they can speak to informally if they were not happy. Health and social care professionals said within surveys sent by the commission that the home responds appropriately if a person who uses the service has raised any concerns. Staff said that they receive regular safeguarding adult training and training records viewed confirmed this. Staff described what they would do if anyone was at risk of abuse, and were knowledgeable of up-to-date safeguarding policy and procedures kept within the home. Staff said they would not hesitate to protect the people in their care. Since the last inspection the home has made two safeguarding adult referrals to the local authority. There have been no referrals made to the protection of vulnerable adults list (POVA). Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 people who use the service benefit from living in a home which is pleasant, comfortable and safe. Evidence: The home was observed to be homely, clean, fresh and comfortably furnished with sufficient domestic staff to maintain a fresh and clean environment throughout the home. Infection control policies and procedures are in place, and staff have received infection control training. Care plans clearly describe how staff are to assist residents to protect themselves and promote infection control. Safety procedures, for example, Fire Safety and Containment of Substances Hazardous to Health (COSHH) are followed by staff, and maintenance of the home is undertaken to ensure the home remains safe and well maintained. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 number and skill mix of staff that have been appropriately recruited and trained contribute to positive outcomes for the people who use the service. Evidence: Staff were observed to be unhurried in their work attending to residents needs with dignity, respect, and with a caring attentive attitude. Health and Social care professionals said in surveys sent by the commission that they are satisfied with the service provided. One comment was, staff are always helpful friendly and approachable with residents and family members. Staff showed awareness of health and safety. Records identified that staff have received mandatory health and safety training and have had training updated as necessary, for example, moving and handling, infection control, health and safety, basic food hygiene and fire safety. Staff also attend specialist training, for example, dementia awareness. Residents and their relatives were generally complimentary about the qualities of the staff team with comments such as, Brilliant, when asked what makes it brilliant the relative said,the people, staff are so attentive. Comments in surveys, were for example, always friendly staff, kept well informed of changes and one that can be viewed as a negative or positve could sometimes be a little more persuasive in encouraging residents to come out of their room and take part, sometimes staff are too kind hearted and residents take advantage. The manager said that the home has had a low staff turnover this year, with only two nurses leaving to work for the NHS, and Care Homes for Older People Page 18 of 24 Evidence: said that the staffing team is quite stable. Staff said within staff surveys sent by the commission that there are always, usually or sometimes enough staff to meet the needs of the residents. One comment was, on occasions more staff should be on shift as I feel the ratio is too low, another comment was, the home could do with more staff so that the staff we have are not stretched to there limit, making people tired and less able in stressful situations. The rota details a full compliment of staff to meet the needs of the residents and the manger said that the home promotes continuity of care by having a separate team of staff for each floor; evident from records that we viewed. The rota identifies that staff work mostly between 40 and 50 hours with some working in excess of 60. Staff have signed to opt out of the 48 hour working time directive. The manager should review staff working times through supervision to ensure staff are not too tired to safeguard the people who use the service. We reviewed the recruitment files of three staff. All necessary pre employment checks had been undertaken including two references and CRB clearance obtained. Management should ensure employment history dates includes the full date of the persons last employment and not just the year to ensure there are no gaps. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from living in a well managed home, where there is evidence that their health, welfare and safety are of primary importance. Evidence: Since the homes last inspection in September 2007, the service has a new manager who is held in high regard by staff, residents, residents relatives and health and social care professionals alike. The manager holds a level 4 NVQ in care and level 4 in management, and has submitted an application to the Care Quality Commission to become the registered manager of the service. In general staff said in surveys sent by the commission that they feel the home is well managed and run in the best interests of the residents. Staff on duty said that they enjoyed working at the home and felt supported by the manager. Residents who were able to express an opinion were positive about the care that they receive. Surveys sent by the commission and completed by health and social care professionals and residents detailed positive comments of the service provided. Care Homes for Older People Page 20 of 24 Evidence: Social care professionals said about the home, the home is much improved with a manager and clinical lead now in place, and activities are improving as prime workers and senior staff are empowering other staff on individual units to carry out tasks, therefore more people in the home are being offered activities. Appropriate quality assurance procedures are in place, including annual surveys, audits of procedures and regular visits undertaken under regulation 26 of the Care Standards Act, by a senior representative of Care UK. Policies and procedures are regularly reviewed and there is an annual development plan. The manager holds regular resident and relative meetings and staff meetings to gain feedback of the service provided. Staff that we spoke to said the manager was supportive. There is a formal supervision plan and those who supervise staff have received supervision training. Supervision is recorded. Staff say in surveys sent by the commission that they feel they have enough support, experience and knowledge to meet the needs of the residents, but some comments conflict this, for example one comment was, the home could do better with professional updates, and another was, could do better by updating all staff of their professional development. Records show that staff do not always receive formal supervision as regular as they should. This is an area that could improve to promote staff development and support the staff team. The home has appropriate health and safety policy and procedures in place. Discussions with staff and records viewed show that all staff have received manual handling training, appropriate training within fire safety, first aid, food hygiene and infection control. Substances which may be hazardous to health are stored in locked cupboards. Environmental risk assessments are completed, records are kept of accidents and incidents and relevant occurrences are notified to the Commission under regulation 37 of the Care standards Act. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: 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). 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