Inspection on 16/01/08 for Birchwood Nursing Home

This is the latest available inspection report for this service, carried out on 16th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Birchwood Nursing Home 26/01/06

Birchwood Nursing Home 26/10/05

Birchwood Nursing Home 20/12/04

Birchwood Nursing Home 16/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Birchwood Nursing Home Lees New Road Oldham Lancashire OL4 5PL Lead Inspector Sandra Buckley Unannounced Inspection 16th January 2008 09:30 Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 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 Birchwood Nursing Home DS0000025456.V358378.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 Adults 18-65. 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. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birchwood Nursing Home Address Lees New Road Oldham Lancashire OL4 5PL 0161 621 2750 0161 621 2779 terence.dwyer@turning-point.co.uk 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) Turning Point vacant post Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 16 (MD) No service user under the age of 18 years to be admitted to the establishment. 6th December 2006 Date of last inspection Brief Description of the Service: Birchwood is a large, detached building situated approximately four miles from Oldham town centre. The home is registered to provide nursing care for up to 16 service users with past and present mental health problems, aged 18 years and over. The property is owned and managed by the charity Turning Point, in conjunction with the local NHS Trust. Their aim is to provide care and accommodation to service users who no longer require care within a hospital setting but still require support and observation. The service offers a step down approach and enables service users to learn or re-learn life skills, enabling them to achieve independence within the community. Accommodation is in 16 single rooms, all of which have en-suite and shower facilities. Two of the rooms have been adapted to form bed-sits, with a cooker and a fridge, to promote independent living. Each room has a telephone, which receives incoming calls. There is a large lounge/dining room and a small library/sitting room. A kitchenette is provided for service users to make refreshments situated in the occupational therapy/computer room. The home provides a designated smoking area for service users. In addition to the en-suite facilities, there is one bathroom suitable for service users who may have a disability, and a domestic type bathroom. Three communal toilets are situated in other areas of the building. The home has appropriate aids and adaptations to promote the independence of their service users. The home’s fees are £750.10. Service users are required to pay for their personal hairdressing and newspapers, also some trips and entertainment in the community. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes This was a key inspection that included a site visit to the home. The clinical nurse manager was not told beforehand that we were coming to inspect; this is called an unannounced inspection. This inspection looked at all the key standards and included a review of all available information received by the Commission for Social Care (CSCI) about the service provided at the home since the last inspection. We took an ‘expert by experience’ with us. During the inspection process we gathered information from a lot of people and places, which included talking with and finding out the views of those who use the service. We sent out surveys to service users, and the ‘expert by experience’ spoke directly with some service users. This gave the people living at the home an opportunity to talk with someone, other than us, about their opinions on the services they received. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Observation of care practices took place and discussions with the clinical nurse manager and staff. A tour of the home was undertaken and a sample of care, employment and health and safety records were viewed. The CSCI requires the home to complete an annual quality assurance assessment (AQAA) in order to demonstrate the level of care provided. The manager had completed this in full and comparisons were made with this document at the time of inspection. On this inspection the outcomes for people in the home did reflect that indicated by the clinical nurse manager in the AQAA, especially in relation to daily life, personal care and protection. However, the clinical nurse manager had recognised what improvements could be made and was taking steps to address the issues. Birchwood has been through an unsettled period due to changes in management. At the time of this inspection there was no registered manager, with the clinical nurse manager taking a lead role supported by a senior manager within Turning Point until a new manager has been recruited. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 6 There have been three adult protection incidents in the home relating to medication procedures, which have resulted in the home implementing protection of vulnerable adults procedures. We are satisfied that appropriate procedures have been followed. What the service does well: The clinical nurse manager obtains professional assessments of need, including occupational health therapists, prior to people being admitted. Professionals must complete a Birchwood assessment to ensure the home receives all the information they need to meet people’s needs. Care plans gave detailed instructions to staff on care delivery and what they need to do to support people. People’s involvement in the home and care planning plays a large role in promoting community cohesiveness. This is done through one to one work with their key workers and regular community meetings. This means people know what they can expect. One person said, ‘I have a key worker who I meet with often and staff have accompanied me to the doctor’s today.’ Another person said, ‘I am involved in care planning, I am not allowed to smoke in my room and it has had to go as part of my care plan.’ People told the expert by experience ‘I go to the community meetings, most people do’ and ‘I forget what to discuss sometimes, we should have a list we should add to, like a shopping list.’ Also ‘We mostly talk about cleanliness and how the place is run’, ‘I am very much treated with respect,’ and ‘When the staff take you to an appointment you can choose if they come in with you or wait outside.’ One relative questionnaire said, ‘Staff attempt to include all clients at all times. I particularly like the common room where clients mix with other clients, staff and visitors. One person said, ‘This is a really good place, there should be more places like this.’ Another said, ‘My sister has been encouraged to lead the life she chooses and I feel the home does well, it has handled episodes of illnesses very well. They have encouraged and tried to get my sister to reach out and achieve more. The last time my sister was in hospital I was contacted by the home and kept informed throughout.’ People in the independent flats said, ‘Staff are working with me on budgeting, shopping and cooking my own meals.’ Also, ‘they do ask you if you want to get up in the morning but you can lie in as long as you like to’. Another person said, ‘I attend a local day centre to help me with social skills and development.’ Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 7 The home operates a quality assurance system that seeks the views of people in the home. A selection of comments made were “I like the freedom of Birchwood, good staff, good people, it is a lovely place” also “I like the atmosphere at Birchwood, the rooms, food and people.” Another said, “I like everything about Birchwood.” What has improved since the last inspection? What they could do better: Although there had been improvements in care planning, the clinical nurse manager should ensure that all information regarding follow-up treatment is recorded in care planning. Some irregularities were found in the recording of medication and two people who self-medicate had no risk assessments in place. This could mean that they are put at risk. Although improvements had been made in the dining experience, more could be done to promote social skills and interaction over a lunchtime period. It was identified through staff interviews that there was a lack of training in specific mental issues and that there was less than 50 of staff NVQ qualified. The clinical nurse manger had recognised these issues and was implementing in-house training provided for support staff from trained nurses on mental health signs, symptoms and management. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 8 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. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Assessments of need are obtained prior to people’s admission in order to ensure that the staff are able to meet people’s needs. EVIDENCE: Three case files were examined in depth. Professional assessment and occupational therapist assessments were obtained prior to people’s admission to the home. In addition to this, if the clinical manager found insufficient information had been provided, the referring agency is asked to complete a copy of Birchwood’s assessment to ensure staff have sufficient information to formulate a care plan. People are provided with a service user guide and licensing agreement which they keep in their bedrooms. The service user guide states that people are encouraged to visit the home for a trial period before making an informed choice. For people entering the home for a trial period the home implements a trial period assessment document, which looks at food hygiene and personal care. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 11 The AQAA states plans for improvement in the next 12 months are to formulate an internal project to improve the audit assessment and care planning system. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People are involved in care planning with their independence being supported by staff through a risk assessment framework. EVIDENCE: Care plans for three people were examined and found to contain detailed instruction to staff on care delivery in line with people’s assessment of need. For example, where poor dietary intake had been identified and a care plan was in place. Information regarding the signs and symptoms of how mental health problems may present, for example, schizophrenia, information was available for staff reference. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 13 Professional appointments were recorded with evidence of people’s health care needs being addressed. A daily action plan was in place and reviews of care planning were undertaken on a regular basis. In all the files examined, clinical risk assessments were in place. However, in one instance, a health care issue had been omitted. The clinical manager took action on the day of inspection to issue care instructions to staff. The clinical nurse manager had recognised the need to move towards a more person centred approach, stating this on the AQAA. The AQAA also said that over the next 12 months it is hoped to formulate an internal project to maintain and improve assessment and care planning and to promote good clinical practice and service user involvement. People in the home are involved in all the processes of care planning through one to one’s with their named nurse or key worker. The expert by experience spoke to a number of people in the home who were was very positive about the care and treatment they received. They felt confidences and their privacy were respected saying, ‘I am very much treated with respect’ and ‘When the staff take you to an appointment you can choose if they come in with you or wait outside.’ Community meetings are held regularly in order to provide a forum for people to express their views on developments in the home and their care and treatment. One person told the expert by experience, ‘I go to the community meetings, most people do, not everybody,’ and ‘I forget what to discuss sometimes, we should have a list we should add to, like a shopping list,’ also ‘We mostly talk about cleanliness and how the place is run.’ People in the rehabilitation flats receive minimum support from staff and are encouraged to budget, shop and cook for themselves within their risk assessment framework. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People have access to local community facilities and are encouraged to maintain family links and build relationships promoting a sense of fulfilment. People are consulted and are offered choices in their daily lives promoting their self-worth. EVIDENCE: There was evidence in record keeping of people having access to community and leisure facilities and choices in their daily lives. One person said, ‘I have been out to the shop today’ and ‘I went to the pictures to see Legend but it was too noisy and I prefer the Johnny Cash film I saw before.’ Another person said, ‘I go to my sister’s regular, but I am having benefit problems at the present so staff have arranged an advocate.’ Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 15 One person in an independent flat said, ‘Staff are working with me on budgeting, shopping and cooking my own meals.’ Also, ‘they do ask you if you want to get up in the morning but you can lie in as long as you like to.’ Another person said, ‘I attend a local day centre to help me with social skills and development.’ A computer is available in the occupational therapy room that is only accessible at certain times of the day. People would benefit if this were more available through the day. The clinical nurse manager said he would review the situation. Minutes of community meetings are on the notice board. Information regarding advocacy services are also on display. People’s spiritual needs are addressed. Minutes of meetings stated that the local church had visited to offer communion. Mealtimes and choices of meals had improved since the last inspection. Several choices were available and reflected on the menu in the dining room. Moving away from a canteen model in order to promote the social skills and interaction could still make improvements. People were offered only fruit juice at lunch. However, one person said, ‘We never get a cup of tea or coffee offered but there is a brew room so we can go and get one if we want after lunch.’ One relative questionnaire said, ‘Staff attempt to include all clients at all times I particularly like the common room where clients mix with other clients, staff and visitors. One person said, ‘This is a really good place, there should be more places like this.’ Questionnaires returned from staff stated that more outings could be organised for those who are less able or reluctant to go out. One person said, ‘The trips are good and well organised.’ The home’s notice board contains displays of photographs and trips out, for example, York and the local theatre. People in the home are supported in their personal development by nursing, support staff and the occupational therapist who provide a multi-disciplinary approach to care and support. One person told the expert by experience ‘I do OT on Wednesday and play bingo and make models too. I am making a model motorbike now.’ Another said, ‘I think the occupational therapist is here for three or four days a week and she has made a difference’. Also, ‘I am hoping to go to the local social club and maybe meet a girlfriend. Another person said, ‘I do bead work at OT, sometimes painting and computer work. I type up the notes for the community meeting and make greeting cards too. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People’s care plans were maintained in good order and people were satisfied that their physical and emotional needs were being met. Medication procedures were not wholly sufficient to protect the interests of people using the service. EVIDENCE: The case files examined addressed education, medical and welfare needs. Each have a daily living assessment from the occupation therapist with this being completed with the key worker and the person concerned. In addition to this, individual support plans had been completed that addressed people’s capabilities to perform tasks within a risk assessment framework. One person said, ‘I have a key worker who I meet with often and staff have accompanied me to the doctor’s today.’ Another person said, ‘I am involved in care planning, I am not allowed to smoke in my room and it has had to go as part of my care plan.’ Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 17 A relative questionnaire said, ‘My sister has been encouraged to lead the life she chooses and I feel the home does well, it has handled episodes of illnesses very well. They have encouraged and tried to get my sister to reach out and achieve more. The last time my sister was in hospital I was contacted by the home and kept informed throughout.’ The clinical nurse manager has introduced a service users’ perception form as a start to person centred planning. This will be the responsibility of a named nurse to complete with the person involved. The AQAA stated that support and individual care plans detail a named psychiatric nurse. People were aware of any monies held on their behalf by the home. People in rehabilitation flats take this responsibility within a risk assessment framework. One person said, ‘Staff keep my money safe for me.’ Examination of financial records found appropriate recordings and balances. People told the expert by experience that, ‘I always receive medication on time.’ ‘If there is anything wrong they get you a doctor right away,’ and ‘They take good care of your physical health here.’ Examination of medication procedures found some irregularities. There were gaps in the recording of medication and two people who self-medicate had no risk assessment. The clinical manager said a checking system was in place, however, this had seemed not to have been picked up at the time of this inspection. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People felt any concerns they may have would be listened to and acted upon. Mandatory training in the protection of vulnerable adults ensures people’s safety in the home. EVIDENCE: Neither the home nor the CSCI had received a complaint since the last inspection. A book is available for people to write in their concerns, complaints and compliments. No complaints were recorded, only compliments. One person said, ‘I would see the manager or staff if I weren’t happy.’ The expert by experience spoke to one person who said, ‘I do not need to make a complaint, but if I did I would see the manager.’ There have been three incidents in the home relating to medication procedures, which have resulted in the home implementing protection of vulnerable adults procedures. We are satisfied that appropriate procedures have been followed. Training in the protection of vulnerable adults is compulsory within the Turning Point organisation. Staff at interview were aware of how abuse may present and their role in prevention. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People are provided with a good standard of accommodation, which is clean and well maintained. People being encouraged to be responsible for their personal rooms, promoting a sense of ownership. EVIDENCE: Improvements have been made through a redecoration programme that is still ongoing. Twelve carpets have been replaced together with some bedroom furniture. The home was well maintained, clean, tidy and free from odour. Gardens had been landscaped and provided pleasant outlook from bedrooms and seating areas for the summer months. There is a smoking room and a small kitchenette room for people to make their own refreshments if they wish. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 20 There is also an activity room that holds a computer; this room is used mainly by the occupational therapists. The clinical manager said it had been discussed that the computer would be more accessible to people in the home if placed in a different area. People had chosen to personalise their rooms, making a homely environment. Birchwood also provides two independent living flats equipped with kitchen area to enable people to develop living skills. One person told the expert by experience that, ‘We have to keep our own rooms clean as best we can. I am very good at it.’ And ‘The furniture and stuff here are alright.’ We noted that some of the rooms were cold. One person said, ‘The heating engineer has been today.’ The clinical manager said there had been problems with heating because it is connected and provides a source of heat to the adjacent secure unit. He confirmed heating engineers are dealing with the problem. One person told the expert by experience that ‘We have two cleaners and I think they come in about five days a week and they are very good.’ Also, ‘We have community meetings every month and we talk about the cleanliness of the home and how the place is run, and stuff like that.’ Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff training in mental health issues needs to be improved in order to maintain the positive outcomes for people in the home. Recruitment procedures are robust and ensure people are protected from potential harm. EVIDENCE: Birchwood has been through an unsettled period due to changes in managment. At the time of this inspection there was no registered manager, with the clinical manager taking a lead role with the support of a senior manager within Turning Point until a new manager has been recruited. This has had an impact on the staff team has reported in the home’s AQAA that there has been an increase in sickness levels. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 22 This was also identified through staff questionnaires, which gave a balanced view of the support they receive, saying “If ever I have any problems I can always talk to some one in supervision or at any time.” Several felt they would benefit through more training in mental health issues and that communication between staff could improve. Also, that people in the home would benefit from a more stable staff team and less bank staff being used. Training records showed that few staff had received specific training in mental health problems and only 40 of staff had achieved NVQ’s, however, several staff were working towards this. This had been recognised on the home’s AQAA with their plans for improvement in the next 12 months being to access further training in mental health awareness. The duty rota on 7th January 2008 showed that a trained psychiatric nurse is always on duty, together with two support staff, a domestic and cook for 14 people living in the home. The occupational therapist works 20 hours a week and there is vacant post for an occupational therapist assistant of 15 hours. The clinical nurse manager said that when numbers rise to 16 people, three support staff will be on duty. The home operates their own bank who are more used to the residents and their personal needs. The clinical manager said that on rare occasions agency staff had to be used but only in emergencies. There was evidence that staff recruitment procedures were followed ensuring the safety and protection of people in the home. Staff supervision took place on a regular basis in order to address any concerns and identify training needs. The make-up of the staff team reflected the gender of the client group. We interviewed two staff members who demonstrated a good knowledge of people’s problems, care and rehabilitations needs. One said they had attended two staff meetings to discuss training needs and that handovers were given at change of shift. Other comments from staff were that they felt there had been a big improvement for people in the home since the employment of an occupational therapist. People in the home told the expert by experience that the manger and staff are very nice. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The management arrangements in place are sufficient to provide an effective management of the home, ensuring residents needs are promoted. The home has a robust quality assurance system in place and the home is run in the best interests of people living there. EVIDENCE: As stated previously in this report, Birchwood has been through an unsettled period and has been without a manager for a period of time. Turning Point has recognised this could impact throughout the home and have taken steps to address this by providing a senior manager to assist the clinical nurse manager until the permanent manager’s post can be filled. Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 24 Regular staff and community meetings take place. The last community meeting was on 11th January 2008, where it was discussed whether people were happy with the church services coming in and if they wished this to be continued; which choice of pantomime people would like to go to and maintenance of hygiene in the tearoom and personal bedrooms. People in the home were confident in staff and management leadership and the recent events did not impacted on people’s outcomes at the time of this inspection. We are confident that the organisation is monitoring this situation and is taking steps to ensure outcomes remain positive. The AQAA states that strategic planning is in place and commissionaire meetings take place at least twice a year to measure value for money. Feedback is sought from people in the home, significant others through community meetings and questionnaires. Questionnaire from people in the home were available for inspection. The following comments were taken from questionnaires: “I like the freedom of Birchwood, good staff, good people, it is a lovely place” also “I like the atmosphere at Birchwood, the rooms, food and people”. Another said, “I like everything about Birchwood.” Health and safety and maintenance of the building and equipment is undertaken by the landlord through the licensing process. Staff receive health and safety training on induction. A number of people spoke to the expert by experience saying, “The clinical manager is good at his job”. Also “They keep us informed if anything is going to change like when they change the time for the fire alarm Saturdays”, “The manager is a great fellow.” “They tell us things at community meetings. We have them every few weeks then they write it up and put it on the notice board.” Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 26 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 YA20 Regulation 15 Requirement Ensure people who self medicate have risk assessments in place with medication records being signed for at the point of administration to ensure the health and safety of people in the home. Timescale for action 28/02/08 Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 27 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 YA13 YA17 YA19 Good Practice Recommendations Provide an agenda list on the home’s notice board in which people can add their issues for discussions prior to community meetings. The dining experience for people in the home should be reviewed to provide a less canteen model and promote social skills and interactions. The health care needs of people should be transferred in to care planning so that staff have ease of access to information and are able to maintain people’s health and wellbeing. Ensure that staff receive specific training in mental issues in order to provide a better understanding of how illnesses may present and their management. 50 of staff should be are trained to NVQ level 2. 4 5 YA32 YA35 Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Birchwood Nursing Home DS0000025456.V358378.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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