Inspection on 14/05/09 for The Birches

This is the latest available inspection report for this service, carried out on 14th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Birches 02/02/06

The Birches 15/11/05

The Birches 27/09/04

The Birches 26/04/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Birches Grammar School Road Brigg North Lincolnshire DN20 8BB The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rob Padwick Date: 1 4 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 29 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: The Birches Grammar School Road Brigg North Lincolnshire DN20 8BB 01652652348 01652653803 manager.thebirches@hica-uk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Humberside Independent Care Association Limited care home 31 Number of places (if applicable): Under 65 Over 65 31 31 learning disability Additional conditions: Date of last inspection A bit about the care home The Birches is purpose-built accommodation situated in the town of Brigg. It provides personal care and accommodation for up to 31 adults with a learning disability in both categories of younger people and over 65 years. The home is owned by Humberside Independent Care Association, which is a not for profit organisation. The accommodation is provided in three eight-bedded bungalows, one fourbedded bungalow and two self-contained flats. Each bungalow has its own Care Homes for Adults (18-65 years) Page 4 of 29 bathroom, shower room, toilets and living/kitchen area providing domestic facilities and equipment. All bedrooms are single rooms and all but two have en-suite facilities. The bedrooms without en-suite have a hand washbasin provided. A central core building contains offices, main kitchen, central laundry, meeting room, sensory environment and a lounge. There is a large garden area with well-tended lawns and parking to the front of the building. The home has its own mini bus. The home is situated about one mile from Brigg Town Centre and its range of shops and amenities. The standard fees charged by the home is #426.40 with additional charges made for specialist needs and for hairdressing, chiropody, toiletries etc. The Birches provides information to residents about its facilities in its Statement of Purpose and Service User Guide. Care Homes for Adults (18-65 years) Page 5 of 29 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home The last time we inspected the service was 17th May 2007. This inspection was done in one day and people did not know we were coming. We looked at written information and visited all the bungalows in the home and spoke to people who live and work there. Care Homes for Adults (18-65 years) Page 7 of 29 To help the way we inspect services someone known as an Expert by Experience assisted us with this inspection visit. Information collected by her is included within this report. What the care home does well What has got better from the last inspection The people that run the home have reviewed the staffing levels to make sure there are enough of them on duty to meet the needs of people living in the home. Care Homes for Adults (18-65 years) Page 8 of 29 More training has been provided to help staff communicate with people living in the home. The people that run the home have carried out repairs to the building to ensure the environment meets the needs of people living in the home. What the care home could do better Records of money belonging to people living in the home must be more accurately kept to ensure their finances can be properly protected. Two written staff references should be obtained to ensure checks can be Care Homes for Adults (18-65 years) Page 9 of 29 made that they are safe to work with people using the service. People living in the home should be encouraged to be as independent as possible. More activities should be available to help people living in the home to lead a lifestyle that meets their needs and wishes. More training should be provided to help staff support people living in the home as they grow older. Care Homes for Adults (18-65 years) Page 10 of 29 The people that run the home should carry out more checks of staff to make sure they are safe to work with people using the service. If you want to read the full report of our inspection please ask the person in charge of the care home. If you want to speak to the inspector please contact Rob Padwick 33 Greycoat Street London SW1P 2QF 02079792000 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 set out 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 Adults (18-65 years) Page 11 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The needs of people living in the home are thoroughly assessed to ensure the service can meet these appropriately and good quality information is available to help those thinking about moving into the home to make a decision about it. Evidence: Very good quality information continues to be available to help people thinking about the home make a decision about it. This information had been updated recently and used pictures and words in order to help them to understand what they can expect from the home. The case files of people using the service contained thorough assessments of their needs, which had been agreed with them and their relatives before they moved in, to ensure the home could meet these appropriately. The assessments provided details of individual strengths as well as the needs of people living in the home and were developed in a format that was simple and easy to understand. The manager told us people thinking about using the service are able to visit and try out the home before they move in and there was evidence the needs of others using the service are considered to ensure compatibility with them as part of the admission process. Social Services staff that we spoke to indicated the home worked well with them and had no concerns about the service. Care Homes for Adults (18-65 years) Page 13 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 living in the home are supported to take sensible risks and make choices about their lives by staff who are provided with a variety of training to ensure their needs can be appropriately met. Evidence: The case files of people living in the home all contained support plans developed from their individual assessments of needs. The support plans were of a high standard and included pictures and words to help people using the service to understand them. The support plans covered details about a wide range of physical, social and emotional issues and contained a good standard of daily recording that documented the moods and behaviours of people living in the home and how they had been. As well as reflecting the individual needs, the support plans also recorded strategies for promoting independence, whilst encouraging people to take control of their lives and enabling them to make decisions and choices about these. There was evidence the support plans were being regularly reviewed and updated to ensure they remained accurate, together with meetings with people living in the home and their representatives to ensure they can contribute their views about their support. There Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: was evidence in some of the case files inspected, of the use of advocates, to ensure people who have no relatives have someone to speak up for them and ensure their rights are protected. The group of people living at The Birches continue to have a wide variety of needs and abilities, and the training records we inspected contained evidence of specialist communication training to help staff understand them better. People living in the home told us they were able to make decisions and choices about their lives and their case files contained details about the management of risks and support provided to help them to take responsibility for making sensible decisions. People using the service confirmed they enjoyed living in the home and we observed staff interacting with them in a friendly and positive manner. Care Homes for Adults (18-65 years) Page 15 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . Whist people living in the home are supported to take part in a variety of activities, further development of these would enable them to experience a lifestyle that meets their needs and wishes better. Evidence: Information provided by the manager indicated people living in the home are able to take part in a range of activities and that an activities organiser had been appointed since our last visit, but had been off long term sick for the past six months. The activity records indicated all of the people living in the home had taken part in some community and other activities over recent months and that those who are more independent, were more able participate in these. Some of the people living in the home told us they went out to clubs, had meals and go on various trips and make independent choices about their lives. Others however, indicated to the Expert by Experience they were more limited with these. The Expert by Experience said When I asked residents what activities they like to join in they said, Listen to music, Watch TV, Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Watch DVDs, Go out for meals, The Gateway Club and Dancing and Singing. I think residents should be encouraged to interact in the community more by going on college courses, or find employment or voluntary work. I think the manger should employ a temporary staff member to do activities so that residents are not affected by staff absence. A recommendation is made about this. We saw evidence that all of the people living in the home had been away on a holiday over the past year and of the involvement of families in the home. We were told people using the service are encouraged to maintain links with their friends and relatives and that some go away at weekends to stay with them. The manager told us people using the service are Encouraged and supported to maintain and develop independent living skills and that support is provided for Opportunities to prepare simple meals and take responsibility of their own rooms. We observed pictorial menus in the process of being developed to help people make choices about what to eat and there was evidence that a healthy and nutritious diet was provided. The home had recently been awarded a 5 star rating from the Local Authority Environmental Health Department, however the Expert by Experience said I would like to see the residents being more involved in the preparation of food and cooking and be able to help themselves to food and drink, rather than asking for staff permission. A recommendation is made about this. Care Homes for Adults (18-65 years) Page 17 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 . The health and personal care of people living in the home are supported by staff who are knowledgeable about their needs and who are appropriately trained. Evidence: People living in the home told us they liked living at The Birches and were happy with the way their support is delivered and we observed staff working them in a friendly and sensitive way. There was evidence in the records of a range training provided to ensure staff have the right skills for their work and that support is provided in a holistic and person centred way. As part of their induction new staff receive training that covers the core principles of care and we observed the dignity of people using the service was respected and maintained. The home has a mixed staff group that includes both male and female carers that allows the individual wishes and preferences of people using the service to be appropriately respected. The case files of people living in the home contained clear information about their health and personal health care needs, together with details about how they liked their support to be provided. The case files contained good information about individual and specialist medical needs and Community staff who we spoke to confirmed good liaison with them was maintained about these. Since the last time we visited, there had been an increase in dependency of some of the people living in the home and there was evidence of appropriate action Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: with increased staffing, and specialist dementia training for the manager, which she told us she planned to develop and provide to staff. A recommendation is made about this. There were individual Health Action plans included in all of the case files inspected, together with other details to ensure these can be appropriately met. Staff files contained evidence of training on a range of specialist medical conditions and those staff we spoke to were confident in their abilities in this respect. The home has medication policies and procedures to guide staff and ensure those using the service are protected from potential harm and the training records confirmed staff responsible had received relevant training in this. We made a random check of the medication and associated records and confirmed these were being satisfactorily maintained. Care Homes for Adults (18-65 years) Page 19 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 concerns and complaints of people living in the home are taken seriously and staff are trained to ensure they can safeguard them from potential abuse. Evidence: The home has a complaints policy and takes concerns about the service very seriously and the manager told us she had a welcoming attitude to receiving these. Copies of information to help people make concerns and complaints were displayed throughout the home with pictures and words, to help them to understand their rights and there was evidence of regular meetings to ensure any concerns can be acted on quickly. People using the service told us they liked living in the home and trusted the staff and we saw evidence of appropriate action to resolve concerns made since the last time we visited. A variety of policies are available to ensure staff can protect people living in the home from potential harm and we saw evidence of appropriate training and refreshers on these. Since the last time we visited some incidents had been referred to the Local Authority to investigate and were told by Social Services staff they had no concerns about the way these had been dealt with by the home. There are generally good systems in place to ensure records of money belonging to people using the service to be accurately kept, however despite these, there was evidence that some errors had occurred. A requirement is made about this. Care Homes for Adults (18-65 years) Page 20 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 living in the home are provided with an environment that is safe and can comfortably meet their needs. Evidence: People using the service live in four separate bungalows were purpose built and provide them with an environment that is clean, safe and is accessible to wheel chair users. A recommendation made following our last visit, relating to repairs had been carried out and a handyman was visiting to attend to other ongoing work. People living in the home are provided with individual bedrooms which are decorated to reflect their personalities and interests and there was evidence that relatives can be involved in this process. Regular checks were being carried out to ensure the building and equipment is kept safe and there was evidence in the staff files of training on a variety of health and safety issues. Some parts of the building were beginning to show some signs of need of redecoration; however we were shown evidence of agreement for work to be completed on this. Specialist equipment had been obtained to maximise the independence of people using the service and each of the individual bungalows inspected were clean and comfortable with evidence the homes domestic staff are appropriately managed. Care Homes for Adults (18-65 years) Page 21 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 . Whilst people living in the home are supported by appropriately trained staff, safe recruitment policies and procedures should be more closely followed to ensure they are safeguarded from potential harm. Evidence: People living in the home told us they trusted the staff and enjoyed living at The Birches and one told the Expert by Experience They are nice and good to me. The people who own the home have a strong training department and a programme for this was available to ensure individual staff have the skills needed to meet the needs of people who use the service. We observed staff interacting with people living in the home in a friendly and cheerful manner and from discussion with them it was clear they knew them well and were committed to doing the jobs. There was evidence in the staff training records of a good induction programme for the service, including a Learning Disability qualification and information in the self assessment, indicated good progress with the staff NVQ training programme with over 55 of them having now obtained this qualification at level 2 or above and others booked to do this. Staff files contained evidence of mandatory training and there was evidence of regular checks to ensure their skills are updated as needed. Following our last visit, we made a requirement that staffing levels should be reviewed to ensure the personal care needs of people using the service are better met and there was evidence the manager had complied with this and increased these at certain key times of the day. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Recruitment policies are available to ensure staff are safe to work with people living in the home and there was evidence in the staff files that these were being generally followed. We saw evidence of required checks of Criminal Records, Personal Identity and employment history were being carried out. However, the file of one recently employed person contained evidence they had started work with only a preliminary Protection of Vulnerable Adults check and one written reference, although we saw evidence that a second verbal reference had been obtained before they had started to work and that they had been closely supervised until their Criminal Records Bureau check had been received. A requirement and recommendation is made as this practice places people using the service at potential risk of harm. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 . Good management and administrative systems were supporting the welfare of people living in the home to ensure their health and safety is promoted and protected. Evidence: The manager is a qualified nurse for people with learning disabilities and has degree in Managing Health and Social Care and has worked within the field of learning disability since 1982. The manager is an NVQ assessor and there was evidence she takes her role very seriously. Staff told us she has an open approach to managing the home and there were good communication systems in place to ensure both staff and people using the service can contribute their views about the home. Regular meetings with staff and people living in the home were taking place and there was evidence of questionnaires issued about the service, together with action plans developed from these. The home has good administrative arrangements to ensure it can monitor its progress against its aims and objectives and thorough quality assurance checks take place as part of this. A recent staff survey showed good levels of understanding on the promotion of dignity to people using the service and we were told about their involvement in various aspects of the home to ensure it is run in their best interests. Systems are in place to ensure the health and safety of people living and working and Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: a random inspection of the records for these confirmed they were being satisfactorily maintained and that appropriate action had been taken when this was when needed. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes  No  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 Adults (18-65 years) Page 26 of 29 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 Description 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 Description Timescale for action 1 23 20 The Registered Person must 30/06/2009 ensure the homes policies concerning money belonging to people living in the home are followed and do not get into a negative balance. This is to ensure the financial interests of people using the service are safeguarded. 2 34 19 The Registered Person must ensure that two written references are obtained for all staff employed. 02/07/2009 This is to protect people living in the home from potential harm. 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 Care Homes for Adults (18-65 years) Page 27 of 29 improving their service. No Refer to Standard Good Practice Recommendations 1 12 The Registered Person should develop the activities for people living in the home to ensure they can participate further in opportunities that meet their wishes and needs. The Registered Person should continue to ensure people living in the home are supported and encouraged to be as independent as is possible. The Registered Person should ensure staff receive training on the specialist age related conditions of people living in the home. The Registered Person should ensure satisfactory Criminal Records Bureau clearance is obtained for all new staff and they are only allowed to start working in the home with a Protection of Vulnerable Adults check in exceptional circumstances. 2 16 3 19 4 34 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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