CARE HOMES FOR OLDER PEOPLE
Birch Green Care Centre Birch Green Care Centre Birch Green Skelmersdale Lancashire WN8 6RS Lead Inspector
Vivienne Morris Unannounced Inspection 1st March 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Birch Green Care Centre Address Birch Green Care Centre Birch Green Skelmersdale Lancashire WN8 6RS 01695 50916 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) birchgreen@springcare.co.uk Springhill Care Group Margaret Jeanetta Ali Care Home 67 Category(ies) of Dementia (35), Old age, not falling within any registration, with number other category (32), Physical disability (6) of places Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 67 service users to include: Up to 32 service users in the category OP (Old age, not falling within any other Category). Up to 6 service users in the category PD (Physical Disability aged 18-65). Up to 35 service users requiring personal care in the category DE - (Dementia). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. Date of last inspection 8th September 2005 Brief Description of the Service: Birch Green Care Centre is situated in a residential area of Skelmersdale. The property comprises of accommodation on two levels, providing both personal and nursing care for elderly people. The first floor accommodates those requiring care associated with dementia. There are also a limited number of places available for persons with physical disabilities. All private facilities are within single bedrooms. A variety of lounge and dining areas are available, although service users may dine in the privacy of their own accommodation if they so wish. Local amenities are situated nearby, including a large shopping centre. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one day during March 2006. The inspection process focused on the outcomes for people living at the home. During the course of the inspection service users and staff were spoken to, relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas and service areas were seen. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which related to staffing levels and which was referred back to the provider for investigation. The home had appropriately addressed the issue of concern. What the service does well:
People living at the home were treated with respect demonstrating that privacy and dignity was promoted at the home. Those living at the care home were able to make decisions and were supported to take some control over their lives. The management of meal times was appropriate. Service users were able to eat within the privacy of their own accommodation if they preferred and a good selection of home cooked fresh food was available in order to maintain appetite and nutrition. The home provided a well-organised and nice environment for people to live in, which was found to be clean, tidy and pleasant smelling. The policies of the home demonstrated that those living there were, as far as possible protected from possible abusive situations. The ratio of care staff to service users had been determined by the dependency needs of those living at the home to ensure that all assessed needs could be adequately met by the staff team. A lot of relevant training was provided for staff, including induction and foundation training to ensure that the staff team collectively had the skills to meet the needs of the people living at the home and that staff were competent to do the job expected of them. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The statement of purpose and the service users’ guide need to be updated to provide people with current information about the home to enable them to make an informed choice about where they wish to live. Service users or their representatives must be given the opportunity to be involved in the care planning process so that they are able to make decisions about the care provided if they so wish. The registered person should be able to demonstrate that services and facilities comply with the Water Supply (Water Fittings) Regulations 1999 to ensure the continued safety of service users. The home should continue to work towards achieving 50 of care staff having obtained a National Vocational Qualification at level 2 or above. The registered manager must undergo some further training in order to keep up to date with changes in legislation and current good practice guidelines. She should also obtain a relevant management qualification in order to develop her management skills and knowledge. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 7 The home should seek the views of stakeholders in the community about how the home is achieving goals for service users. Systems could be improved in relation to service users’ money to ensure that it is consistently safe guarded and not pooled. 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. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Prospective service users and their representatives were not provided with up to date information about the home. EVIDENCE: Although the statement of purpose and the service users’ guide were well presented documents and provided people with detailed information about the home, both need to be updated to reflect the current management structure of the home and the recent increase of registered beds so that prospective service users and their representatives are able to make an informed choice about where to live. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 10 Those living at the care home were treated with respect and dignity and their privacy was not compromised when personal or nursing care was being provided. EVIDENCE: The care records of four people living at Birch Green were examined at the time of the inspection. Although standard 7 was not fully assessed on this occasion it was evident that service users had not always been involved in the care planning process so that they were given the opportunity to make decisions about the care provided if they so wished. This requirement is therefore carried forward from the previous inspection report. The pharmacy inspector assessed the management of medications at this inspection. A detailed report of the findings will be forwarded to the home with details of any requirements and recommendations made. The plans of care demonstrated that the privacy and dignity of those living at the home was protected at all times and service users confirmed that this was the case. Staff were instructed during induction about how to treat service users with respect and were seen to be knocking on resident’s bedroom doors
Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 11 before entering and were seen to be talking with residents in a respectful manner demonstrating that service users were treated well. The policies and procedures of the home and the service users’ guide demonstrated that the privacy and dignity of service users was respected at all times. Comment received included, “the staff are helpful and they respect me as a person”, “it is like home from home living here” and “The staff are very good. They really look after me”. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 Service users were able to make choices and were encouraged to have some control over their lives. Meals times were well managed to ensure adequate nutritional intake for those living at the home. EVIDENCE: Although standard 12 was not fully assessed on this occasion, the three recommendations made at the previous inspection had been appropriately addressed by the home. The hobbies and leisure interests of people living at the home were well recorded showing that these had been taken into consideration when providing activities at the home. At the time of the inspection there was one person using advocacy services to act on their behalf and two people were managing their own financial affairs demonstrating that those living at the care home were given the opportunity to make decisions and to have some control over their lives. The written policies and procedures of the home supported this evidence. Meal times were well managed. The inspector saw those living at the home being asked which selection they preferred from the menu for the following day. Those spoken to were aware of what the meal was for lunch and commented that the food served was of a good standard. A new chef had
Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 13 recently been appointed and the menu offered a good variety of fresh home cooked food to ensure that appetite and nutrition was maintained. The dining tables were pleasantly laid and staff were seen to be assisting service users with their meals, as necessary, in a discreet and sensitive manner. One service user commented, “The staff are excellent, we always have a bit of fun” and another said, “The food is marvellous, I always eat everything”. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The policies of the home demonstrated that those living there were, as far as possible protected from possible abusive situations. EVIDENCE: Policies and procedures were in place at the home in relation to the protection of vulnerable adults, which included ‘whistle blowing’ and were in line with the Department of Health guidance ‘No Secrets’ to ensure that those living at the home were protected as far as possible. All staff working at the home had undergone an abuse awareness-training course to ensure that they were aware of how to manage abusive situations. A policy was in place in relation to physical and verbal aggression displayed by service users to ensure that staff fully understood their role should such a situation arise. Systems were in place to demonstrate that the money and valuables of those living at the home were appropriately managed, ensuring that they were safely retained and protected. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Service users lived in a clean and pleasant environment, which was free from offensive odours. Adequate procedures were in place for the control of infection. EVIDENCE: Detailed policies and procedures were in place in relation to the control of infection so that staff were aware of measures to take in order to protect those living at the home. Laundry facilities were appropriately sited to reduce the possibility of cross infection. The home was found to be clean, tidy and pleasant smelling, providing a nice environment for people to live in. The registered person should be able to demonstrate that services and facilities comply with the Water Supply (Water Fittings) Regulations 1999 to ensure the continued safety of service users. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 The number and skill mix of staff on duty met the needs of service users. The care staff were competent to perform the duties required of them. Service users were in safe hands. EVIDENCE: A clear staff rota was in place at the home demonstrating which staff were on duty at any time of the day and night and in what capacity they were employed, demonstrating that the skill mix of staff was appropriate to the needs of those living at the home. A clear procedure was in place for calculating the ratio of care staff to service users in relation to individual dependency assessments to ensure that adequate care was provided to those living at the home. Regular dependency reviews were being conducted to ensure that staffing levels were adjusted accordingly as occupancy and dependency altered. The home was found to be clean, tidy and pleasant smelling, which demonstrated that domestic staff were employed in sufficient numbers to maintain a high standard of cleanliness within the home. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 17 There were 37 care staff employed, 13 of whom had completed a National Vocational Qualification (NVQ). A high percentage of care staff were also in the process of undergoing a National Vocational Qualification demonstrating that the home was working towards achieving 50 of care staff being trained to NVQ level 2 or above to ensure that staff were appropriately trained to meet the needs of those living at the home. In depth Induction training had been provided for all staff within the first six weeks of employment, which was recorded in individual workbooks demonstrating that new staff had been provided with relevant information in relation to the aims and objectives of the home. Staff had been provided with a variety of training courses, including a number of compulsory core training sessions. The plans of care were very well written providing staff with clear guidance as to how individual needs were to be met and staff spoken to were knowledgeable in relation to the needs of those living at the home. A lot of relevant training was provided for staff and individual training and development programmes were in place so that the manager of the home could determine at what stage staff were at in relation to their training needs and to ensure that those working at the home were competent to do the job expected of them and to ensure that they were able to meet the assessed needs of those living at the home. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 35. The registered manager had not undergone sufficient core training and management training to ensure that the home was consistently effectively managed. Service users’ financial interests were in general safeguarded. EVIDENCE: The registered manager of the home is a first level registered nurse and has been in post for a period of 12 months, although she has worked at the home since 2002. She has undergone some training whilst managing the care home but further training is still needed, particularly core training, to demonstrate that the she is keeping up to date with changes in legislation and current good practice guidelines. The registered manager had enrolled on a National Vocational Qualification, level 4 training course to develop her personal management skills and knowledge.
Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 19 Although standard 33 was not fully assessed on this occasion, the views of stakeholders in the community should be sought on how the home is achieving its goals for service users. Therefore, this recommendation will be carried forward from the previous inspection report. Service users’ personal allowance records were examined, which demonstrated that any transactions were recorded and receipts were given for any valuables deposited at the home or returned to service users’ families to ensure that in general safeguards were in place for the protection of service users’ money and valuables. However, two service users were using the same bank account, which did not demonstrate that the money of these people was totally safe guarded. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X X Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 4(1)(2) 6(a) Requirement Timescale for action 31/03/06 2. OP7 3 OP31 The statement of purpose must be reviewed and updated to provide people with current information about the care home. A copy must be forwarded to the Commission for Social Care Inspection once the amendments have been made. 15(1) Unless it is impracticable to carry 30/04/06 out such consultation, the registered person shall, after consultation with the service user, or representative of his, prepare a written plan (the service user’s plan) as to how the service user’s needs in respect of his health and welfare are to be met. (Timescale of 31/11/05 not met). 9 (2)(b)(i) The registered manager must 31/07/06 have the skills necessary for managing the care home. Training to NVQ Level IV is required to be undertaken. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 22 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. 4. 5. 6. Refer to Standard OP1 OP26 OP28 OP31 OP33 OP35 Good Practice Recommendations The service users’ guide should be reviewed and updated to reflect current information about the care home. The registered person should be able to demonstrate that services and facilities comply with the Water Supply (Water Fittings) Regulations 1999 The home should continue working towards a minimum ratio of 50 of care staff having achieved a National Vocational Qualification at level 2 or above. The registered manager should obtain a relevant management qualification. The registered person should seek the views of stakeholders as to how the home is achieving goals for service users. Service users’ money should not be pooled, but should be retained in separate bank accounts. Birch Green Care Centre DS0000025564.V280012.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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