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 09:30 13 March and 23rd March 2007
th 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.V323350.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 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.V323350.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Birch Green Care Centre Address Birch Green Care Centre Birch Green Skelmersdale Lancashire WN8 6RS 01695 50916 01695 51306 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) Springhill Care Group Margaret Jeanetta Ali Care Home with Nursing 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.V323350.R01.S.doc Version 5.2 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 1865). 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. 1st March 2006 2. Date of last inspection Brief Description of the Service: Birch Green Care Centre is a purpose built establishment, providing nursing and personal care for up to 67 elderly people, including those whos care needs are associated with Dementia. The home is set in pleasant, well maintained grounds. A patio area with garden furniture is available for those wishing to spend some time outdoors. Private accommodation is located on two levels, the first floor being accessible by passenger lift or stairs. All bedrooms provide single accommodation. A number of pleasant lounges, quiet rooms and dining areas are available throughout the home, where a variety of activities may take place. The fees currently range from £342.50 - £515 per week. Additional charges are incurred for hairdressing, magazines/newspapers, toiletries, transport and some activities. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two regulatory inspectors from the Commission for Social Care Inspection conducted an unannounced site visit to this service over two days in March 2007, which formed part of the key inspection process. During the course of the site visit, discussions took place with those living at the home, as well as relatives and staff. 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 were seen. Comment cards were received from nineteen people living at the home and seventeen relatives, their feedback being reflected throughout this report. The information provided by the home on the pre-inspection questionnaire has also been taken into consideration when writing this report. The inspectors observed the activity within the home and ‘tracked’ the care of four people during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. What the service does well:
The information gathered before admission was sufficiently detailed, providing staff with a clear picture of each individual, so that they were confident that the assessed needs of people could be adequately met. The plans of care were well written documents, providing staff with guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. One comment received from a relative was, “This home is wonderful. Staff are very attentive and meet my relatives needs well” and a resident said, “The staff are very good, they attend to what I need quickly”. A variety of external professionals had been involved in the care of people living at Birch Green Care Centre to ensure that their health care needs were being appropriately met. A range of risk assessments were in place to ensure that systems were implemented to protect the health and safety of anyone on the premises. The routine of the home was fairly flexible and aimed to allow residents their freedom and independence by enabling them to have some control over their
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 6 lives and therefore promoting equality and diversity. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. One relative said, “People are treated as individuals and the routines of the home are very flexible. People who live here are able to do what they want during the day”. Those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users guide so that people were given enough information about how did they could make a complaint should they so wish. The policies and procedures in relation to safeguarding adults were in accordance with the Department of Health guidance ‘no secrets’, so that people knew the procedure to take should an allegation of abuse be received by the home. The finances of residents were adequately protected by the policies, procedures and practices of the home. The home was tastefully furnished and pleasantly decorated to a good standard and the premises, both internally and externally were generally well maintained providing those living at Birch Green Care Centre with a safe, clean, comfortable and homely environment in which to live. One visitor spoken to who has several relatives living at the home said, “This is a beautiful place for my relatives to live”. The home was pleasant smelling and effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staffing levels were calculated in accordance with the assessed needs of people to ensure that adequate care was delivered. Recruitment procedures and financial arrangements were in place at the home, which demonstrated that those living at Birch Green Care Centre were adequately protected. A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet people’s assessed needs. Each new member of staff was taken through a detailed induction programme so that they were deemed competent to do the job expected of them. The people living at Birch Green Care Centre and their relatives spoke highly of the management of the home and felt that it was well run. One relative commented, “This home is by far the very, very best”, and another said, “I wouldn’t have my relative anywhere else, it is a very well run home and they (the staff) are marvellous”. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 7 The health, safety and welfare of residents, in general, were protected by the policies, procedures and practices of the home so that any hazards, which could pose a potential risk, were minimised or eliminated. The home was well managed by a competent person and a team of skilled senior staff, who together had completed a wide range of training so that they were able to deliver the care required by the individual residents. What has improved since the last inspection? What they could do better:
It is important that all information, which is gathered before admission to the home is detailed on the individual’s plan of care. This would provide staff with relevant information to ensure that a consistent and holistic approach to care and support is provided. Any new information, which is recorded on the plans of care needs to be clear, so that staff are aware of people’ individual needs. The care records should not provide any conflicting information so that the delivery of inappropriate care is avoided. A formal process should be adopted so that it is clear how the level of risk has been calculated in order to support any action taken to reduce the identified risk. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 8 The management of medications could have been better. A requirement and some recommendations have been made to ensure that medication practices are consistently safe. Staff need to be reminded about the importance of not discussing the needs of residents within the communal areas of the home. People living at the home should be able to make a telephone call in private at their leisure. Leisure activities were not always provided in accordance with the preferences of residents, so that they were able to continue their interests whilst living at the home and so that they were able to maintain links with the local community. Service users were not always offered a full range of options from the menu to ensure adequate dietary intake. Liquidised meals were not well presented, as they were very bland in colour, being served on the same colour of plate, and therefore these meals did not look appetising in order to promote appetite and aid in nutrition. Therefore, not all people at the home were provided with the same opportunities, in that those needing soft diets were not served appetising diets like those being able to eat a normal diet. The bathrooms and toilet ceilings on the ground floor need some minor repair work. Also the walls of one of the units at the home need attention, so that these areas are brought up to the standard of the rest of the premises. Although systems were in place to ensure that the quality of service provided was closely monitored, evidence was not available to show that any shortfalls identified had been addressed. Some bathrooms were ‘cluttered’ as they were being used as storage areas, which reduced people’s choice of bathing areas within the home. A representative from the organisation should visit the home unannounced and prepare a written report on the conduct of the care home at least once a month so that the standard of care provided can be regularly monitored. All staff should receive formal supervision at least six times a year so that they are able to discuss any issues with their line manager and so that they can receive feedback on their performance and highlight any areas of training needed. 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. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 9 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.V323350.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Birch Green Care Centre had a good system in place to assess the needs and requirements of prospective residents prior to admission. This was to ensure that the home could provide the individual level of care and support required. EVIDENCE: In order to ensure that residents were only admitted to Birch Green Care Centre if their health, personal and social care needs could be fully met, a member of the management team had undertaken an assessment of people’s current strengths and needs in order to determine if the level of care and support required could be provided by the home. The information obtained had then been recorded, which was supported by a Health and/or Social Services assessment of current needs and requirements. In situations where a resident was to be admitted to the home on a continuing care basis, a pre admission assessment was not completed by the home, but
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 11 the staff team relied on information provided by other external professionals, which gave enough detail of individual needs and requirements. Staff spoken to knew about the needs of people and how to access the care plans, policies and procedures, which showed that they were able to obtain relevant information if they needed it. A relative of a resident spoken with confirmed that a pre admission assessment had been undertaken when her husband was admitted to the home and she said “I am very happy with the care my husband is receiving here, they go to a lot of trouble, I know he is happy, therefore I am happy”. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the management of medications could have been better, the health, personal and social care needs of people living at the home was, in general, being met. EVIDENCE: The care of four people living at the home was ‘tracked’ during the course of the site visit. All four plans of care were found to be well written documents. However, information gathered during the pre-admission process for one resident had not been consistently recorded on the initial care plan, so staff were not fully aware of all the assessed needs of this person at the time they moved into the home. Residents or their relatives had been given the opportunity to be involved in the care planning process, so that they could have some in put into the care provided. The plans of care had been consistently reviewed every month to show that people’s current needs were reflected.
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 13 It was noted that on one of the care plans the original information had been crossed out and on review the new details written below, which made it difficult to decipher the current information. Care records for one resident provided some conflicting information in relation to the nutritional risk assessment, which showed a score of 15 in the care plan, but only a score of 11 on the actual assessment. Conflicting information could be confusing for staff and could result in inappropriate care being delivered. The plan of care for another resident was not being followed in day to day practice as it was indicated that dietary intake should be recorded daily and the resident should be weighed every week. There was no evidence to demonstrate that the resident’s dietary intake was being recorded and the resident was being weighed every month, rather than on a weekly basis. Three members of staff spoken with confirmed that that they felt sufficient written information was provided to ensure a good quality of care, supplemented by a verbal handover of information at the beginning of each shift. This ensured that staff coming on duty, were made aware of any changes required to the level of support and care of each resident. We noted whilst touring the home that specialised equipment was provided for those requiring it, such as mechanical beds, pressure relieving equipment and hoists so that people living at the home were cared for in comfort. All comment cards received from seventeen relatives showed that they were satisfied with the overall care provided to the people living at the home. The pre inspection questionnaire and the care records showed that a variety of external professionals were involved in the care of people living at the home to ensure that their health care needs were being appropriately met. Comment cards received from two external professionals showed that they were satisfied with the overall care provided, although one did say that there had been an incident with the management of medications, but that this had been dealt with appropriately once reported. Comments received on comment cards from relatives included, “ I am thankful that my relative is in care at Birch Green”, “Excellent care is being provided” and “The staff are always very nice and I can ask them anything about my relative. The staff keep me informed of any changes”. Comment cards received showed that everyone was treated equally and that people felt that they received medical support when needed. Seven residents indicated on their comment cards that they usually received the care and support they needed and twelve indicated that they always received the care and support needed. Appropriate pressure relief was being delivered and Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 14 specialised equipment was provided to make the lives of people living at the home as comfortable as possible. A wide range of assessments were in place so that the health and safety of people living in the home were protected within a risk management framework. However, it was sometimes difficult to be sure that all relevant risk assessments had been undertaken in full. For example, care records for one resident indicated that a nutritional risk assessment had been conducted, but there was no evidence available to show how the level of risk had been determined. The pre inspection questionnaire showed that there had been no changes to the medication policies and procedures since the last inspection so that current information was still being provided for staff in relation to the safe management of medications. Clear medication records were maintained and photographs were retained of each resident on their Medication Administration Records for identification purposes. However, the overall management of medications could have been better so that people living at the home were adequately protected against any mishandling or drug errors. The care staff responsible for the administration of medications to residential clients had received training in the safe handling of medications. Registered nurses were responsible for the administration of medications to people receiving nursing care. However, hand written entries on the Medication Administration Records had not been consistently signed, witnessed and countersigned so that the possibility of transcription errors was minimised. The receipt of medications had not consistently been recorded on the Medication Administration Records and the receipt and destruction of controlled drugs had not always been signed, witnessed and countersigned in the controlled drugs register, so that the possibility of any mishandling of medications was reduced. However, it was evident that two members of staff checked controlled drugs twice a day, which is good practice. The refusal of any medications was not always recorded on the Medication Administration Records and the amount administered of variable dose medications had not consistently been identified so that the possibility of drug errors was reduced. Residents spoken with felt that their privacy and dignity was well respected and that staff were sensitive when they needed help with personal care. Staff were in the main seen to be respectful and mindful of residents feelings with one resident stating in a quality questionnaire completed in November 2006, “I Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 15 am impressed by the care and courtesy given to me by the staff, they are always helpful and fortunately have a good sense of humour”. Through direct observation in the dementia care unit, staff were seen to be very caring and respectful to residents and did not try to rush the resident. Individual residents were talked to and assisted at a pace that was acceptable to the individual. A number of staff spoken with confirmed that they were advised of the home’s expectation in respect of maintaining resident’s privacy and dignity at commencement of employment and through various training opportunities. However it was noted that on two occasions during the course of the inspection, two different members of staff were heard to discuss the needs/preferences of certain residents when in a communal area of the home. It is important to remind staff that the privacy and dignity of residents must always be respected and any personal information must be kept confidential. Residents had access to a telephone in a communal area of the home. Although this could not be used in private, the inspectors were informed that if a resident needed to make a call in private, then the office telephone could be used. Some residents were seen to have their own private telephone lines installed in their bedrooms to enable them to make and receive telephone calls in private, as they pleased. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of residents experienced a lifestyle that did not always satisfy their social or recreational interests and needs. Residents were encouraged to keep in regular contact with family and friends in order to maintain close links with their loved ones. EVIDENCE: Comments received about social activities were mixed. Relatives of residents in the dementia care unit confirmed that regular ‘in-house’ activities organised by the activities coordinator did take place and were enjoyed by residents. However, people living in others areas of the home clearly stated that they did not feel that appropriate social activities were provided on a regular basis. Therefore, it was not evident that everyone in the home was provided with the same opportunities. From discussion with the activities coordinator and observation of the weekly activities programme, it was apparent that only ten hours per week of the activities coordinator’s time was actually spent in direct activity with service users. This was broken down into one hour in the morning and one hour in the afternoon five days a week. The activities coordinator explained that the rest of her time was spent decorating the home for birthdays/ significant events,
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 17 shopping for service users, shopping for the kitchen when needed, some gardening, and anything else that may crop up unexpectedly. The activities coordinator stated that an external entertainer had been arranged for one day last year and that the residents on the ground floor had enjoyed it. However, when the same entertainer returned earlier this year, only three residents from the ground floor wanted to join in, so eventually the entertainment was transferred to the residents on the first floor in the dementia care unit. Although occasional group outings were arranged, which residents enjoyed, for example boat trips or a trip to Southport, in general, outings to the local shops or places of interest were normally on a one to one basis leaving the remaining residents without any organised activity, which does not demonstrate that equality was being considered in these instances. It is understood that a resident social activities questionnaire was provided to residents in December 2006 to try and establish what sort of activities residents would like to do. However, the majority of residents were reluctant to express a preference. Of the care records seen a good social history was taken so that staff were aware of people’s interests and past lives so that they were more able to relate to people living at the home. One resident spoken with stated that she would like to be taken out to the shops. Two other residents spoken with did not feel that any activities were provided except bingo, with one resident saying that the social highlight of this week for her was being able to speak with the inspector. Whilst some limited group activities were made available there was nothing to evidence that activities were linked to individual care plans. This raised questions regarding equality and diversity issues especially in relation to people with mobility restrictions or other medical conditions, cultural requirements or any gender requirements. For example, male service users may like an activity to suit their interests such as football, gardening or being able to regularly enjoy a pint at the local pub. On the other hand female residents may like to be involved in activities such as flower arranging, needlecrafts or cooking. A reminiscence activity group could be attempted or a current affairs discussion instigated, perhaps linked to items in a daily newspaper. Residents could be encouraged to help make the decorations for the home rather than just enjoy seeing the home decorated. It is important that a range of activities be made available on a regular basis. This may mean several different activities taking place for shorter periods of time on the same day to suit different interests and levels of concentration. Activities may need to be rotated after several weeks to maintain the interest of residents and prevent the loss of a more stimulating environment.
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 18 A number of residents spoken with confirmed that they are able to make decisions about their chosen daily routines. As directly observed during the course of the inspection, social relationships were encouraged either through family or friends visiting the home at a time of the resident’s choice, or trips out with family and friends. Residents were free to entertain their guests either in the privacy of individual bedroom accommodation or within any other communal area of the home. Several relatives were spoken with who visited the home very regularly. All stated that they were made to feel very welcome and that they had a good relationship with the staff. One relative stated, “I could not wish for a better place, the nurses are so caring. Birch Green is the tops”. This same person also stated that she is always kept informed of anything significant regarding her relative. Another relative wrote on the home’s internal quality questionnaire “very caring and helpful staff in all areas both for my mother and me. I have nothing but praise and respect of all the staff” Residents were encouraged to maintain control of their own financial affairs for as long as they wish to and have capacity to do so. Details in respect of local advocacy services were made available to residents and relatives and also referred to in the Service User Guide. Through discussion with residents and observation of some bedroom accommodation, it was confirmed that residents were encouraged to take personal possessions with them into the home to make their private accommodation more homely and comfortable. Meals and mealtimes at Birch Green Care Centre were regarded as a priority with a varied and balanced menu provided in accordance with the known dietary preferences of people living at the home. Specialist diets in respect of medical needs were provided and diets in respect of religious or cultural requirements could also be accommodated, as needed. There was a choice of main courses and desserts at lunchtime and evening meals. However, some negative comments were expressed by a number of people as to the way the food was cooked. This was reported to be quite variable and dependent on who did the cooking. People spoken with stated that there were a wide variety of foods available and that generous portions were served. Observation of the four weekly rotating menu confirmed that there was a good variety of nutritious food offered with a choice of menu available at each meal. It was understood from discussion with the general manager that she was aware of the concerns raised and explained that there had been some difficulty in recruiting a suitable cook. It is hoped that this issue will be resolved in the near future. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 19 Residents were able to choose which area of the home they ate their meals and this was evident during the course of the inspection. It was observed that the lunchtime meal being served was in the main attractively presented and enjoyed by the residents. However, several soft meals that had been provided were extremely bland looking and not well presented. Therefore these people were not receiving an appetising diet like those able to eat a normal meal. This could have been easily improved if more thought had been put into how the meal looked on the plate and what could have been done to make the meal look more attractive and appetizing. It was noted that staff discretely and sensitively offered support when assisting a resident to eat their meal to ensure the dignity of individuals was maintained. We observed that residents were invited to select the meal of their choice from the rotating menu of the day, prior to the meals being served. Although the carer who undertook this task asked each service user individually, the full range of foods identified on the weekly menu was not always offered. For example, one resident chose to have a sandwich for her lunch and did not want either of the choices for the evening meal. She was then asked if she would have a sandwich for her evening meal instead of the choices on offer, even though she had eaten a sandwich for lunch. Although the weekly menu indicated that a jacket potato or omelette was always available for main meals, the carer attending to this resident was not aware that other alternatives were available and went to check the weekly menu herself. In these instances all available food should be offered to enable residents to make an informed choice from a wide range of food or alternatively the resident could have been asked what they would have actually like to eat for that particular meal. This could have enabled a meal of choice to be provided. Although it was established that special diets were provided to meet any medical, religious or cultural needs, the newly appointed cook, when asked, was not aware that some residents required a diabetic diet. It is extremely important that the dietary requirements of all individual residents are clearly communicated within the entire staff team to ensure that an appropriate diet is provided. From discussion with the cook on duty, it was apparent that a sufficient budget was provided to ensure sufficient food stocks and fresh fruit and vegetables were always available. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were well managed and people living at the home were adequately safeguarded. EVIDENCE: A detailed complaints procedure was in place at the home, which was displayed prominently in each bedroom and which was included within the service users guide, showing that people were given enough information about making a complaint should they wish to do so. Three of the seventeen comment cards received from relatives indicated that they were not aware of the home’s complaints procedure. However, the remaining fourteen indicated that they would know how to make a complaint, should they wish to do so. Two relatives spoken to said that they would know who to speak to if they wanted to make a complaint and one relative said that she had needed to make a complaint to the home, which was responded to promptly. Residents spoken to at the time of the site visit said that they would know what to do if they were not happy about something at the home. A system was in place at the home so that any complaints received could be recorded and any recurring patterns identified and regularly monitored. The pre-inspection questionnaire showed that the home had received one complaint since the last inspection, which had been dealt with according to the home’s complaints procedure and was found to be not upheld. The
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection had not received any complaints about this service since the last inspection. Policies and procedures were in place at the home in relation to safeguarding adults, which were in accordance with Department of Health guidance, so that people were fully aware of the action to take should an allegation of abuse be reported to the home. Staff spoken to confirmed that they had received training in relation to safeguarding adults and the training records seen supported this information. Staff were aware of what they should do if they had any concerns about the welfare of anyone in their care to ensure that appropriate action would be taken. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home was good, providing people living there with safe, comfortable and homely surroundings. EVIDENCE: People residing at Birch Green Care Centre lived in generally well-maintained accommodation that was domestic in character and had been designed to meet the individual and collective needs of residents accommodated. The environment was clean and homely, providing people with comfortable surroundings in which to live. Bedrooms were personalised to reflect the needs and wishes of the occupant. People living at the home were very happy with their private accommodation. Communal space was well designed and spacious with various seating areas that residents could access with ease. New carpets had been laid in the corridor areas since the last inspection, which enhanced the general environment. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 23 However it was noted that some repair work was required to a number of areas particularly in the ground floor bathrooms. The ground floor toilet ceilings also needed some attention, as well as some walls in one of the units. A number of bathrooms were cluttered with aids such as hoists and wheelchairs making the baths inaccessible. These should be removed to a more appropriate storage area so that people living at the home are given the opportunity to use these bathrooms, if they so wish. The outside garden and patio areas were provided with sturdy furniture to enable residents to sit out in the summer months. The laundry department was suitable for the needs of people living at the home and it was well organised, providing sufficient equipment, so that laundry was completed in a timely fashion. Detailed policies were in place at the home to ensure that the control of infection was being adequately met so that the health and safety of people living there was appropriately safeguarded. We noted that the laundry door was unlocked when vacant, which allowed easy access to the laundry machinery and domestic products kept in this area. However, it would be unlikely that people currently living at the home would access the laundry of their free will. Therefore, it is recommended that a risk assessment be conducted and strategies be put in place based on the outcome of the assessment. The inspectors observed that a relaxed and happy environment was provided for those living at the home, so that they were comfortable and so that they felt safe. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People working at the home were well trained and in sufficient numbers to meet changing needs of residents and the recruitment procedures were robust, adequately safeguarded those living at the home. EVIDENCE: At the time of the initial site visit there were 59 people living at the home. The numbers of staff on duty at Birch Green Care Centre were calculated in accordance with the individual assessed needs of people living at the home and qualified nursing staff were on duty at all times to ensure that the needs of people were being adequately met. Additional staff were deployed at peak times of activity during the day, so that the needs of those at the home were attended to promptly. During the daytime and evening period, designated care staff were normally assigned to the same unit so that consistency of care was being provided. There was sufficient ancillary staff employed to ensure that standards in respect of domestic and catering duties, were in the main, maintained. Both staff and people living at the home considered that the level of staff on duty was sufficient to address individual needs and requirements and this was reflected in the staff rota seen. One service user stated, “ I get all the help I need”.
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 25 Training for staff was given high priority at Birch Green Care Centre and there was a clear commitment to the training and development of all the people working at the home. All care staff were encouraged and enabled to undertake a National Vocational Qualification (NVQ) in care. Approximately 92 of the care staff team had achieved this recognised qualification at level 2, which is commendable. In addition to this a substantial number of care staff were either perusing or had achieved an NVQ at a more advanced level. This shows that people at Birch Green Care Centre were appropriately and sufficiently trained to do the job expected of them. Staff spoken with were able to give good examples of recent training which they had undertaken, included mandatory courses, such as moving and handling, food hygiene, fire training, health and safety and safe guarding adults, so that they were aware of the important aspects of looking after people within a care setting. The qualified member of staff spoken with also stated that she had recently attended some additional courses, including palliative care and end of life training so that anyone reaching this stage would receive appropriate care. We saw a new induction-training programme that was very comprehensive and detailed, which was in the process of being introduced to care staff within the first six weeks of their employment so that they were deemed competent to do the job expected of them. Staff spoken with felt that the training provided was very valuable and enabled a good quality of care to be provided, as well as allowing them to develop their knowledge and skills. A training plan was in place, showing that a lot of courses were arranged for the near future, demonstrating on going development for staff. Birch Green Care Centre operated a thorough and structured recruitment programme in order to protect those living at the home. From observation of four recently appointed staff member’s personnel files, it was evident that the policy and procedures in respect of staff recruitment had been followed. Robust checks had been conducted on these staff members before employment to ensure that they were suitable to work with vulnerable adults. People living at the home and their relatives spoken with were very positive in their comments regarding the staff group. The interaction observed between staff and those living at the home was friendly, informal and comfortable, which made those living at the home look happy and content. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was based on openness and respect, although the supervision of staff and the quality assurance systems could have been better. The finances of people living at the home were adequately safe guarded and, in general, the health and safety of people was protected. EVIDENCE: The registered manager had undertaken a variety of training courses since the last inspection, whilst managing the care home, including commencing a National Vocational Qualification at level 4, thereby increasing her knowledge and skills and extending her personal development. The people spoken to on the day of the site visits were very positive about the management of the home and felt that it was well run.
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 27 The home regularly reviewed aspects of its performance through a good programme of self-review, audits and consultations, which included seeking the views of people living at the home, staff and relatives. However, although there was clear evidence of a recent questionnaire being provided to a variety of different individuals, there was little evidence to demonstrate that the outcome of the more negative comments had been addressed. For example, although one person identified that they would like “more trips out, more activities, more outside walks, work in the garden” there was nothing evident to confirm that this had been addressed to the service user’s satisfaction. The staff questionnaire also raised a number of negative issues relating to their work. However discussion with a member of staff identified that although staff were encouraged to complete the questionnaire, she did not feel that the outcome had made any difference and nothing had changed. The pre-inspection questionnaire showed that there had not been any changes to the policies and procedures since the last inspection and that policies and procedures were available in the reception area of the home so that everyone had easy access to any information required. Regular meetings were held at the home for various groups of people, with minutes retained so that all relevant people could refer to discussions, which had taken place. Although we were informed that the operations manager visited the home at regular intervals there were no reports of her visits available on site, showing that she conducted a formal audit of the service every month, in accordance with Regulation 26 of the Care Homes Regulations. The financial interests of people living at the home were safeguarded by the procedures adopted. Wherever possible, people were encouraged to remain financially independent, assisted by their family or alternatively an independent advocate was approached to assist people with their financial affairs. Where the home did retain money or valuables on behalf of people living at the home, this was appropriately recorded and secure facilities were provided for the safe keeping of monies and valuables. However, it was noted that monies held on behalf of people were retained collectively in the secure facility provided by the home. It is strongly recommended that people’s money be individually stored in the safe provided, rather than retained collectively. Since the site visit the general manager has confirmed that this issue has been addressed and that any money held on behalf of people living at the home is now being retained securely on an individual basis. At the time of inspection, staff spoken with could not confirm that formal supervision had taken place on a regular basis and supervision records were not available from July/August 2006. Through discussion with the general
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 28 manager it was understood that formal supervision had been allowed to lapse due to a member of the management team being on extended sick leave. As recommended, all management and care staff should receive formal one to one supervision. At minimum, staff supervision should cover all aspects of practice, philosophy of care in the home and career development needs and should be provided at least six times a year. This would provide opportunity to discuss individual issues including the outcome of the staff questionnaire in order to establish any issues or concerns of the supervisee, which could then be addressed. Daily informal supervision was a routine feature at the home to ensure that staff were sufficiently competent to undertake their roles. Records showed that staff appraisals had recently taken place and staff members spoken with confirmed this. One relative had stated on the internal quality assurance questionnaire, “ I cannot thank the lovely staff enough at Birch Green Care Centre. In my eyes it’s the very best, my relative could not be in a better place. I always think it is more like home from home”. Another comment made was, “On my relative’s behalf I confirm that Birch Green is second to none as regards my relative’s welfare and happiness. I am extremely grateful to all concerned. I see no need to introduce change in any direction”. One visitor informed us that he had several relatives living at the home, saying, “That shows how satisfied I am with the standards of care and how well the home is managed”. A wide range of environmental risk assessments had been conducted, which were sufficiently detailed, showing that systems had been put in place in order to reduce the possibility of injury to people living at the home. The pre-inspection questionnaire showed that systems and equipment within the home had been appropriately checked so that the health and safety of people living at the home was protected. This was confirmed by examination of a random selection of service certificates. Accidents occurring in the home had been accurately recorded so that the manager was able to audit and monitor the frequency of accidents. The environment was free from any hazards, which could pose risks to those living at the home and fire drills were conducted periodically to ensure that all staff were familiar with the fire procedure and evacuation plan within the home. Policies and procedures were in place at the home in relation to Health and Safety issues, moving and handling, food hygiene and Infection Control practices, so that staff were aware of the importance to ensure that the health, welfare and safety of people living at the home was consistently protected.
Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 29 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 30/04/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medications received into the care home, including consistently recording the receipt of medications onto the Medication Administration Records. The registered person shall 31/07/07 having regard to the number and needs of people living at the home ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. The registered person shall 30/06/07 having regard to the number and needs of people living at the home ensure that suitable provision is made for storage for the purposes of the care home. Where the registered provider is 31/05/07 an organisation or partnership the care home shall be visited by a representative of the organisation, as defined in regulation 26 of the care homes
DS0000025564.V323350.R01.S.doc Version 5.2 Page 31 Requirement 2. OP19 23(2)(b) 3. OP19 23(2)(l) 4. OP33 26(2)(3) (4) Birch Green Care Centre regulations. Visits shall take place at least once a month and shall be unannounced. The person carrying out the visit shall interview, with their consent and in private, people living at the home, their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home; inspect the premises of the care home, its record of events and record of complaints and shall prepare a written report on the conduct of the care home, which shall be retained at the care home and submitted to the Commission if requested. 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. Refer to Standard OP7 Good Practice Recommendations The initial care plan should be based on the information gathered before admission, so that all assessed needs are recorded and so that staff are aware of how needs are to be met. The plans of care should be written in a clear format so that all staff are able to easily refer to them as required. The care records should not provide conflicting information so that appropriate care can be constantly delivered. It is recommended that whenever a significant risk is identified, a formal written risk assessment be undertaken to protect the resident and to support the reason for actions taken. Care plans should be followed in day-to-day practice to ensure that people’s needs are being fully met. Hand written entries on Medication Administration Records should be signed, witnessed and countersigned to avoid
DS0000025564.V323350.R01.S.doc Version 5.2 Page 32 2. OP8 3. 4. OP8 OP9 Birch Green Care Centre 5. 6. 7. OP10 OP12 OP15 8. 9. 10. OP31 OP33 OP36 any transcription errors. The receipt and destruction of controlled drugs should always be signed, witnessed and countersigned in the controlled drugs register, so that the possibility of any mishandling of medications is reduced. The refusal of any medications should always be recorded on the Medication Administration Records and the amount administered of variable dose medications should be consistently identified. Staff should refrain from discussing anything about residents within the communal areas of the home, so that confidentiality is maintained at all times. The registered person should ensure that regular and suitable activities are provided for all the people living in the home in accordance with individual preferences. The registered person should review the management of meals to ensure that people are offered the full range of choices available on the menu and to ensure that all relevant staff are aware of individual dietary requirements. The registered person should also ensure that people are always served with well-cooked meals, which are consistently well presented in order to promote appetite and aid in nutrition. The registered manager should continue to work towards achieving a National Vocational Qualification at level 4. Any issues identified through questionnaires or surveys should be considered and addressed, where appropriate, so that the quality of service can be constantly improved. All staff should receive formal supervision, at least six times a year so that their performance is monitored and so that any concerns may be discussed and training needs identified. Birch Green Care Centre DS0000025564.V323350.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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
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