Inspection on 22/07/09 for Birch Green Care Centre

This inspection was carried out on 22nd July 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Birch Green Care Centre 05/12/07

Birch Green Care Centre 13/03/07

Birch Green Care Centre 01/03/06

Birch Green Care Centre 08/09/05

Birch Green Care Centre 06/01/05

Birch Green Care Centre 06/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Birch Green Care Centre Birch Green Care Centre Birch Green Skelmersdale Lancashire WN8 6RS Lead Inspector Vivienne Morris Key Unannounced Inspection 22nd July 2009 09:15 DS0000025564.V376612.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Birch Green Care Centre DS0000025564.V376612.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 51301 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 Manager post vacant Care Home 74 Category(ies) of Dementia (38), Old age, not falling within any registration, with number other category (36), Physical disability (6) of places Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender:Either whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category - Code OP (Maximum No. 36) Dementia - Code DE (Maximum No. 38) Physical disability - Code PD (Maximum No. 6) The maximum number of service users who can be accommodated is: 74 Date of last inspection 5th December 2007 Brief Description of the Service: Birch Green Care Centre is a purpose built establishment, providing both nursing and personal care for up to 74 elderly people, including those who have care needs associated with a dementia related illness. 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 a 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. At the time of this key inspection the fees ranged from £396.50 - £686.50 per week. Additional charges were being incurred for hairdressing, toiletries, private chiropody, magazines and newspapers. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The site visit to this service was conducted over one full day in July 2009 and this formed part of the key inspection process. The visit was unannounced, which means that the people living at the home, relatives, staff and managers did not know it was going to take place. The pharmacy inspector was also involved in the inspection process because of recent concerns about the management of medications. During the course of the site visit, discussions took place with those living at the home, as well as relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation and all communal areas were seen. Comment cards were received from 27 people involved with the service and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, which gives information to the Commission about how the home is meeting outcomes for people using the service and how the quality of service provided is monitored. It also gives us some numerical information about the service. We observed the activity within the home and ‘tracked’ the care of five people living there 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 Care Quality Commission had received one complaint since the last key inspection, which was referred back to the provider to investigate using the home’s complaints procedure. Four safeguarding referrals had been made since the last key inspection. Strategy meetings were held for three of these referrals. No further action was taken for one, the home is monitoring the issue more closely for another and a random inspection was conducted for the third, so that the pharmacy inspector could look at the management of medications, following which an enforcement notice was issued to the home. Correct procedures were not followed in the fourth safeguarding referral as the previous manager conducted a full investigation before reporting the incident under safeguarding procedures. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 6 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 fully met. This information formed the basis of the initial care plan so that staff were fully aware of the needs of people moving in to the home. The plans of care were very detailed and provided staff with clear guidance about how the needs of people were to be met. They were written in the first person and those living at the home or their relative had, in general, been involved in the care planning process. A review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. 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 in relation to pressure, nutrition and continence were being appropriately met. A wide range of detailed risk assessments were in place to ensure that strategies had been implemented to protect the health and safety of anyone on the premises. When asked on the comment card what the service does well, one staff member wrote, ‘The majority of staff work well together. Val (General Manager) gives excellent staff support and the residents’ needs come first. The new manager has demonstrated that she has the drive to support staff to raise the standard of care higher. She appears to be a real team player like Val. The cleaners are highly thought of by the residents and other staff’ and another commented, ‘Individual needs are always met. Staff training is very good. Everywhere is always kept lovely and clean. The manager’s door is always open. The menu is varied and food is well prepared’. One relative answered the same question be saying, ‘the staff are great. They treat my relative with respect and they respect the family too’. The people living at the home looked very happy to be there and one told us, “I wouldn’t be here now if it wasn’t for the marvellous staff at Birch Green. I have put weight on and I am so much better that when I came in. It is the best move that I have ever made”. 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. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 7 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 they could make a complaint should they so wish. The policies and procedures in relation to safeguarding adults were detailed 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 very good standard and the premises, both internally and externally were well maintained providing those living at Birch Green Care Centre with a safe, clean, comfortable and homely environment in which to live. The home was pleasant smelling throughout and effective infection control measures were in place to ensure that the health and safety of people was well protected. Recruitment procedures and financial arrangements were in place at the home, which demonstrated that those living at Birch Green Care Centre were well 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. New members of staff were taken through a detailed induction programme so that they were deemed competent to do the job expected of them. It was pleasing to note that staff had received training on Person Centred Care and specific dementia care training so that they could deliver an individualised package of care. We received 23 comment cards from people living at the home. When asked what the service does well comments included. ‘It provides a good service and good family support’, ‘I am satisfied with the whole service’, ‘overall the home provides a good standard of care’ and two people simply wrote, ‘everything’. What has improved since the last inspection? There were no requirements made at the last inspection. However, additional staff had been deployed as a direct result of audits conducted to monitor the quality of service provided. The company had invested significant resources in upgrading the home, providing new seating in the dementia care unit and 11 new large single ensuite bedrooms with toilets and showers. The ground floor reception area and the lounge in the dementia care unit had been refurbished and the ground floor corridors had also been tastefully redecorated. There was work underway to create two multi-purpose shower/therapy rooms and plans were in place to Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 8 enhance the reception area of the dementia care unit designed to create a more open space for people living on this unit. New signage was in place so that people could find their way around the home more easily and the external grounds had been upgraded with resurfacing of the existing car park and new car parking spaces being created, including some disabled spaces. Hot water temperatures were being checked appropriately and better systems were in place for bathing people at the time of this visit. The portable appliances were being tested by a trained and competent person to ensure that they were safe for use. When asked if there was anything else people would like to tell us, one person wrote on the comment card, ‘some areas of the menu have improved, such as the Cornish pasties and some of the old favourites have returned, such as, bacon ribs. The beef burgers have improved too’. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Birch Green Care Centre DS0000025564.V376612.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.V376612.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 was not applicable to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Birch Green Care Centre has a good system in place to assess the needs of people before they are admitted to the home so that the staff team are confident that they can deliver the care and support required. EVIDENCE: We ‘tracked’ the care of five people living at Birch Green during the course of our inspection. Care records showed that enough information had been gathered about people before they moved into the home, to ensure that the staff team were confident that they could provide the care and support required. However, details obtained had not always been kept on the individual’s records so that staff could easily refer back to this information should they need to do so. Residents spoken with confirmed that someone had visited them before they Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 11 were admitted to Birch Green Care Centre to find out what they would need if they decided to move into the home. The relatives of people living at the home were encouraged to provide information, which would give the staff a clear picture of individual needs, so that care staff could talk to people about their past history and about their interests. 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. Comment cards were received from 23 people living at the home. 15 of these people said that they received enough information to help them decide if Birch Green was the right place for them to live. We saw that the Service Users’ Guide was available within each bedroom, so that people had all the relevant information about the home at hand, should they need it. Birch Green Care Centre DS0000025564.V376612.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The privacy and dignity of people living at the home is well respected and they are fully supported to meet their personal care needs. Certain aspects of their health care needs are fully met, but the management of medications is poor. EVIDENCE: The plans of care were extremely detailed, person centred records, being written in the first person and in most cases had been developed with the involvement of the people living at the home or their relative. Each plan of care had been reviewed and updated every month, providing staff, in general, with a very clear picture of people’s assessed needs and what care and support was required. However, for one person the plan of care did not include what was happening in day-to-day practice in relation to the support needed for the administration of their medications. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 13 Discussions took place, where possible, with the people whose care we ‘tracked’ and we observed staff supporting people, being sensitive in their approach and appreciative of the responses and conversations needed. The care plans were written in such a way that risk assessments were incorporated into them, making the plan of care very positive and easy to follow, showing that those living at Birch Green Care Centre received a personalised care service. 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. Records showed that a wide range of external professionals were involved in the care of people living at Birch Green to ensure that they were supported to meet their pressure care, nutritional and continence needs. However, the management of medications was poor as detailed later in this section, which had a direct impact on the health care needs of people living at the home. 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 seen to be respectful and mindful of residents’ feelings. Through direct observation, staff were seen to be very caring and gentle towards residents and did not try to rush them. Individual residents were talked to and assisted at a pace that was acceptable to the individual. Induction records showed that new staff were advised of the home’s expectation in relation to maintaining people’s privacy and dignity and the home’s policies, procedures and documents reminded staff about the need for respect. Relatives spoken to told us that staff were able to provide the right care and support needed by people living at the home and that they always treated people with respect and dignity. One of these people said, “My husband receives excellent care. The staff go through his care plan with me so that I know what care is being provided for him” and another commented, “my mum cannot do anything herself and yet she has no pressure sores and never has had. The communication from the home is excellent. They phone us and tell us anything to do with my mum”. Comment cards were received from twenty three people who lived at the home, twenty of these people said that, in general they received the care and support needed, including medical attention. The others said that they sometimes did. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 14 When asked what the service does well one person wrote, ‘I feel well looked after’ and another told us, ‘Birch Green provides everything for me and it meets all my needs’. When asked what the home could do better one person living at Birch Green wrote on the comment card, ‘to help me to clean my teeth more regularly’. Three of the four staff members who sent in comment cards told us that they were always given up to date information about the needs of people in their care and a fourth said that they sometimes were. The plans of care seen reflected clearly any changes in the needs of people, describing how these changes were to be appropriately met by the staff team. As part of the inspection a pharmacist inspector looked at how medicines were being handled because we found serious shortfalls on our last visit that meant medicines were not always being handled safely. We found general improvements in the ordering and stock control of medicines that helped make sure there was a sufficient supply kept in the home. Managers and staff were carrying out regular checks of the medicines and they said formal competency checks on staff were planned to help make sure staff have the necessary skills. We carried out detailed checks of the medicines and found a clear system of stock control that helped make sure medicines could be fully accounted for. However, we found some mistakes that showed staff were not always following the correct procedures. On the day of our visit one person had gone without their morning medicines because the home was waiting for them to be delivered. Some medicines were not being given at the right time in relation to food intake because the instructions were not being properly followed. The previous day a medicine used to prevent strokes was given at the wrong dose and time because the records were not properly checked when giving it out. A recent mistake made by nursing staff had resulted in the wrong dose of a strong pain killer being given because they had not checked the medicines correctly whilst preparing them. One person had a strong pain relief patch applied a day late because staff had forgotten to replace it and another person did not get any medicine to help prevent nausea for five days because it had been accidentally thrown away. Giving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. We found examples of poor record keeping that had contributed to some of the mistakes. Of particular concern was the lack of records for medicines disposed of. The nurse on duty said staff had discarded numerous unwanted medicines Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 15 but no record had been made making it impossible to account for them. Handwritten records, although usually double-checked, were often poorly completed with important information left off. We found the records of eye drops and external medicines such as creams were not always correct and we gave some advice about how to make the necessary improvements. Having clear and accurate records helps make sure people get their medicines given to them correctly. We checked how controlled drugs (medicines that can be misused) were handled. The cupboards used for storage were secure and special registers were used for record keeping. Stock levels were correct but on the previous day a record had not been properly made and we found that the procedures for handling and recording controlled drugs had not been correctly followed because a controlled drug had been given to a person but this had not been fully witnessed by two staff. Poor handling of controlled drugs can lead to them being misused and mishandled. We looked at a sample of care plans and records to check if medicines were properly reflected in them. We saw two good care plans about how to support people to look after their own medicines and these were reviewed regularly to make sure they were up to date. We spoke with one person who was happy to look after their own medicines and they said staff gave them the right amount of support. However, one persons care plan who was regularly refusing their medicines had no information about how this was to be managed and no formal contact with their GP had been made. Having clear written care plans helps make sure the health and wellbeing of people is properly protected. Birch Green Care Centre DS0000025564.V376612.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 at the home experience a lifestyle that satisfies their social and recreational interests and needs. People are encouraged to keep in regular contact with family and friends in order to maintain close links with loved ones. EVIDENCE: Two activity co-ordinators were appointed at Birch Green who were responsible for the organisation and provision of activities. Both these staff members were employed for 35 hours per week, which provided people living at the home with a high level of social activity resources. It was evident that a substantial amount of work had been done by the activity co-ordinators to implement and further develop more personalised social care services, particularly in relation to person centred individual goals for the people living at Birch Green Care Centre, which is commendable. Records seen gave some good information, providing a clear picture of people’s social interests and past lives so that staff could focus on things Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 17 people enjoyed doing. One relative told us, “Karen who does the activities on the ground floor is excellent. One person who was sitting in her bedroom told us that she enjoys joining in the activities and watching the entertainers who come to the home. She said that she has her meals in the dining room, because she likes having a chat to the other people in the home. Records showed that one person had been a keen gardener and another enjoyed flower arranging. Staff had made it possible for these two people to maintain their interest whilst living at the home, which was pleasing to see. It was noted that trips out were a regular feature at Birch Green Care Centre and people told us that they had thoroughly enjoyed a recent barge trip. Outings were arranged on an individual basis or in small groups so that more person centred social care activities could be arranged. Regular external entertainers visited the home, which people seemed to enjoy. Some relatives told us that they enjoyed a recent quiz held at the home and that they could join in any activities they wish. A number of residents spoken with confirmed that they enjoyed the activities provided and that they were able to make decisions about their chosen daily routines. Ministers from the local parishes visited Birch Green on a regular basis, so that the religious needs of people living at the home were consistently met. When asked what the service does well, one person wrote on the comment card, ‘the home does activities well’, another commented, ‘the home is very clean and feeds us very well. It provides plenty of activities which I try to join in’ and a third told us, ‘the cleaners do a good job and the staff care about me’. When asked what the service could do better three people living at Birch Green told us that the home could arrange more trips out to different places and one person wrote on the comment card, ‘the meals could be served on time and we could have a better variety instead of lots of casseroles. We could have bacon chops for example. There are too many things served in gravy’. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 18 We noted that the people living at the home were clean and nicely dressed and that staff were respectful towards them. We saw staff assisting people with their meals in a sensitive manner, allowing them time to enjoy their food. We observed lunch being served. We saw that people were able to dine within the privacy of their own bedrooms, if they preferred and others chose to eat in the communal dining rooms, which were pleasant areas in which to dine, with nicely laid tables and a leisurely, unrushed atmosphere. Hot and cold beverages were available and plenty of choices were being offered with staff addressing people individually. The menu was prominently displayed in the dining room, but this did not correspond with the evening meal being prepared. We were told this was because of market availability. At lunch time one resident said, “Oh the soup is very good, it is thick and full of vegetables. Very nutritious”. All those spoken with on the day of our visit said that they enjoyed the meals served. We noted that blue plastic aprons were used to protect people’s clothing if needed, which were not very dignified for the people using them. It was pleasing to see a company representative dining with one of the people living at the home at lunch time. Several relatives were spoken with who visited the home regularly. All stated that they were made to feel very welcome and that they had a good relationship with the staff. Information was readily available about visiting arrangements and one relative said, “I feel very comfortable visiting Birch Green. Staff are very good to residents and relatives and if I am here at a meal time I am always asked if I would like something to eat. Relatives are also offered beverages during their visits and a vending machine is available near the dining room”. Two visitors told us that their relative had settled into the home very well. One of them said, “it is like home from home. A very friendly atmosphere. The staff are lovely and Birch Green is very family orientated”. Details in respect of local advocacy services were made available to all residents and relatives and also referred to in the Service Users’ Guide. Through discussion with residents and observation of some bedroom accommodation, it was confirmed that residents were encouraged to take personal possessions with them to Birch Green to make their private accommodation more homely and comfortable. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 19 Birch Green Care Centre DS0000025564.V376612.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were well managed and people living at the home were safeguarded. EVIDENCE: A detailed complaints procedure was in place at the home, which was included within the Service Users Guide and available within each bedroom, showing that people were given enough information about making a complaint should they wish to do so. Twenty of the twenty three people who sent us comment cards and who live at Birch Green said that, in general, staff listened to them and acted on what they said. Three people said that they sometimes did. One relative said, “The staff always listen to what I have to say and they always take my views in to consideration”. All those who submitted comment cards said that there was someone they could speak to informally if they were not happy with something at the home. Fifteen of these people told us that they would know how to make a complaint. Residents and relatives spoken to at the time of our visit all said that they would know what to do if they wished to make a complaint and that they would feel comfortable approaching the staff about their concerns. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 21 A system was in place at the home so that any complaints received could be recorded and any recurring patterns identified and regularly monitored. 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, but this was soon to be updated and training records seen supported this information. All four staff members who submitted comment cards indicated that they would know what to do if a resident, relative or advocate had any concerns about the home. Birch Green Care Centre DS0000025564.V376612.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the 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 environment within Birch Green Care Centre is excellent, providing people living there with safe, comfortable and homely surroundings. EVIDENCE: The environment was clean, homely and pleasant smelling throughout, providing people with very 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 and all those who sent in comment cards told us that the home, in general, was always fresh and clean. Communal space was well designed and spacious with various seating areas that people could access with ease. Our tour of the premises confirmed that the maintenance of the home was of a very good standard, providing a safe and homely place for people to live in. However, the ceiling in the ground floor bathroom was in need of painting. It Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 23 is recognised that a substantial amount of work had been done to the environment since our last key inspection, which provided people with exceptionally pleasant surroundings in which to live. Details of these improvements can be found within the summary section of this report under the heading, ‘what has improved since the last inspection’. 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. We were told that plans were to extend the laundry department in order to house more equipment since the increase in the number of beds. 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. Clinical waste was being disposed of correctly to reduce the possibility of cross infection. Birch Green Care Centre DS0000025564.V376612.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of 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 so that those living at the home were safeguarded. EVIDENCE: At the time of the site visit to this service there were 67 people living at Birch Green Care Centre. Qualified nursing staff were on duty at all times to ensure that the appropriate care and support was being delivered. The duty rota showed that 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. Although there was no evidence to suggest that the care and social needs of people living at the home were not being sufficiently met, it was established that there was no recorded system in place for calculating staffing levels in accordance with the changing needs of the people living at the home. We were told that a combination of dependency records were used to determine how many staff need to be on duty at any one time. When asked if staff were available when they were needed, the responses from those who sent in comment cards varied. Five people said staff were always available, 12 people said that they usually were and another three responded Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 25 by saying they sometimes were. When asked if there was anything else that people would like to tell us, one person wrote on the comment card, ‘on the whole the staff do their best’. Three members of staff who submitted comment cards told us that there were usually enough staff on duty to meet the needs of the residents and staff spoken with on the day of our visit felt that there were enough staff on duty to meet the assessed needs of people living at the home. At the time of our visit we found that people were supported to meet their personal and social care needs and that their pressure, nutritional and continence needs were being fully met. 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 new staff had an induction-training programme which was very comprehensive and detailed. All care staff were encouraged and enabled to undertake a recognised qualification in care and it was commendable to see that 89 of staff had achieved this qualification. This showed that people working 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 safeguarding adults, so that they were aware of the important aspects of looking after people within a care setting. They also confirmed that training courses were provided in relation to the specific needs of people living at the home, so that they were confident to be able to give the care required. We were told that the company had invested in providing a good percentage of staff with specialist dementia care training through the Alzheimers society, following which 100 pass rate was achieved in the examination, which is commendable. Training records and the home’s self – assessment supported this information. One staff member when asked about training replied, “Oh, gosh we get loads of training”. We examined the training matrix which confirmed what staff had told us. Those who sent us comment cards told us that they were given training which was relevant to their role, which helped them understand and meet individual needs of people and which kept them up to date with new ways of working. Birch Green Care Centre operated a thorough and structured recruitment process in order to protect those living at the home. We looked at three staff member’s personnel records. It was evident that the policies and procedures in relation to staff recruitment had been followed in day-to-day practice. Robust checks had been conducted on these staff members before they started work to ensure that they were suitable to look after the vulnerable adults living at Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 26 the home. All four staff members who sent in comment cards indicated that appropriate checks had been done on them before they were employed. 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.V376612.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the 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 home is managed in the best interest of the people living there. However, the health and safety of people could be better protected by staff consistently following the medication policies and procedures in place at the home. EVIDENCE: The manager of Birch Green Care Centre had only recently been appointed and so she had not been registered with the Care Quality Commission. Those spoken with were complimentary about her management skills and felt that the home was being well run. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 28 The home had regularly reviewed aspects of its performance through a good programme of detailed self-reviews, audits and consultations, which included seeking the views of people living at the home, staff, relatives and stakeholders in the community. 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. People spoken to confirmed that meetings did take place to allow information to be passed on and so that the managers of the home could obtain some feedback about the service provided. 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. 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. 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 able to access additional information should they require it. A random selection of service certificates were examined, which showed that systems and equipment had been checked by external contractors to make sure that they were safe for use. The management of medications was poor, which had a direct impact on the health and safety of people living at the home and the overall management of the home. Giving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. Birch Green Care Centre DS0000025564.V376612.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 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 3 X 3 X 3 X x 2 Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13 Requirement Records of medicines received, given to people and disposed of must be clear, accurate and complete. This will help prevent mistakes and make sure medicines are handled safely. Medicines must be given to people correctly because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. Timescale of 17/07/09 not met. Timescale for action 10/09/09 2. OP9 OP38 13 10/09/09 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 OP15 Good Practice Recommendations It is recommended that an alternative protection for clothing be purchased so that people living at the home can dine in a more dignified manner. DS0000025564.V376612.R01.S.doc Version 5.2 Page 31 Birch Green Care Centre 2. 3. 4. 5. OP15 OP19 OP27 OP31 Arrangements should be made to ensure that the meals served coincide with the menu so that people get the food they have ordered. The ceiling in the ground floor bathroom should be attended to so that this area is brought up to the same standard as the remainder of the home. It is recommended that a recorded system be implemented for calculating staffing levels in accordance with the changing needs of the people living at the home. The manager of the home should submit an application to the Care Quality Commission as soon as possible to ensure a stable management structure for Birch Green. Birch Green Care Centre DS0000025564.V376612.R01.S.doc Version 5.2 Page 32 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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