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 5th December 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Birch Green Care Centre DS0000025564.V354111.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.V354111.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 Post Vacant Care Home 67 Category(ies) of Dementia (35), Old age, not falling within any registration, with number other category (32), Physical disability (6) of places Birch Green Care Centre DS0000025564.V354111.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). 13th March 2007 Date of last inspection Brief Description of the Service: Birch Green Care Centre is a purpose built establishment, providing both nursing and personal care for up to 67 elderly people, including those whos care needs are 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 £386.00 - £507.00 per week. Additional charges were being incurred for hairdressing, private chiropody, magazines and newspapers. Birch Green Care Centre DS0000025564.V354111.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 one day in December 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 thirteen 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. Some of this information forms part of this inspection report. The inspectors observed the activity within the home and ‘tracked’ the care of three 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. When asked what the home does well the manager told us that prospective residents were assessed prior to admission to identify their needs and requirements and that this information was entered onto the pre-admission forms, which were kept with the care plans. The residents’ health, personal and social care needs are set out in comprehensive care plans and are supplemented in the daily verbal handovers ensuring that such needs are recognised and acted upon by staff. There is good interaction with external professionals and a reliable process of referral to medical advice. Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 6 When asked on the comment card, what the service does well, one relative wrote, “I think Birch Green Care Centre is a very lovely home for people like my dear relative who needs 24 hour care. The staff and cleaners are really very kind and loving. The home is lovely and clean and well run. The old people are well looked after”. The plans of care were well written documents, providing staff with clear, detailed guidance about how the assessed needs of people living at the home were to be accurately met and how people were to be well supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. One comment received from a relative was, “They (the staff) give full support in all medical problems and give full and enjoyable support with regards to occupational therapy. Dietary requirements are fully met”. 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 wide range of detailed risk assessments was in place to ensure that systems were 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, “They (the provider) do expect a high standard of care, which staff try to give, but I think there are not enough staff to maintain high standards” and another stated, “The staff are very kind and caring and they look after the residents well, doing their best for them at all times”. When asked what they do well, the manager wrote on the home’s self assessment, “We support the residents in maintaining contact with their relatives and friends. We provide a good variety of nutritious food and a choice of menu”. 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 lives, including managing their own finances, within a risk management framework and therefore promoting equality and diversity. Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 7 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. 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. When asked what the service does well, the manager told us, “The complaints procedure is available for people to use. The home deals with complaints promptly and diligently, ensuring that the nature, investigation and outcome of the complaint is appropriately recorded as well as being brought to the attention of the operations director and staff are provided with training in respect of safeguarding adults”. 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. 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. When asked what the service does well the manager told us, “We provide a relaxed and happy environment in which residents feel safe and are comfortable”. The manager of Birch Green Care Centre wrote on the home’s self assessment, “There is a training programme in place in which 86 of care staff have achieved a recognised care qualification. There is good interaction between staff and residents and there is a good skill mix of staff providing care.” 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.
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 8 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, “The home is well run and the managers are very nice and friendly”. 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. When asked, on the self-assessment, what they do well, the manager wrote, “Systems and equipment are appropriately checked to ensure the health and safety of people within the home. The application of a quality assurance audit tool for residents, relatives and staff”. What has improved since the last inspection?
When asked how the home had improved in the last twelve months, the manager said that the development and implementation of a revised preadmission assessment document had improved the gathering of appropriate information prior to the people’s admission to the home. The manager also said that improvements have been made in recognising and prioritising the residents’ care needs as well as understanding the individuality of each resident. All information, which had gathered before admission to the home was included on the individual’s plan of care, providing staff with relevant details to ensure that a consistent and holistic approach to care and support was being provided. Any new information, which was recorded on the plans of care, was clear, so that staff were aware of individual needs to ensure that appropriate care was consistently delivered and that the health and safety of residents was promoted within a risk management framework. The management of medications had improved significantly since our last visit to this service, which was commendable. The requirement and all the recommendations made at the last inspection had been appropriately addressed to ensure that medication practices were consistently safe.
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 9 When asked what had improved since the last inspection, the manager told us, “There is improved awareness amongst staff about the social, cultural and religious needs and interests of people living at the home and we continue to deal with issues that maintain the confidence of residents and relatives” The provision of leisure activities had improved since the last inspection as the preferences of people living at the home had been taken into consideration, 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. People living at the home were being offered a full range of options from the menu to ensure adequate dietary intake. Liquidised meals were well presented and looked appetising in order to promote appetite and aid in nutrition. All the people living at the home were provided with the same opportunities, in relation to the quality and choice of meals served. The manager of the home told us that an extensive re-decoration programme has been undertaken over the past twelve months and this information was supported by our observation of the premises during our site visit to this service. The manager of the home told us that improvements had been made to the induction programme since the last inspection and an improved planned training programme had been developed and implemented”. Monitoring of the quality of service provided included feedback from stakeholders in the community, such as doctors, nurses and other external professionals who were involved in the care of the people living at the home. The manager told us that improvements had been made since the last inspection by the introduction of a revised quality assurance audit tool. A representative from the organisation visited the home unannounced and she had prepared a written report on the conduct of the care home at least once a month so that the standard of care provided could be regularly monitored. All staff had received formal supervision at least six times a year so that they were able to discuss any issues with their line manager and so that they could receive feedback on their performance and highlight any areas of training needed. Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 10 What they could do better: 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.V354111.R01.S.doc Version 5.2 Page 11 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.V354111.R01.S.doc Version 5.2 Page 12 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. Standard 6 was not applicable to this service. 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: Seven comment cards were received from people living at Birch Green, which showed that, where possible, they had received enough information before they moved into the home. We saw that the service user’s guide was available within each bedroom, so that people had all the relevant information about the home at hand, should they need it. Care records examined showed that enough information had been obtained about people wishing to move into the home, to ensure that the staff team were able to meet the assessed needs of each individual before offering them
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 13 a place at the home. Details gathered, in some instances, included a personal profile, which had been written by relatives and which gave staff a brief summary of the individual’s past social history, so that they were able to relate to life histories and particular interests of individual residents. This was considered to be good practice. 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. Residents spoken with confirmed that someone had visited them before they were admitted to Birch Green Care Centre to find out what they would need if they were admitted to the home. Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 14 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 Good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of people living at the home was being consistently met and their privacy and dignity was always maintained. EVIDENCE: Comment cards were received from seven residents, all of who said that in general they received the care and support, which they needed, including medical attention as required. One person added, I really enjoy being here and another told us, “The staff are all very good. They help me to have a bath and get dressed and anything else that I might need”. Comment cards were received from three relatives, all of who stated that the needs of people living at the home were, in general, always met and that they were kept up to date with important issues affecting their relative. However, one relative wrote on the comment card, “ I’m always informed, but there may be a big time delay before information is passed on”. Relatives said that, in
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 15 general, staff had the right skills and experience to look after the residents and that they always gave appropriate care and support to people as was needed. Both staff members who sent in comment cards indicated that they were not always told about the changes in the needs of the people living at the home. However, 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. One resident wrote on the comment card, “The carers are extremely conscientious and caring to the residents. They do a wonderful job”. A comment card was received from a General Practitioner, who indicated that the health care needs of people living at Birch Green were always met. One resident told us, “I weighed seven stones when I came in earlier this year and now I am 10 stones. I am going to the dentists today in a taxi with one of the girls (a staff member)”. 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. The plans of care were written in a person centred way, explaining the support needed for people to have a good quality of life whilst living at Birch Green Care Centre. Discussions took place, where possible, with the people whose care we ‘tracked’ during our site visit and we observed staff supporting people, being sensitive in their approach and appreciative of the responses and conversations needed. Staff had written in one person’s plan of care, on behalf of the resident, ‘I Would like staff to treat me with dignity and respect should I need assistance’. 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. 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. 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 relatives showed that they were satisfied with the overall care provided to the people living at the home. Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 16 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. Clear medication records were maintained and photographs were retained of each resident on their Medication Administration Records for identification purposes. The overall management of medications had significantly improved since the last inspection 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. 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 respectful 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. 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 and records seen supported this information. Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. People living at the home experienced a lifestyle that satisfied their social and recreational interests and needs. Residents were encouraged to keep in regular contact with family and friends in order to maintain close links with loved ones. EVIDENCE: 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. The activities programme was prominently displayed, which was in picture format, making it ‘eye catching’ and more interesting for those living at the home. People spoken to confirmed that special events were always celebrated in style and they told us how much they had enjoyed the Halloween party. Activities were being provided in accordance with the different needs of the people living at the home, to ensure that they were able to join in, if they chose to do so. Some trips out had taken place in the summer time, including
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 18 a much enjoyed barge trip. A record of residents’ preferred activities was maintained following a survey earlier in the year and the manager told us that he planned to incorporate these preferences into the person centred care planning, which would be considered good practice. One resident said, “I am happy here. The staff are great. I cannot grumble at all”. A number of residents spoken with confirmed that they were able to make decisions about their chosen daily routines. One resident said, “I think I will have a bath today. The staff will help me”, and another stated, “I love living here. It is smashing. I can choose to do what I want, when I want”. During the course of our site visit, we saw that social relationships were encouraged either through family or friends visiting the home at a time of the resident’s choice, or trips out into the wider community with family and friends. Residents were free to entertain their guests either in the privacy of individual bedroom accommodation or within any communal area of the home. 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. At the time of our site visit the hairdressing salon was open and people were seen enjoying the experience of having their hair done to their liking. The hairdresser was seen speaking to people, telling them of their hairdressing appointments for the day. Residents were seen to be relaxed, enjoying a calm and peaceful atmosphere and staff did not appear to be rushed, but had time to converse with people living at the home in a sensitive way. One resident commented, “We have a good laugh here. Everyone is so friendly”. A member of staff was heard supporting one person to get up in the morning. She was very patient and worked at a pace suitable for the resident. Comment cards were received from seven residents, who said that there were always suitable activities arranged and that staff listened and acted upon what people living at the home said. One person wrote, Activities are available if I want to be involved”. One person spoken to said she was settled and happy, adding that Birch Green felt like home and that she liked having a good laugh and got on well with everyone. Another person living at the home said, “The staff are beltin’. The food is good and the staff are good”. 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 Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 19 their meals, as was required in a sensitive manner, allowing them time to enjoy their food. People living at Birch Green, in general, said that they always liked the meals at the home. One person wrote on the comment card, “Oh yes, I eat everything that’s put in front of me”. We spoke to the agency chef, who was on duty at the time of our visit and who was very enthusiastic about his work. He told us that he had worked at the home on a regular basis and he seemed to be aware of the different needs and preferences of the residents. Choices of meals were clearly identified on the menu, with alternatives available, as required and food was freshly made to ensure that those living at the home received a well-balanced, nutritious diet. Staff were seen offering people choices at breakfast time and another member of staff was observed asking residents what they would like for lunch. People spoken to confirmed that a wide range of choices were available at meal times and that the food served was always of a good quality and plentiful. We observed two meals being served during our visit to this service. On both occasions 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 leisurely, unrushed atmospheres. One person living at the home said, “The food is marvellous. I eat everything. Breakfast is exceptionally good. We get a good choice of meals”. 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. Residents were encouraged to maintain control of their own financial affairs for as long as they wished to, allowing them some control over their lives. Details in respect of local advocacy services were made available to all 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. Birch Green Care Centre DS0000025564.V354111.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 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. Two of the three comment cards received from relatives indicated that they were aware of the home’s complaints procedure and all the comment cards received from people living at the home indicated that they would know what to do if they were not happy and wished to make a complaint. Residents and relatives spoken to at the time of the site visit all said that they would know what to do if they wished to make a complaint. 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 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.
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 21 Staff spoken to confirmed that they had received training in relation to safeguarding adults and training records seen supported this information. Both 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. One of them wrote, “Sometimes I feel that one nurse is hard to approach”. Staff spoken to 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.V354111.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 Birch Green Care Centre 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, homely and, in general, pleasant smelling, 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 and all those who sent in comment cards indicated that the home was always fresh and clean. Communal space was well designed and spacious with various seating areas that residents could access with ease. An extensive redecoration programme
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 23 had been implemented and our tour of the premises confirmed that the maintenance of the home was of a good standard. 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 saw that a relaxed and happy environment was provided for those living at Birch Green, so that they were comfortable and so that they felt safe. Birch Green Care Centre DS0000025564.V354111.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 site visit to this service there were 62 people living at Birch Green Care Centre. Qualified nursing staff were on duty at all times to ensure that the needs of people were being adequately met. 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 needs of people living at the home were not being sufficiently met, it was established that the staffing levels were being calculated in accordance with historical information and not totally in accordance withy individual assessed needs. Some people felt that there were not always sufficient numbers of staff on duty. One person wrote on the comment card, “Staff are usually available when they are needed, but you must understand that the home is nearly always short of staff”. When asked on the comment card how the care home could improve, one relative wrote, “They could improve by employing more staff, as there always seems to be a shortage. Staff do not stay in the employment of the care home for any length
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 25 of time”. However, another relative stated, “The home does not need to improve. The staff are very good”. One member of staff indicated on the comment card that there were never enough staff on duty to meet the individual needs of all the people who use the service, adding, “We have 9 or 10 residents to feed at mealtimes between three members of staff. Sometimes residents don’t get their meals until 6pm, when they are ready at 5pm”. The other member of staff who submitted a comment card indicated that there were usually enough staff on duty to meet the needs of the residents. One staff member wrote, “Sometimes I feel that I am not spending enough time with residents because of time issues. We are always running around, trying to get everything done”. When asked on the comment card, what the service could do better one member of staff wrote, “Employ more staff. Senior nurses are always in the office doing paperwork and seemingly under pressure. They don’t acknowledge the carers stress or pressure, when the workload is heavy”. Although there was no evidence available at the time of the site visit to suggest that there were not enough staff on duty, as it was found that the needs of people were being adequately met. In light of the comments made about the staffing levels at the home, it is recommended that the registered person ensures that every resident’s needs are consistently being met by the number of staff on duty at anyone time. 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 recognised qualification in care and it was commendable to see that 86 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 safe guarding adults, so that they were aware of the important aspects of looking after people within a care setting. The induction-training programme was very comprehensive and detailed, which was introduced to new 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
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 26 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 process in order to protect those living at the home. From observation of three staff member’s personnel files, it was evident that the policy and procedures in respect of staff recruitment had been followed in day-to-day practice. 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. Both staff who sent in comment cards indicated that appropriate checks had been done on them before they were employed, that their induction partly covered everything they needed to know to do the job and relevant training was provided to help them to understand and to meet individual needs of residents. One staff member stated, “The training is very good and is always updated”. Birch Green Care Centre DS0000025564.V354111.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. 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 some areas of health and safety could have been better managed. The finances of people living at the home were adequately safe guarded and staff were sufficiently supervised. EVIDENCE: The manager of Birch Green Care Centre had only recently been appointed and so he had not been registered with the Commission for Social Care Inspection. He had the right qualifications and experience to run the nursing home and those spoken with were complimentary about his management style. Staff spoke to felt that things had changed for the better since new manager had arrived. We discussed at length, with the manager, the plans for the future. He
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 28 was very enthusiastic and was positive that the service for people living at Birch Green could be improved. One staff member wrote on the comment card, “I think the home is well managed and the staff are very kind, genuine people. We all work well in what can be a very demanding role”. The comment card sent by a GP provided all positive responses to the questions asked. He added, “The home is doing a very good job in the community”. Both staff members who submitted comment cards indicated that the way in which information about residents was passed between staff did not always work well. One staff member wrote, “Sometimes a nurse forgets about information I have passed on. We do not have handover meetings in the mornings. Sometimes it is the afternoon before you know if there has been an incident in the night”. The home 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. The results of the surveys returned by the residents had been published in graph format so that any interested person knew how the home was meeting its goals for the people living there. 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. At the time of our site visit, records seen showed that formal supervision had taken place on a regular basis so that the training needs of staff could be identified and so that those working at the home could receive some feedback about their work performance. 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.
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 29 The home’s self-assessment showed that systems and equipment had been appropriately checked so that the health and safety of people living at Birch Green was adequately protected. However, it was established that there were two separate methods in place for checking the temperature of bathing water and not all staff were aware of the correct procedure to follow, despite mandatory health and safety training for staff including correct bathing procedures. We found some hot water outlets to exceed the recommended temperatures, which did not totally protect the safety of the people using these facilities. However, this situation was rectified whilst we were at the home. The temperature of bathing water had not been recorded and hot water temperatures, throughout the home had not been recorded at regular intervals to ensure that people were being consistently protected. Recorded evidence showed that the home had been experiencing difficulties in getting the portable electrical appliances tested, due to cancellation by the contractors. However, we were informed that this had been arranged for the very near future. 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. Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 30 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 4 8 3 9 3 10 3 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 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 3 X 3 X 3 3 X 2 Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 31 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. Standard Regulation Requirement Timescale for action 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 OP27 Good Practice Recommendations Staffing levels should be calculated in accordance with the assessed needs of the people living at the home, to ensure that appropriate care is constantly being delivered. In light of the comments made about the staffing levels at the home, it is recommended that the registered person ensures that every resident’s needs are consistently being met by the number of staff on duty at anyone time. Hot water temperatures should be checked weekly and the temperature of bathing water should be recorded at each bath for every resident. Only one method of checking water temperatures should be in place in order to eliminate any confusion and all care staff should be fully aware of the correct bathing procedures to ensure that the safety of people living at the is consistently promoted.
Birch Green Care Centre DS0000025564.V354111.R01.S.doc Version 5.2 Page 32 2. OP38 3. OP38 A competent person should test the potable electrical appliances every year to ensure that the home provides a safe environment for the people living there. Birch Green Care Centre DS0000025564.V354111.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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