CARE HOMES FOR OLDER PEOPLE
Birch Green Care Centre Birch Green Care Centre Birch Green Skelmersdale Lancashire WN8 6RS Lead Inspector
Vivienne Morris Announced Inspection 8th September 2005 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.V250338.R01.S.doc Version 5.0 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.V250338.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Birch Green Care Centre Address Birch Green Care Centre Birch Green Skelmersdale Lancashire WN8 6RS 01695 50916 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) birchgreen@springcare.co.uk Springhill Care Group Care Home 61 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (31), Physical disability (6) Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. The home is registered for a maximum of 61 service users to include: Up to 31 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 years). Up to 30 service users requiring personal care in the category DE(E) (Dementia over 65 years of age). 2 named service users in the category DE - (Dementia under 65 years of age) requiring personal care may be accommodated within the overall number of registered places. The registered provider should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any reasonable guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 6th January 2005 6. 7. Date of last inspection Brief Description of the Service: Birch Green Care Centre is situated in a residential area of Skelmersdale. The property comprises of accommodation on two levels, providing both personal and nursing care for elderly people. The first floor accommodates those requiring care associated with dementia. There are also a limited number of places available for persons with physical disabilities. All private facilities are within single bedrooms. Although en suite facilities are not provided at Birch Green, there are an adequate number of toilets located at appropriate positions around the home. A variety of lounge and dining areas are available, although service users may dine in the privacy of their own accommodation if they so wish. Local amenities are situated nearby, including a large shopping centre. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was conducted over one day during September 2005. The inspection process focused on the outcomes for people living at the home. During the course of the inspection service users, relatives and staff were spoken to, relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas and service areas were seen. The Commission for Social Care Inspection had received one anonymous complaint about this service since the last inspection, which related to staff not being adequately trained and which was referred back to the provider for investigation. The complaint was not upheld. What the service does well:
The plans of care were very well written documents providing clear guidance for staff as to how individual needs were to be met. The care records showed that health care needs were met and that those living at the home had access to specialist professional advice. A variety of risk assessments had been conducted and appropriate interventions put in place for those identified as being at risk. A detailed social history had been obtained and recorded so that staff were aware of individual’s backgrounds and preferences. A colourful, varied activity programme was in place and a person was employed who specifically coordinated and provided activities. Visitors were made welcome to the home, ensuring that service users maintained social contacts. The wishes of those living at the home were acknowledged and respected. A detailed complaints procedure was in place so that those living at the home and their relatives were aware of how to make a complaint. The home was decorated and furnished to a high standard. The environment was well maintained providing a safe place for people to live. The gardens were well maintained and a pleasant area for people to sit outdoors was available. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 6 In general effective quality monitoring systems were in place, which demonstrated that the service was run in the best interests of those living at the home. The registered manager ensured the health, safety and welfare of service users and staff by ensuring compliance with relevant legislation and making sure that the systems and equipment within the home had been appropriately serviced and that staff had received adequate training and supervision. What has improved since the last inspection? What they could do better:
More detail should be gathered prior to admission so that a clear picture of resident’s individual needs is built up to ensure that the home can determine if the assessed needs can be adequately met by the staff team. The plans of care must be drawn up with the involvement of the service user or their representative to ensure that they have some involvement with the care provided. The home should proceed in the recruitment of a permanent chef to ensure that the standard of food and nutrition is maintained for those living at the home. The manager of the home must review the cleaning protocol to ensure that adequate odour control is maintained throughout the home. The home should continue to work towards 50 of care staff achieving a National Vocational Qualification at level 2 or above, to ensure that staff receive adequate training to perform their duties. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 7 The quality assurance monitoring systems should be extended to seeking the views of relatives and stakeholders in the community as to how the home is achieving goals for service users. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home had not obtained enough detailed information about prospective service users prior to admission to ensure that all assessed needs could be adequately met. EVIDENCE: The care of two service users was ‘tracked’ during the course of the inspection, although the records of eight were examined. For those residents funded by the local authority a social worker had completed an assessment of the individual prior to admission, a copy of which was retained by the home for staff reference. The home had also conducted an assessment of service user’s needs prior to admission. However, this was in the form of a tick list and was not detailed in relation to psychological needs, preferences and social care needs, to enable the home to determine if the staff team could meet all the individual’s needs. Service users’ surveys had been conducted, which indicated that those living at the home felt that a thorough assessment of needs had been conducted before admission.
Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 10 Plans of care were in place for each person whose records were examined, which were based on the information obtained prior to admission. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 The plans of care were well written, detailing how health, personal and social care needs were to be met. Service users’ health care needs were being fully met. EVIDENCE: The care plans examined were very well written documents providing staff with clear guidance as to how individual needs in relation to health, personal and social care were to be met. The plans of care had been reviewed on a monthly basis, or more often if required and those seen reflected any changes in service users’ circumstances to ensure that current needs were being adequately met. One comment received was “In this care centre they really do care. Excellent care is given continually”. The plan of care for one resident had been agreed with their representative, but there was no evidence to demonstrate that the other care plan had been developed with the individual service user, therefore evidence was not available to demonstrate that all those living at the home had some input into the care which they were receiving.
Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 12 The home had conducted a variety of risk assessments and appropriate measures had been put in place to manage those identified as being at risk, including advice sought from a number of external professionals, to ensure that health care needs were adequately met. At the time of the inspection there were no residents with pressure wounds. However, assessments had been conducted to identify those at risk of developing pressure sores and specialised care and equipment had been provided, in accordance with the plan of care. Care records showed that professional advice had been sought regarding the assessment and management of service users who were incontinent and sufficient supplies of aids and equipment needed for the management of incontinence were available at the home to ensure that these needs were appropriately met. An activity programme was in place and freedom of movement within the home was evident to show that opportunities were given for appropriate exercise. However, one comment received by the inspector related to a physiotherapist not being available. This was discussed with the managers of the home, who informed the inspector that physiotherapy would be accessed as required in accordance with recommendations from the medical staff. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13 Not everyone living at the home found that the lifestyle matched their individual preferences and expectations. Service users were able to maintain contact with friends and relatives EVIDENCE: A colourful activities programme was displayed at the home and included in the service users’ guide so that those living there were aware of forthcoming events. This programme incorporated a variety of activities, including weekly communion, occasional trips out and birthday wishes to residents who celebrated birthdays that week, making the programme interesting reading for those living at the home. A record of participation in activities was retained for each person living at the home to monitor the level of activities provided to individuals. A member of staff was specifically responsible for the coordination and provision of activities within the home to ensure continuity and stimulation. At the time of the inspection one service user was seen to be using the computer supplied for residents’ use by the home, which demonstrated that leisure interests were maintained for this person. Information about individual leisure interests and preferences had been gathered and recorded on a social profile. This information for one resident whose care was ‘tracked’ was very detailed, providing staff with a clear picture
Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 14 of their social history, so that staff understood the background and preferences of this person. The plans of care were well written in relation to social care, providing staff with clear guidance as to how their social care needs were to be met and demonstrating that those living at the home were able to have some control over their lives. However, the inspector noted that the leather settee in the reception area of the first floor was very low and was restricting those who chose to sit in this area. The inspector received comment cards from 35 residents, 30 relatives and two external professionals. In general very positive comments were made. However, a small percentage felt that the food was not always up to standard, although others were satisfied with the food served. This issue was raised with the managers of the home who informed the inspector that the home was in the process of recruiting a chef to fill the current vacancy. An agency chef was being utilised as a temporary measure. A small percentage of those who returned the comment cards also felt that suitable activities were not always provided, although others felt that the provision of activities was satisfactory. Although the home had conducted surveys for those living there, the results being published in the service users’ guide, it is recommended that the manager discusses and records individual leisure preferences and takes these into consideration when formulating the activity programme. Comments received from those living at the home included, “I like designing greeting cards on the computer”, “I enjoy the trips out” and “I have been here for a number of years and I have never regretted a moment”. A policy in relation to visitors to the home had not been developed. However, the service users’ guide demonstrated that those living at the home were able to receive visitors in private and residents spoken to confirmed this, adding that visitors are always made welcome. One file examined showed written instructions from the resident requesting staff to not allow access to a named visitor, demonstrating that resident’s wishes were respected. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Complaints were well managed. EVIDENCE: A clear written complaints procedure was in place at the home, which was included within the service users’ guide, to ensure that those living at the home and their relatives were aware of how to make a complaint. The procedure also informed people of how to refer a complaint to the Commission for Social Care Inspection if they so wished. A record was kept of all complaints made, including details of any investigation and action taken to ensure that complaints were appropriately managed and so that the manager was able to monitor any recurring pattern. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The home was well maintained, providing a safe and pleasant environment for those living at the home. EVIDENCE: Service users commented that their private accommodation was well presented and comfortable. One service user said, “it is splendid living here, the staff are all lovely. My room is lovely. I couldn’t wish for anything more”. The home provided several comfortable lounge areas with a range of seating. Large dining rooms were available, which were tastefully decorated and well furnished. Bedrooms were being decorated on a rolling programme. Appropriate records were being maintained. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 17 The grounds were well maintained, and were fully accessible to those using wheelchairs. A very pleasant, colourful patio area had been developed, where those living at the home were able to enjoy the garden areas. The fire alarm system within the home had been serviced. The Environmental Health Officer’s inspection report had identified a small number of issues that had been addressed. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 The needs of those living at the home in relation to the provision of food and nutrition were not consistently met. Service users were protected by the home’s recruitment procedures. EVIDENCE: A clear staff Rota showing which staff were on duty at any time during the day and night and in what capacity was kept. Registered nurses were on duty at all times. The registered manager had implemented a system for calculating the ratio of care staff to service users, in accordance with the dependency levels of service users. Additional staff were on duty during the busier periods of the day. Staff providing personal care to service users were at least aged 18 and staff left in charge of the home were qualified nurses. A separate staff rota was in place for ancillary staff, which showed that an agency chef was utilised to perform cooking duties. However, the home was in the process of recruiting a permanent chef. The manager of the home should proceed with this process to maintain the standards of food and nutrition. Although the home was clean and tidy at the time of the inspection, an unpleasant odour was evident in one of the units within the home. The manager of the home must review the cleaning protocol to ensure that a good standard of odour control is maintained throughout the home.
Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 19 The records of two staff members were examined at the time of the inspection, which showed that references and POVA checks had been obtained prior to employment. Confirmation of registration had been obtained from the Nursing and Midwifery Council in respect of qualified nurses and a current work permit was on file for the overseas nurse. Criminal Record Bureau disclosures (CRB) had been applied for prior to the commencement of employment and appropriate supervision of staff was in place. An equal opportunities policy was in place at the home and staff completed equal opportunities monitoring forms on application for employment. Staff had been issued with the relevant codes of professional conduct and had received contracts of employment. Comments made by those living at the home included “I can’t praise Birch Green Care Centre enough. The staff are friendly and caring and the home is spotlessly clean”, “It is splendid here, the staff are all lovely. My room is lovely. I couldn’t wish for anything more”. One adverse comment was made to the inspector regarding staff attitude. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 38 The home was run in the best interests of those living there in relation to the quality of the service provided. The health, safety and welfare of those living at the home was promoted and protected. EVIDENCE: The home had achieved the investors in people award, and a full internal audit system was used. Copies of recent internal audits of care plans, medications and the environment had recently been completed to ensure continual selfmonitoring of the service. Service user and staff satisfaction questionnaires had been completed and were available in the home, some results had also been included in the service users’ guide so that interested parties could determine the quality of service provided. The registered person should now extend this process to seeking the views of relatives and stakeholders in the community Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 21 Recorded minutes of meetings had been retained in the home to ensure that people were given the opportunity to be involved in the day-to-day operation of the service. Some comment cards received by the inspector indicated that people were not always made aware of forthcoming inspections, although a notice was clearly displayed within the home to inform people of this planned inspection. Written policies and procedures had been reviewed and updated to ensure that staff were kept up to date with changing legislation and good practice guidance. All systems and equipment within the home had been appropriately checked and serviced, with records available for inspection to demonstrate that the manager of the home ensured safe working practices and the health, safety and welfare of service users and staff. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 22 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 3 Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Timescale for action Unless it is impracticable to carry 30/11/05 out such consultation, the registered person shall, after consultation with the service user, or representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall, 30/11/05 having regard to the size of the care home and the number and needs of service users keep the home free from offensive odours. Requirement 2 OP27 16(2) 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 OP3 Good Practice Recommendations The home’s pre-admission assessment should be in accordance with standard 3 of the National Minimum
DS0000025564.V250338.R01.S.doc Version 5.0 Page 24 Birch Green Care Centre Standards for Care Homes for Older People. The inspectors recommend that greater detail be obtained prior to admission in order to ensure that the home can fully meet the individual needs of the service users. 2 3 4 5 6 OP12 OP12 OP12OP27 OP28 OP33 It is recommended that the manager discusses and records individual leisure preferences and takes these into consideration when formulating the activity programme. The registered person should consider exchanging the settee on the first floor with a more suitable piece of furniture to prevent those sitting in it being restricted. The registered manager should proceed with the recruitment of a permanent chef to ensure that standards relating to food are maintained. The home should continue working towards a minimum ratio of 50 of care staff having achieved a National Vocational Qualification at level 2 or above. The registered person should seek the views of relatives and stakeholders as to how the home is achieving goals for service users. Birch Green Care Centre DS0000025564.V250338.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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