Inspection on 21/11/07 for Birch Tree Lodge

This inspection was carried out on 21st November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Birch Tree Lodge 07/04/08

Birch Tree Lodge 09/07/07

Birch Tree Lodge 06/06/06

Birch Tree Lodge 01/12/05

Birch Tree Lodge 12/05/05

Birch Tree Lodge 17/12/04

Birch Tree Lodge 22/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Birch Tree Lodge 11 Toller Road Quorn Loughborough Leicestershire LE12 8AH Lead Inspector Keith Williamson Unannounced Inspection 21st November 2007 09:30 Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 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 Tree Lodge DS0000001758.V353825.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 Adults 18-65. 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 Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birch Tree Lodge Address 11 Toller Road Quorn Loughborough Leicestershire LE12 8AH 01509 415665 01509 415842 manager.birchtree@aermid.com 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) Aspire Lifestyle Limited Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration. Date of last inspection 9th July 2007 Brief Description of the Service: Linden Lea is a residential home for 4 adults with learning disabilities with three resident at the time of the visit. Residents all have complex needs including autistic spectrum disorder and epilepsy. The home is situated in a quite residential part of Quorn village and is close to local amenities such as shops and public transport links. The home is an adapted property, with a lounge, games room, conservatory and bedroom to the ground floor. All other residents’ bedrooms and office are on the first floor. To the rear of the home is a secluded garden. The fees charged range between £1153.00 and £1476.16 per week. A copy of Service Users Guide and Statement of Purpose were available, and seen on this occasion. A copy of the last Commission For Social Care Inspection (CSCI) inspection report is displayed in the kitchen of the home, and copies of this report are available from the acting manager. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspections is on outcomes for residents and their views of the service provided. The main method of Inspection used was ‘case tracking’ which involves selecting a sample number of clients and tracking the care they received through talking with them where possible, and looking at their records and accommodation, in this case one resident was chosen. This visit took place over one day, commencing at 9.30am and took five hours to complete. An opportunity was taken to talk to residents and staff, look around the home, view records, policies and care plans. Information was gathered prior to the site visit from sources such as the residents, their relatives and others’ comment cards. Further information was obtained from the Annual Quality Assurance Assessment (AQAA), which gives information on the home, and is filled in by the manager. All three of residents were seen and two residents were spoken with. One staff member and the acting manager were also spoken with. What the service does well: Residents care needs are assessed and a contract is produced prior to moving into the home. A care plan is then produced, and these documents are produced in an easy read format using pictures and symbols. Staff check some medicines on a daily basis, and make sure others being returned to the chemist are marked down in a book. Resident’s time during the week is taken up by college courses or social care time. Meals are varied and times served are flexible. Residents have access to fresh fruit. Complaints information is displayed in the home, and is also available in an easy read format using pictures and symbols. Staff are aware of how the whistleblowing procedure works. The home is comfortable and clean, and staff were aware of cross contamination and cross infection issues. Staff do a number of health and safety checks to help keep the home safe. Staff employed by the last manager had a number of checks before they were allowed to work at the home. Staff have had one to one supervision meetings set up with the manager. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The assessment process is detailed and effective resulting in accurate information for prospective residents and staff. Though the Statement of Purpose, and Service User Guide have yet to include quality assurance information. EVIDENCE: The Statement of Purpose, which sets out the latest aims, objectives and philosophy of the home, about its services, facilities, and current staffing, was available for inspection on this occasion, though this has yet to be amended with the current staffing details. Neither the Statement of Purpose nor Service User Guide includes any quality assurance information. Residents’ needs are assessed prior to moving into the home. The registered manager compiles information using the health and social service assessment and other self produced assessment information, providing a base from which care plans are produced. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 9 The one case tracked resident has a contract on file; this was produced in a pictorial form, which is large writing with additional pictures. This has yet to be completed stating the residents’ specific bedroom. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are looked after well in respect of their personal care needs choices and areas of risk are assessed appropriately. EVIDENCE: The care plan was examined in detail, this had been recently reviewed and some changes made to the plans. This was not signed by the resident, a relative or member of staff and no evidence is in place to indicate the plan was shared with the resident. Decision-making is recognised in the home, the care plan having suggestion as to how this is achieved. Risk assessments are included in the care plan, these have details of individual resident’s needs, and the equipment needed to keep residents safe. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported in maintaining a good lifestyle. EVIDENCE: One resident has a college course for part of the week; details of this are into the plan of care. The residents’ care plans tells the staff what self-care and practical life skills people have but does not tell them what needs to be developed. No residents were able to comment on visiting, but the acting manager stated this was unrestricted. The case tracked resident did not have a bedroom door key; again the acting manager stated these are offered following a risk assessment. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 12 Meals are varied and flexible, residents participate in menu selection by means of likes and dislikes list, and personal preference at each meal. The menu was seen, and this reflects the residents’ individual cultural dietary needs. Residents’ daily routines are flexible and varied; evidence of individual treatment was seen in the daily records. One resident asked for, and was given a piece of fresh fruit, from the supply in the pantry. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Residents are not well looked after in respect of their health and personal care. Improvement is needed in the documentation relating to residents medication. EVIDENCE: The locks on the toilet doors have not been changed, and do not give any level of privacy to those in the home. Bedroom doors can be locked but no resident has yet been given a bedroom door key. Staff now have access to a mobile phone and can support that resident whilst out of the home. Residents healthcare is not well covered, with no evidence of annual health checks, though there is evidence on file of specialist health appointments with consultants and other healthcare professionals. Overall medication continues to be poorly managed with missing signatures on the medication administration records (these mar charts are used to record what medicine has been given and when). New medication delivered from the chemist had not been marked into the stock of medicines and was still in the Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 14 box to be sent back to the chemist. On checking the stock levels, there was excess stock of certain medication in the home. The policies and procedures to help and instruct how medicine is given to residents, are not detailed enough to ensure residents safety in the home. There were some improvements from last visit with no evidence of hand written medication records. A duplicate book is used for any medicine being returned to the chemist. A certain type of medication is regularly checked by staff at the beginning of each day, this is to ensure the numbers of medication in stock is correct. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Though complaints and safeguarding information is available in the home, the lack of recent Adult Protection training, places residents at risk in the home. EVIDENCE: There have been no complaints forwarded to the Commission for Social Care Inspection. There have been no complaints recorded by the home. Complaints information is clearly displayed in the Service User Guide, and is available in a pictorial version, which would help the current residents in making a complaint. Staff told the Inspector what they knew about Adult Protection and whistleblowing procedures. There has been no Adult Protection training since before the last visit and this must be arranged soon to ensure all staff are aware of the full range of Adult Protection issues. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and clean environment. EVIDENCE: The general décor in the home is good, with carpets and floor coverings in a good condition. The home is clean, and residents’ bedrooms are personalised, with various pictures and electrical equipment. The home is registered for four residents, and one room is currently being used to provide a “sleep in” room for staff. The acting manager stated that the future provision of this accommodation had yet to be decided. There is no current plan for refurbishment, and the outstanding work identified at the last visit, has not been done. The nameplate to the front door of the home, is still in that of the old name for the home, and the toilet door locks Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 17 have not been changed. The acting manager stated there was some improvement work due to take place the week following the visit. Staff had a good awareness of cross contamination and cross infection issues. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, & 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. A high staff turnover, and lack of consistent staff training puts residents at risk in the home. EVIDENCE: Of the staff files seen, many staff had training qualifications; these included the National Vocational Qualification (level two), a nationally recognised course for staff in caring. The staff team consists of some permanent staff, however a large number of agency staff and staff from another home in the “group”. This does not offer consistent care to the residents, and can affect residents’ moods and behaviour. The inspector looked at how staff are employed. A number of checks were made by the previous manager to ensure permanent staff, are who they say they are, this helps to keep residents safe in the home. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 19 Staff training is not well planned, with not enough staff completing the courses that should be done every year. Other staff training given by the District Nurse, to allow care staff to give injections should also be refreshed each year, this is not happening, and puts residents at risk. Staff supervision, which is one to one meetings between staff and the acting manager, have been organised, the dates are in place, and the sessions started. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The health and safety of the home is adequate, but the lack of a permanent manager, high turnover of staff and lack of quality assurance procedures does not provide a stable environment for residents. EVIDENCE: There is an acting manager in post who has not yet applied to be the registered manager of the home. A permanent manger must be put in post. Quality assurance which is the way the staff ask the residents and any other interested person, how good the home cares for people live there, has not been started. Some way of asking residents and their relatives must be put in place for this to happen. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 21 Health and safety is good, with staff doing tests on the fire system, hot water and fridge temperatures on a regular basis. The fire risk assessment and escape plan have been recently re-written. Staff have access to policies and procedures, these are up to date. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 1 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 1 1 X 3 X Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 23 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 YA1 Regulation 4 (1) a,b,c Requirement The Statement of Purpose, and Service User Guide must be produced in a way residents can understand, and include feedback from any quality assurance exercises in the home. This would ensure all residents and relatives had adequate information prior to moving into the home. 2 YA18 12 (4) (a) The residents’ right to privacy and to be treated with dignity in all areas of the home used by residents. (This requirement with an original timescale for action of 09/09/07 remains unmet) 3 YA19 13 (1) b Residents must have regular healthcare input from an appropriately qualified Doctor. This would ensure ongoing availability to healthcare. 18/02/08 18/01/08 Timescale for action 18/01/08 Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 24 4 YA20 13 (2) There must be an accurate record of all medication received and administered by the service including any defined codes for any non-administration This would ensure the correct resident got the correct medication. 18/01/08 5 YA24 23 (2) b There must be a plan of maintenance and renewal of furniture and fittings. This is to ensure that any item requiring to be replaced is done so in a timely fashion. 18/01/08 6 YA33 19 (1) a There must be a system introduced where a core number of staff are used in the home. This is to ensure residents are given consistent care in line with their plan of care. 18/01/08 7 YA35 18 (1) a, c A staff-training programme designed to enable staff to meet the individual needs of residents, and training the law states must be implemented is put in place. This would enable all staff to be equally skilled to meet residents’ needs. 18/02/08 8 YA37 8 (1) a A qualified and experienced manager must be employed, and registered with the appropriate authority. This would ensure an accountable person was in charge of the home. 18/03/08 Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 25 9 YA39 24 Effective quality monitoring systems must be put in place, to ensure the development of the home is continual, and is to the benefit of residents. This would ensure that residents could comment on, and influence the development of the home. The Registered Person shall visit the care home at least once a month; Seek the views of the residents and their representatives, staff, inspect the premises and check the record of events and compliance and prepare a written report on the conduct of the care home. A copy of the report must be sent to the Commission for Social Care Inspection This would ensure the Responsible Individual oversaw continued development of the home. 18/01/08 10 YA39 26 18/01/08 11 YA40 13 (4) c The policies and procedures used by staff must be regularly reviewed. This is to ensure staff have the appropriate information on how to deliver care to residents in the home. 18/01/08 Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA7 Good Practice Recommendations The resident or a relative could be asked to sign the care plan when they are being reviewed. Then nameplate for the home still refers to the previous name not Birch Tree Lodge. This may cause confusion to people visiting the home. Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 © 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 Birch Tree Lodge DS0000001758.V353825.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!