CARE HOME ADULTS 18-65
Birch Tree Lodge 11 Toller Road Quorn Loughborough Leicestershire LE12 8AH Lead Inspector
Keith Williamson Unannounced Inspection 7th April 2008 09:30 Birch Tree Lodge DS0000001758.V361930.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.V361930.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.V361930.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.V361930.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No additional conditions of registration. Date of last inspection 21st November 2007 Brief Description of the Service: Birch Tree Lodge 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 some physical health needs. 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.V361930.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 speak with 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. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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. This makes sure that the resident’s needs will be understood and met. Staff check some medicines on a daily basis, and make sure others being returned to the chemist are recorded in the paperwork. Decisions that the residents make are recorded in the daily notes. Resident’s time during the week is taken up by college courses or social care time. Staff have access to a mobile phone and can safely support residents whilst out of the home. Meals are varied and times served are flexible, and residents have access to fresh fruit. Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 6 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 a safe place to live in. Staff employed in the home have a number of checks before they were allowed to work at the home. Supervision, which is a meeting between the manager and staff on a one to one basis, is continuing. What has improved since the last inspection? What they could do better: The Statement of Purpose has yet to be amended with the current staffing details and the latest quality assurance information. Care plans could be shared with residents, and their comments noted if in agreement with the plan. The residents’ care plan informs the staff what selfcare and practical life skills people have but does not tell them what skills need to be developed.
Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 7 Risks are recognised in the form of risk assesments, these are detailed to the resident and explain to staff how to keep people safe in the home, however have yet to be updated to take into consideration the revised assessment information. Residents take part in activities; the record of these is produced after the event. This could be produced in a way to promote the choices the resident had. The home is registered for four residents, though one bedroom is currently being used to provide a “sleep in” room for staff, a firm decision on this, or providing alternative staff facilities is needed. The nameplate to the front door still mentions the name of the home prior to being changed, this requires changing. The insurance certificate was noted to be out of date; the acting manager stated that the head office was sending a copy of the certificate. 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.V361930.R01.S.doc Version 5.2 Page 8 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.V361930.R01.S.doc Version 5.2 Page 9 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. 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 and the latest quality assurance information. Residents’ needs are assessed prior to moving into the home. The three current residents have lived in the home for some time. The acting manager is currently compiling re-assesments of the residents; from which a new style care plan is produced. Residents all have a contract on file; these are produced in a pictorial form, which is large writing with additional pictures. These have yet to be completed indicating the residents’ specific bedroom. Birch Tree Lodge DS0000001758.V361930.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 and choices. Areas of risk are assessed appropriately. EVIDENCE: The acting manager has started to produce a new style “person centred” care plan. The care plan was examined in detail, this had been recently amended and the changes made reflected the re-assessment of needs. Care plans are still 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 suggestions as to how this is achieved. Daily records show what choices were given to residents. Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 11 Risk assessments are in place, these have details of individual resident’s needs, and the equipment needed to keep residents safe. These have yet to be updated to reflect the revised assessment information. Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 12 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, 14, 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: Care plans include details of residents continuing college courses, and leisure time. This is currently in the form of a record of the events have taken place. The acting manager stated this would be amended to record the planned activities for each resident. The residents’ care plan informs the staff what self-care and practical life skills people have but does not inform staff what needs to be developed. No residents were able to comment on visiting, but the acting manager stated this was unrestricted.
Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 13 One resident was keen to share his experiences at college on his cooking lessons, and on going swimming. He confirmed choices are also offered at meal times, what is offered on the menu and times of going to bed and rising. The menu was seen, and this reflects the residents’ individual cultural dietary needs, and is backed up by a likes and dislikes list. Evidence of individual treatment was seen in the daily records. Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 14 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 good This judgement has been made using available evidence including a visit to this service. Residents’ health and safety has improved by better staff practices in respect of health, personal care and medication. EVIDENCE: Personal support is offered to residents on a flexible basis, and is reflected in the care plans. Residents confirmed that they could rise and go to bed when they wanted, but also agreed that routines were in place on days they were going out. The locks on the toilet doors have now been changed, so giving a level of privacy to those in the home. Bedroom doors can be locked, but currently no resident has expressed an interest of having a bedroom door key. This is reflected in the care plan, and is subject to review. Staff continue to have access to a mobile phone and can support residents whilst out of the home.
Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 15 Residents’ healthcare has improved, with evidence of recent health checks with local a General Practitioner. Evidence is also on file of specialist health appointments. The administration of medication has improved greatly with no 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 was accurately recorded, along with items being returned to the chemist. All these records are now held on the mar chart, as the “returns” book (the record of medicines returned to the pharmacy) has been done away with. Stock levels of medication are kept to a minimum, and all medication is now stored in a purpose built metal cupboard. The company policies and procedures to help and instruct how medicine is given to residents have recently been revised, though these were not seen on this occasion. Staff continue to check the numbers of some medicines on a daily basis. Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 16 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 good This judgement has been made using available evidence including a visit to this service. Recent improvements in protection information, and planned training for staff, have made the home safer for residents. EVIDENCE: There have been no complaints forwarded to the Commission for Social Care Inspection about the home. There have been no complaints recorded by the home since the last visit. 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 complaints, adult protection and whistleblowing procedures. Adult Protection training was arranged but the trainer cancelled this at short notice. The acting manager is in the process of re-arranging the training from more than one source, to ensure no repeat of these issues. There have been no protection issues forwarded to the Commission for Social Care Inspection. Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in an environment that is homely, comfortable and clean. EVIDENCE: The general décor in the home is poor, with a number of areas needing refurbishment. Some of the work has been entered in the maintenance book, but this is not being kept up to date, and not all issues have been added to the maintenance plan. 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.
Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 18 The nameplate to the front door of the home is still in that of the previous registered name for the home. The toilet door locks have now been changed, but the “star” type deadlocks are still in place and must be removed or disabled as they pose a potential risk to residents. Staff were aware of cross contamination and cross infection issues. Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 19 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): 34, 35 & 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The use of a consistent number of staff, and training and supervision programme has improved the safety for residents in the home. EVIDENCE: Staff training has commenced and the courses that staff have undertaken consist of those that by law must be run annually. The acting manager has developed a more consistent number of staff working in the home; this has increased the possibilities of uninterrupted work with people in the home. No new staff have commenced since the last visit, the acting manager stated three new staff are to be employed, this would further improve the consistency of staff working with residents. Staff supervision, which is one to one meetings between staff and the acting manager, continue to form a part of staff development.
Birch Tree Lodge DS0000001758.V361930.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 adequate This judgement has been made using available evidence including a visit to this service. Improvements in staffing numbers and quality assurance are apparent in the home. However issues remain over lack of a registered manager and minor health and safety breaches in providing a safe environment for residents. EVIDENCE: A permanent manager has been employed is awaiting her Criminal Records Bureau documentation, to enable her to forward the application to become the registered manager of the home. Since the employment of the manager 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 now been started. Questionnaires have been
Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 21 sent to residents’ relatives, though the returned number are less than hoped for, the acting manager stated the outcomes would be added to the Service User Guide. Health and safety is generally good, with staff still doing tests on the fire system, hot water and fridge temperatures on a regular basis. The fire risk assessment and escape plan are up to date and the testing of the electrical system has now been completed. However the insurance certificate was noted to be out of date; the acting manager stated that the head office was sending a copy of the certificate, but up to the point of the inspection report being written, had not been forwarded onto the Inspector. The registered person has commenced his visits to the home, however does not complete a written record of these visits. These are required to ensure the ongoing development and improvement of the home. Copies of these visits are also required to be sent to the Commission for Social Care Inspection. completed. Staff have access to policies and procedures, these have been re-issued by the company head office, though have yet to be put into files. Birch Tree Lodge DS0000001758.V361930.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 3 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 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 X 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 1 2 X 1 X Birch Tree Lodge DS0000001758.V361930.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 YA39 Regulation 26 Requirement 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. This requirement had a timescale of 18/01/08, which has not been met. Enforcement action is now being considered. Timescale for action 07/04/08 Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 24 2. YA42 13 (4) The Registered Person shall ensure an up to date certificate of insurance is displayed at all times in the home. This is to ensure that people in the home can be sure of that public liability is covered by the company. 09/05/08 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 YA18 Good Practice Recommendations The resident or a relative could be asked to sign the care plan when they are being reviewed. Adult protection training should be re-arranged as soon as possible, to ensure all staff are aware of protection issues and how to act if those become apparent. Then nameplate for the home still refers to the previous name not Birch Tree Lodge. This may cause confusion to people visiting the home. 3. YA23 Birch Tree Lodge DS0000001758.V361930.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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