Inspection on 01/06/06 for Birchdale Nursing & Residential Home

This inspection was carried out on 1st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Birchdale Nursing & Residential... 09/06/08

Birchdale Nursing & Residential... 13/06/07

Birchdale Nursing & Residential... 31/01/07

Birchdale Nursing & Residential... 21/10/05

Birchdale Nursing & Residential... 19/04/05

Birchdale Nursing & Residential... 05/11/04

Birchdale Nursing & Residential... 29/06/04

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

CARE HOMES FOR OLDER PEOPLE Birchdale Nursing & Residential Home Moore Street Gateshead Tyne & Wear NE8 3PN Lead Inspector Miss Andrea Goodall Key Unannounced Inspection 1st & 2nd June 2006 9:30 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 Birchdale Nursing & Residential Home DS0000018168.V296511.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. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birchdale Nursing & Residential Home Address Moore Street Gateshead Tyne & Wear NE8 3PN 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) 0191 477 6777 0191 477 4241 None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Jean Helen Wright Care Home 63 Category(ies) of Dementia (28), Dementia - over 65 years of age registration, with number (28), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (38), Physical disability over 65 years of age (3) Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st October 2005 Brief Description of the Service: Birchdale Residential and Nursing home is a 63-place purpose built facility. All of the bedrooms are single rooms. The home predominantly provides a service for older people with a dementia type illness. The home has three floors of accommodation. At this time the top floor provides residential care and the lower ground floor is used to provide nursing care. The middle floor is unoccupied. Each floor of the Home contains lounges, dining rooms, bathrooms, toilets and bedrooms. There is one main kitchen and a laundry. Each unit is accessed via a central reception area. There is a passenger lift that serves all 3 floors. Birchdale has easy ramped access into the reception entrance on the middle floor. There is also good access around the homes corridors. The home is close to local bus routes and short walk from a metro station. The home is in a residential area on a steeply sloping street. There is good car parking at the front of the home. The weekly fee is £360 for residential care and £370 for nursing care (the latter is under review). Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 2 days. On the first day 2 inspectors visited the home. One inspector spent time with the residents to see how they are cared for by staff, examined some parts of the building and joined residents for lunch to see what the meals are like here. One inspector spend the visits talking with the new Manager about the progress of the service, and looking at management records, staff records and health & safety records. The second visit was by one inspector. That time was spent with residents, looking at their activities, talking with staff, and looking at residents care, financial and menu records. Before the inspection comment cards were sent to the home for residents and their relatives. Three comment cards were received from relatives. One resident filled in a comment card with some help. Many of the people who live here find it hard to express their views due to their dementia needs. Inspectors looked at how the staff support the residents and how care plans show whether their needs are being met. The home has 2 recorded complaints since the last inspection. The complaints records showed that these have been dealt with by the home with input and oversight of Gateshead Social Services Department. What the service does well: There was a good atmosphere in this home during both these visits. In the residential unit people were busy and lively. In the nursing unit it was quieter. There was a good rapport between staff and residents in all areas of the home. During discussions staff showed that they have a very good knowledge of different peoples different needs. The quality of the lunchtime meals was good. One resident said the food is good and you can ask for cups of tea if you want. There was a good choice of 3 different main dishes for lunch. Staff are making a menu book with photographs of different dishes to help residents make their choices at mealtimes. Staff were respectful, sensitive and discreet when they were helping residents. Staff were helpful, friendly and welcoming to visitors. In discussions staff said that they enjoy their jobs and that they feel the new Manager is a good leader to make Birchdale a good place to live and to work. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 6 There is a redecoration programme that is on-going, but in the meantime Birchdale is a comfortable and safe building for people to live in. What has improved since the last inspection? There have been several improvements to this home since the last inspection. After many different managers, a new permanent Manager has been appointed, and it is expected that this will bring stability and continuity to the running of this home. The Manager has already made a number of changes that have made the daily routines better for the people who live here. Now there are no set morning routines so that residents can get up at whatever time they want, and have breakfast when they want. Relatives now have more information about the home and the terms and conditions of living here. A new assessment record will now include details of peoples dementia and mental health needs (although staff still need training in completing this record). Care plans are much improved and give a good report of the individual needs of each person. There are now life stories that tell the staff about the lives of each of the residents. There is also information on each persons care files about the sorts of activities that they used to enjoy and things that they like to do now. In this way all the staff can understand the likes and dislikes of each person. Cleaning programmes and clean carpets have made odour control much better so it is a more pleasant environment for residents and their visitors. Some redecoration has started to a couple of rooms, and there is an action plan for the rest. Since the last inspection most care staff have had some good training in dementia awareness, Protection of Vulnerable Adults, and managing challenging behaviour. In this way they are better equipped to understand peoples needs, how to protect them from poor care, and how to help them if they become upset and angry. There are now permanent nursing staff so that the home does not have to use agency staff. In this way nursing staff can get to know the needs of each resident and provide them with continuity of care. Since the last inspection the Manager has had a meeting with relatives and given them a questionnaire to get their views about Birchdale. A summary of the comments by relatives will be printed in the information packs for new residents, so that they can see what other people think of the home. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 7 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. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 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 Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 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): 1 & 3 (standard 6 does not apply to Birchdale Care Home) Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. There is an information pack and terms and conditions statement for potential residents, so that they or their representatives can see what to expect from the service. Assessment records of peoples specific mental health and dementia needs are improving, but staff need training in how to complete them so that they are meaningful. EVIDENCE: The home has a Service Users Guide in the form of an information pack, which includes brief details of the home, complaints procedure, and a copy of the previous inspection report. The Manager stated that since the last inspection all residents or their relatives have been provided with a Service Users Guide pack. All relatives have also been provided with a copy of the Terms and Conditions of Residence. In this way, residents or their representatives have greater information than previously, and so can make a more informed decision about whether the service at Birchdale could meet their needs. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 10 Birchdale Care Home aims to provide care specifically for older people with mental health and dementia care needs. However the former assessment documents did not include sufficient details to determine whether those needs could be met. Since the last inspection Four Seasons Healthcare Limited have introduced a new assessment document that will be used for assessing the needs of potential residents. This new assessment record now includes a number of areas relating to mental health and dementia care needs. In this way the home should now be able to determine whether a persons needs can be met at Birchdale. The assessment outcomes can then support the development of a care plan, which should set out the specific needs and goals for each person. However care staff need training in using this tool as several references in the document use psychiatric terminology. It was clear from examination of new residents care files that staff are unsure of the record as many sections were incomplete. Also several assessment records were not signed or dated by the person carrying out the assessment. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 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, 8, 9 & 10 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. Residents needs are set out in an individual plan of care so that all staff understand how to support each person, but there are no specific records about behavioural needs. Residents have access to community health care services so that their health care needs can be met. Support with nutritional health is improving. Residents are treated with respect. EVIDENCE: There have been significant improvements in the standard of care planning at Birchdale. There are care plans in place for each resident, and these are now up-to-date and in good order within individual care files. The new Manager is keen to introduce person-centred planning (that is, supporting each person as an individual). The care plans for each person now include a number of appropriate goals/needs and clear details of how those needs can be met. The care plans aim to promote residents social, physical and personal care needs. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 12 The care plan goals/needs are evaluated on at least a monthly basis. Some evaluation records were meaningful reports of any changes or support needed that month. Other evaluation records can be too brief e.g. continue with plan of care with no further summary of the actions or support that had been required during that month. There is a form for residents or relative to sign to show their involvement in care planning. Of the sample of care plans examined these were not completed so there was no evidence that residents or their representatives had been involved. There were no records of how residents can make their own choices and decisions, or what support they need with this. In discussions staff demonstrated a good knowledge of peoples behavioural needs, and there were some references in care plans to a couple of peoples behavioural needs. However there are no behavioural guidelines for staff to follow in order that they provide consistent support, prevention or redirection of any behavioural episodes. There are no specific records of behavioural episodes that might indicate particular triggers or patterns. There are no risk assessment documents to show how staff manage this area of care or how they can ensure that no residents, staff or visitors are at risk of injury due to the behavioural needs of a small number of residents. Residents health care needs are assessed and there is access to community health care services where required, including GP, CPN (Community Psychiatric Nurse), Falls Prevention Officer, optician, and chiropodist. At this time there are no known arrangements for regular dental checks. There are brief nutritional assessments in place for each resident with monthly review and weight records. These would be reactive to a change in nutritional need, rather than pro-actively promote good nutrition. However the Provider is to introduce comprehensive MUST (Malnutrition Universal Screening Tool) assessments, which will support the home in ensuring the nutritional health of the people who live here. Following concerns about several residents weight loss at the last inspection there have been monitoring visits to the home by CSCI, Social Services Department and health care professionals. Since then the home has sought the advice of dieticians and has replaced faulty weighing scales. There is now greater communication between care staff (who record residents weight) and the catering staff (who are knowledgeable about increasing the calorific content of residents meals where necessary). These measures should now continue to improve the management of nutritional health of the people who live here. Medication is managed appropriately. Medication records are in good order, and medication is suitable stored. At this time one residents medication is crushed to make it easier for them to swallow. However several different Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 13 medications are being crushed together and it is not known whether, during this process, some drugs may have an adverse affect on the chemical or pharmacological contents of others. (The pharmacist is now to supply these medications in liquid form.) Throughout these visits staff were seen to be friendly, respectful and helpful in their manner whilst supporting residents. All staff, including ancillary staff, are knowledgeable about residents individual personalities, preferences and personal care needs. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 14 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, 13, 14 & 15. Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to follow their own routines where staffing levels allow. Residents can choose to join in a range of activities, but there are not sufficient staff to support people for ad hoc trips outside the home. Residents are supported to make choices and this area is improving for menu choices. Residents are offered appetising meals. EVIDENCE: It was evident from discussions and from daily records that residents are enabled to get up and go to bed at their own preferred times. To support this good practice breakfast times are now flexible so that late risers can enjoy a later breakfast up to about 10.30am. Residents with good mobility have good freedom of movement around the home. There was a very sociable atmosphere in the residential unit. There is an Activity Co-ordinator who has introduced lots of activities to suit different individual interests. There are now good activities life stories for each person that describe their life history, the interests they used to have and their current preferred pastimes. In this way staff have a good understanding of the types of activities that individual people may enjoy. The activities have included aromatherapy hand massages, ball games, skittles, art, and knitting Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 15 groups. Records show that some residents have taken part in short activities on an almost daily basis, and this supports their well-being. The home has had input from Equal Arts (a charitable group) who helped residents create some art pieces that were then exhibited at Saltwell Towers (a local centre). Some residents then went to view the exhibition which was a valuable outcome to their activity. There have also been some outings for small groups of residents, such as memory walks and visits to the local school (that some people attended when they were young). Some people have been with staff to local shops, to a café for a drink, or to the local church. These short trips are both stimulating and engaging for those residents, as well as supporting their continued inclusion in the local community. One resident said that they had no fresh air and would like to go out. It may be that not everyone has had the chance yet to go out on a local trip. The Activities Co-ordinator recognises the value of ensuring everyone has the chance to go out from time to time. However this is limited to staffing levels available, and as there are only 2 staff to the residential unit extra staff would have to be brought in, even for a short local walk. In discussions one resident said, There is nothing about the home that makes me unhappy. The food is good, and you can ask for cups of tea if you want. Most other people find it difficult to express their views due to their dementia care needs but they were seen to be offered choices, such as being offered support to have a lie down after lunch if they wanted. Residents are offered 3 choices at main meal times, and staff support this with their knowledge of peoples individual likes and dislikes. The Activities Coordinator is making 2 books of photographs, one showing different activities and one showing different meals. In this way it is hoped in the future to offer residents a way of making informed choices. Lunchtime meals were substantial, well presented and of good quality. Those in the nursing unit who needed physical support to eat were given this in a sensitive manner. Some people in the residential unit might have eaten more if they had greater verbal encouragement (e.g. prompts to use different cutlery) but the limited staff in this unit meant that staff had to respond to those with the greatest needs only. There are some people who now have high calorie diets to support their nutritional needs. There are also 8 residents who have liquidised foods due to their health needs. The head cook is very knowledgeable about this area of care. It is very good practice that each individual food is liquidised separately and presented attractively on the plate to encourage residents to enjoy their Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 16 meals. Staff told the resident what was on their plate and what foods they were being served at each spoonful, and this is good practice. There are now some snacks and drinks available in the small kitchenettes on both units, such as biscuits, yoghurts, and juice. In this way staff can help a resident to have something to eat when they are hungry, which may be other than at mealtimes. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 17 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 & 18. Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. Relatives know how to make a complaint, but the procedure needs amending so that it is clear. Staff receive training in Protection of Vulnerable Adults procedures so they know how to report any poor practices or suspected abuse. EVIDENCE: The Provider does have a comprehensive complaints procedure, and there is a brief reference to the complaints procedure in the Service Users Guide pack. However this information out dated as it still refers to the NCSC, not the CSCI. The Manager and administrative staff immediately changed this on the few copies in the home, but the Four Seasons procedure still does not include the address and telephone number of the CSCI. There is good communication between relatives and staff, and in the comment cards most relatives stated that they would know how to make a complaint. There have been 2 complaints recorded since the last inspection, both were from social care professionals. These were investigated and a written response sent to the complainants. Both complaints were upheld and as a result practices and records in the home have changed to improve the service. Most residents could not comprehend the written complaints procedure but most are able to make their dislikes know either verbally or through gesture, e.g. pushing away a meal if they did not like it. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 18 All staff have had in-house training in POVA (Protection of Vulnerable Adults) through Four Seasons Healthcare Limited. The Manager is aware of the forthcoming changes to the Local Authority POVA procedures and is awaiting information about this. Since the last inspection most care staff have now had training in managing challenging behaviour. This will support staff in their understanding and care of people who display aggressive behaviour. However there are no incident records, guidance and risk assessments in place. In this way, the home currently cannot explore the reasons why such behaviour is occurring so cannot know how to take action to reduce or prevent it. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 19 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, 25 & 26 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. There are on-going refurbishment works to the home to bring the decoration up to acceptable standards for the people who live here. The home is maintained to make it generally safe for residents. Improvements are to be made to the lighting to WCs to make them safer for residents to use. Odour control has improved so that the premises is a more pleasant place for residents and their visitors. EVIDENCE: There is a redecoration programme in place to redecorate, re-carpet and replace worn furniture in bedrooms and lounges. Although the programme is a couple of months behind schedule, improved decoration is apparent in a small number of rooms and this programme is to continue. The programme currently does not include refurbishment of bathrooms. These also show signs of wear and tear, including broken or missing tiles, grubby paintwork and mismatched furniture. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 20 General maintenance checks make sure that the home is safe for the people who live here. However the sink and splashback in the nursing unit kitchenette is not sealed so cannot ensure good infection control. Also the tap in one bedroom would not turn off which was irritating to the resident. It has been reported at several previous inspections that lighting to WCs is still very dim due to the type of light fitting, which will only accept a 60w bulb. During this inspection the maintenance staff had begun to order a different type of light fitting. These are now to be fitted to each WC so that 100w bulbs can be provided to increase the lighting to the right level, and this will improve the safety of the people who live here. There have been significant improvements to the management of odour control in the home. This has been achieved by improved practices around clinical waste and cleaning schedules. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 21 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, 28, 29 & 30. Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. There are not sufficient staff in the residential unit to provide proper supervision for the residents. Residents are protected by the interview and recruitment checks of new staff. Increased suitable training for staff in NVQ and dementia care means that more staff are trained to care for the people who live here. EVIDENCE: On the nursing unit there is one qualified nurse and 2 care staff for the 13 residents who need nursing care. There are now 4 RMNs (Registered Mental Nurses) permanently employed so the home rarely has to use agency staff. This is an improvement as the home can now provide some continuity of care as nursing staff can become familiar with individual residents needs. However, in the residential unit there are only 2 care staff to support 15 residents. Four of the residents require 2 staff to support them with personal care needs. At these times there are no other staff to supervise the health & safety of the remaining 14 residents. The situation has to be supplemented at some times by the laundry/domestic staff, especially at lunchtimes, which removes those staff from their own roles. The Activities Co-ordinator also spends about 15 hours a week with residents from this unit either in or out of the home. However at all other times there are insufficient staff to ensure the care and supervision of residents. In this Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 22 way staff have to remain task-orientated in order to manage peoples basic physical needs. Staff personnel files held by the home are in good order and include all relevant information. The interview practices of the Manager now supplement the recruitment checks to ensure that only suitable staff are appointed. Of the 14 care staff, 2 have achieved NVQ level 2. Since the last inspection a further 10 care staff are working towards this qualification. Only 2 care staff are not involved in this training. Since the last inspection staff have had several other training opportunities. Most staff have now completed a Dementia Awareness training course through a local college. This is suitable training for care staff who work in homes like Birchdale that purport to provide specialised care of older people with dementia and mental health needs. The Manager has a teaching certificate and is also provides in-house training sessions for care staff in the needs of the people who live here. Three of the RMN staff have now completed the Validating Death training, and the remaining RMN is nominated for future training in this area. This is necessary, as doctors no longer visit care homes to confirm expected deaths. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 23 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): 31, 32, 33, 35, 36 & 38 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. A Registered Manager is now in post and residents should benefit from the planned improvements to the service. The Manager seeks the views of residents and relatives. Residents are not supported to make the best of their personal financial interests. The health and safety of residents is promoted, but incomplete records do not always reflect this. EVIDENCE: Since the last inspection a new Manager has been appointed, and has recently been registered by the CSCI. The Manager is a qualified RMN and has many years experience of working in services for older people with dementia and mental health needs. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 24 It is anticipated that the management arrangements will now bring stability and continuity to the running of this home. The Manager has already made a number of changes that have had a beneficial impact on the daily routines for the people who live here. Discussions with several staff indicated that the Manager has provided leadership, direction and support to the running of the home. There are clearly good relationships between the Manager and staff, and the morale of staff has improved. There is also a good rapport between home personnel and relatives and visitors to the home. Relatives have indicated that they are kept involved and informed. The Provider has a quality assurance system in place and the home is reviewed via a number of audits. The Manager has also sought the views of relatives via a Relatives Meeting and through a relatives questionnaire. Their responses generally reflect the improvements to the service. (At this time the questionnaires have not been dated for future reference, and a summary has not yet been included within the Service Users Guide.) The Manager does spend time with residents to seek their views. However, their comments about the service have not yet been formally included in the quality assurance process, and this is an area for the Manager to pursue. On request, the home will support residents to keep small amounts of personal finance for day to day purchases such as toiletries and hairdressing. The home keep a small float of cash that residents can withdraw from, rather than individualised wallets. The records of transactions are computerised so that printed statements can be provided. There is also a handwritten record of any purchases made by staff on behalf a residents and this correctly includes 2 signatures. However there is currently no description of where monies have been received from or paid to. In some cases large amounts of monies (e.g.£ 300 - £600) had been withdrawn from a couple of the residents accounts but with no indication in the records or in cheque stubs of where these had been paid to. Residents personal finances are kept in one corporate bank account. Of the small sample of records examined, 2 residents had large sums of savings (over £3,000 and £1,800 respectively) that are pooled in this non-interest account, rather than accruing interest in an individual savings account. This is clearly not in their best financial interests. Since her appointment the Manager has not had sufficient opportunity to carry out individual staff supervision sessions with all staff members, although she has held staff meetings. It is acknowledged that the Manager has prioritised her time in order to work towards improvement in the service for the people who live here. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 25 Staff receive statutory training in health & safety matters. Since the last inspection 3 staff have qualified as first aiders. It is intended that three more staff are to attend this training in order to ensure that there is a qualified first aider on duty at all times. Health & safety checks are carried out, although there were some gaps in the records of hot water temperature checks. In-house fire instruction is carried out along with fire drills. However the records do not reflect the required 3 monthly instructions for night staff. Fire alarm testing is carried out at the required weekly intervals, but there are currently 2 separate records for this and neither reflect the actual practice, perhaps due to the unnecessary duplication. The home has a central passenger lift that serves all three floors of accommodation. There is a second passenger lift that serves the lower ground floor and middle floor only. (The middle floor has not been used for some time). This second lift is out of use as it has some minor faults and has not been fully serviced for some time. Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 26 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 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 x 2 Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14(2)a Requirement Timescale for action 01/08/06 2. OP7 15(2) Staff must have training in using the new assessment tool in order that they complete each section, and are able to understand the implications of the outcomes. Care plans must include 01/08/06 meaningful evaluations that report a summary of the support required that month. Care plans must demonstrate the involvement of the resident and/or their representative. (Previous timescales not met – 1.12.04 and 20/09/05.) Behavioural guidelines and risk 01/08/06 assessments must be in place to support the staff to manage incidents of challenging behaviour. (Previous timescale of 21/11/05 not met.) Any interventions by staff to support a resident during behavioural episodes must be recorded. Measures to record, report, respond to and manage the DS0000018168.V296511.R01.S.doc 3. OP7 13(7) 4. OP8 12(1)a 13(1)b 01/11/06 Birchdale Nursing & Residential Home Version 5.2 Page 28 16(2)I 5. OP9 13(2) 6. OP16 22(7)a 7. OP19 13(3), 23(2)b 8. OP25 23(2p) 13(3) 9. 10. OP27 OP29 18(1a) 24(2) 16(2m) 19(4) 11. OP35 12(1)a & 20(1) 12. OP38 13(4) 13. OP38 13(4)a 23(4)d nutritional health needs of residents who experience weight loss must continue. Advice must be sought from a pharmacist about the appropriateness of crushing several medications together. Four Seasons Healthcare Limited must ensure that the complaints procedure that is provided to residents and/or their representatives includes the name, address and telephone number of the CSCI. The splash back and sealant to the sink in the lower ground kitchenette must be made good to prevent water damage and cross contamination. A programme of fitting new light fittings to WCs must be put into place to ensure that lighting in WCs reaches a minimum luminescence of 150 lux. (Previous timescales of 06/10/04 and 25/03/06 not met). Staffing levels at Birchdale must meet the assessed needs of residents. Four Seasons Healthcare must review the application form and interview form to ensure it is DDA compliant. (Previous timescales of 11/03/05 and 27/01/06 not met.) Those residents with large sums of monies being held in a corporate bank account by the Provider must be supported to open an individual, interestaccruing savings account of their own choice. Sufficient staff must be qualified first aiders to cover the 24 hour period. (required at the last inspection - timescale 11.03.05) Night staff must receive fire instruction not less than every 3 DS0000018168.V296511.R01.S.doc 01/07/06 01/08/06 01/08/06 01/09/06 01/08/06 01/10/06 01/09/06 01/10/06 01/08/06 Page 29 Birchdale Nursing & Residential Home Version 5.2 months. Water temperature records must reflect the monthly checks. The weekly fire alarm tests must be recorded on a weekly basis. 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. 2. 3. Refer to Standard OP4 OP15 OP28 OP33 Good Practice Recommendations All assessment records should be signed and dated. The home should continue with plans to provide meal choices in accessible formats for residents, including the use of photographs. The home should continue with the current NVQ training to ensure that a minimum of 50 of care staff achieve NVQ Level 2 Award. Relatives questionnaires should be dated for future reference; a summary of responses should be included in SUG packs; and consideration should be given to how residents views can be can be included in the quality assurance process. Records of residents personal finances should include details of where money has been deposited from and where withdrawals have been paid to. Four Seasons Healthcare Limited should give consideration to setting an amount at which residents personal monies would be moved to an individual savings account. Staff should have opportunities for supervision sessions with their supervisor at least 6 times a year. If and when the second passenger lift is ever brought back into use it should be fully serviced and repaired. 4. 5. 6. 7. OP35 OP35 OP36 OP38 Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 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 Birchdale Nursing & Residential Home DS0000018168.V296511.R01.S.doc Version 5.2 Page 31 - 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!