Inspection on 13/06/07 for Birchdale Nursing & Residential Home

This inspection was carried out on 13th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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... 31/01/07

Birchdale Nursing & Residential... 01/06/06

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 Irene Bowater Key Unannounced Inspection 08:00 13th and 22 nd June 2007 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.V336640.R02.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.V336640.R02.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) Position Vacant 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.V336640.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 31st January 2007 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 not used at present. Each floor of the home contains lounges, dining rooms, bathrooms, toilets and bedrooms. There is one main kitchen but each unit has a small kitchenette area where drinks and light snacks can be made. Each unit is accessed via a central reception area. There is a passenger lift that serves all 3 floors. The laundry is located on the lower ground floor and services the whole building. 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 ranges between: £370 for local authority funded places providing personal care only, £380 for local authority funded nursing places, excluding free nursing care fee, £430 for privately funded places providing personal care only and, £557 for privately funded nursing care, excluding free nursing care fee. Other costs such as hairdressing (between £6-16), chiropody (£8.50) and toiletries are not included within the current fee level. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • Information we have received since the last visit on 31 January 2007 • How the service dealt with any complaints and concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service and their relatives, staff and other professionals The Visit: An unannounced visit was made on 13 and 22 June 2007. During the visits we: • Talked with people who use the service, relatives, staff, the manager and visitors • Looked at information about the people who use the service and how well their needs are met • Looked at other records which must be kept • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for • Looked around the building to make sure it was clean, safe and comfortable • Checked what improvements had been made since the last visit We told the manager what we found. What the service does well: The Commission for Social Care Inspection sent surveys out to some of the people who use the service and to some of their representatives Comments received included: “Absolutely in the time I have needed services, whatever my problem, they have responded, quickly and emphatically. Everyone from the cleaner to the manager has been approachable and helpful”. “I find things very good.” Relatives said they would be able to use the complaints procedure if they had a concern. The residents have brought some small items with them which they can keep in their bedrooms and has helped to make them feel at home. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 6 Staff are respectful and sensitive with residents when helping them or when speaking to them. Staff have good contact other professionals and ask for advice from them when needed to ensure peoples health care needs are met. Residents are supported to make some decisions to help them keep some control of their lives. The cook keeps good records any special diets including likes and dislikes. She is very clear about how to offer a balanced diet that is tasty and nutritious. Residents said: “The grub is so” “It’s nice” “My dinner is lovely”. Visitors are welcomed at any time and clear details of how to contact families are available Proper checks are carried out before anyone is offered a job so that the residents are kept safe. What has improved since the last inspection? There have been some improvements since the last inspection. There is a new manager and senior nursing staff who are starting to work together to improve all parts of the service. More flexible routines are in place which means residents are now offered more choices about how to spend their day. Their wishes and individual rights are now being respected. Meal times are better with staff making sure everyone has ample to eat and drink. A lot of work is planned to improve the building and decoration which is helping to make Birchdale a nicer place for the residents to live in. Staff are getting support from the manager and they are keen to improve the care given. The staff have a hand book which clearly tells them what is expected in their role and outlines their terms and conditions. This also includes a section on “equality and diversity”. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 7 What they could do better: Further work is needed on the care plans so that they are clear and detailed about the care provided. Residents and their representatives need to be involved in planning their own care with staff. Information about residents’ past lifestyles and choices need to be written down so that staff can continue to support them or help them access help from others. Staff need to make sure that they check and record when some medicines are opened. This is to make sure they are given before the short expiry date. Handwritten directions must have two witness signatures. This will make sure residents receive their medicines safely. Information about residents’ previous lifestyles and choices need to be written down so that staff can continue to support them. Staff need to make sure that they check and record when some medicines are opened. This is to make sure they are given before the short expiry date. Handwritten directions must have two witness signatures. This will make sure residents receive their medicines safely. Improvements to the environment must continue to take place. This will make sure that the home is a pleasant, safe and comfortable place to live. And will also help people with dementia find their way around the home and keep some independence. Improvements to the soiled laundry area and replacement of the sluice disinfectors are needed to make sure the home is free from infection. In house maintenance checks must take place according to procedures and records of all checks must be kept. There is no activities person in post at the moment. The care staff are arranging any activities. This means that for a lot of the day there is little for residents to do. More staff are needed at peak times to make sure the quality of life of the residents is improved. At the moment there are not enough cleaning staff hours to keep the home clean and odour free, so more domestic staff need to be recruited as quickly as possible. The manager must progress with the application to become registered. Appropriate dementia care courses must be sourced and completed by the manager and deputy manager. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 8 Progress must continue to recruit Registered Mental Nurses so that all of the care and specialist needs of residents can be met. All staff must have up to date training in safe working practices with records kept. 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. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 9 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.V336640.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3. (Standard 6 is not applicable to this service) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are not given clear and sufficient information on which to make a considered choice of where to live . The rights and obligations of both parties are clear to enable prospective residents make informed choices. The admission assessments and procedures do not ensure that residents’ care needs will be met. EVIDENCE: The home has developed a Statement of Purpose and Service User Guide, which sets out the aims and objectives of the home. Some of these to not Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 11 reflect the current staffing in the home. This is because the home has no Registered Mental Health trained staff on the nursing unit although recruitment is underway. The Service User Guide is not in large print or picture style and people may find it difficult to understand. Individual copies are available to potential and current residents. Everyone is given a contract when they are admitted to the home. This sets out what residents can expect to receive for the fees they pay and sets out terms and conditions of occupancy. Residents admitted to the home have a range of care needs carried out by care managers, nurse assessors and the home manager. The Company have an assessment document that included areas specifically about the needs of residents who have a dementia or mental health related illness. Staff are also able to record what peoples assessed needs are and how they should meet these needs based on a “person centred approach to care”. The care plans on the upstairs unit were very clear. Information about life history’s, current likes, dislikes and information about how they want personal care to be provided were available. Social assessments and well being care plans were also available. There have been some improvements in the assessment recording on the nursing unit. The nurses are starting to use a “person centred approach” to care delivery but they still need to recognise that residents previous lifestyle and social care needs also influence how their nursing needs will be met. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The care planning documentation is comprehensive and person centred. However, lack of recorded detail prevents the system from being fully effective. This means that residents’ needs may not be recognised and fully met. The systems for the administration of medicines are sufficiently robust to make sure resident’s wellbeing is fully met. Personal support is currently promoting residents rights to privacy and dignity EVIDENCE: Each resident has a plan of care based on the admission carried out by care managers, the home manager and where necessary nurse assessors Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 13 Staff complete pressure sore risk, dependency, moving and handling, nutritional assessments using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessments. These tools help the staff understand the level of risk each resident has and helps them complete a care plan based on holistic care needs. The care plans on the upstairs unit which provides personal and social care for people who have a dementia type illness were clear and easy to understand. The plans showed that residents’ previous lifestyles and current preferences have been taken into account when planning care. Life and social histories were completed and it was easy to see how individuals care needs were being met. For example being supported to go home on a regular basis and being supported to care for a much loved cat. Other information included how staff were managing to deal with behaviours that could challenge and how they were making sure those with low appetite received a nutritious diet. There have been a lot of changes of staff on the nursing unit. All of the care plans were evaluated and brought up to date in April 2007. The lack of regular nursing staff means that some care plans have not been reviewed since that date. The new deputy manager is reviewing all of the care plans to make sure that they are based on a person centred approach to care rather than a “medical model” of care. Several of the residents have air cell mattresses and cushions to prevent pressure damage. Advice is gained from other professional such as tissue viability specialists, speech therapists and continence advisors. Visits from the multi disciplinary team are clearly recorded in individual care plans. The wound care recording has improved since the last inspection Fluid balance and food monitoring charts are in use for resident who are not eating and drinking adequately. They do not demonstrate what drink and food has been taken or what drinks have been offered and taken throughout a 24hour period. The chart did not specify what the resident actually drank. Food charts showed what was offered and refused but then did not describe what alternatives had been provided. Daily progress records are being completed in more detail regarding daily personal care and activities. However there are still some unclear records. For example “settled day” and “good compliance” do not show how staff are giving support and sometimes complex nursing care to residents. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 14 Families are sometimes included in regular reviews that are held to establish if needs of the resident have changed. However, where families are not involved this information needs to be noted and reasons documented so that there is a full picture of the resident that will to enable the correct decisions to be made. The residents have access to all NHS facilities to ensure their healthcare needs are met. There are regular visits from GP’s and other health professionals including, opticians and chiropody services. Medication policies and procedures are available for staff to use. The nursing staff are responsible for the safe administration of medicines to the residents who have nursing needs. The senior care staff administer medication to residents who have social and personal care needs. The non-nursing staff have completed a “Safe Handling of Medicines” course. Records are in place for all medicines received, administered and disposed of. An audit of Controlled Drugs and the Medicine Administration Records (M.A.R.) showed no discrepancies. The staff are not recording when eye drops are opened and two signatures are needed on the M.A.R when staff are handwriting directions. Both units are very busy caring for residents who have complex health care needs. On both units the staff were unhurried, kind and respectful .at all times. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are not always given sufficient opportunities to participate in social activities. This means that their lifestyle choices are limited. Positive contact is actively encouraged by the home and ensures that relatives and other visitors can visit often. Staff are now offering adequate support to residents so that they take some control over their lives. A good choice of nutritious and appetising meals are available to ensure individual dietary needs and preferences are met. EVIDENCE: The home does not have an activities person in post. Notices on the wall and conversations with residents and staff suggest that previously there was until Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 16 recently lots of activities in the home that suited residents’ interests. There was some input from a charitable organisation called Equal Arts and some of the artwork made by residents is on display on the walls. There are some activities planned for the coming months including a summer fayre, barbeque, memory walk and a birthday party for a resident who is 104. Staff on the upstairs unit had time to spent time talking to residents in groups and on an individual basis. Some residents had their nails done, others watched a DVD of their choice and one resident enjoyed knitting. One resident was supported to care for the much-loved cat. There have been some improvements on the nursing unit in that residents are now encouraged to stay in bed until breakfast time and are supported to have breakfast in their rooms if they wish. The staff routines are becoming more flexible which helps residents decide where and how they spent their time. Given the dependency of the residents and the staffing levels of one nurse and two carers it is difficult to make sure that individual social care needs are met on a daily basis. There were few visitors during the site visit. There was evidence from the care plans that families visit on a regular basis and are welcomed at any time. Information about advocacy is available in reception and on notice boards. Some residents have access to solicitors and the Court of Protection to make sure they can have some control over their lives. Many of the residents have brought small items with them making their rooms homely and reflective of their previous lifestyles, religious beliefs or cultural backgrounds. A Short Observational Framework Inspection was carried out on the nursing unit between 11:40 am and 13:35 pm. This means that an inspector observes the staff practices and interactions with a small group of residents over a set time. There was not much happening for residents before lunch and the majority of them were asleep in the lounge. Late morning staff offered and gave drinks and pieces of fruit to the residents and then they began assisting them to the dining room for lunch. This was carried out in a sensitive way with staff talking to residents through what they were doing. Residents were encouraged to walk and when they needed support staff walked at their pace. Once residents were seated they were again offered choices of tea juice and choices for the lunchtime meal. The nurse was always available making sure that residents were given the support they needed and gave encouragement to residents who were eating independently. The staff interaction and practices at meal time on this unit is improving Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 17 Some residents cannot tell staff when they don’t like the food or when they have had sufficient to eat. They use other means of communicating such as turning their head or pushing the plate away. Care staff don’t always recognise this and further training would be of benefit to make sure residents are making appropriate choices. The practices have improved with the mealtimes being less hurried and organised on this unit. Choices for lunch were roast lamb, roast potatoes, two vegetables, Yorkshire pudding and gravy or fish and chips. Dessert choices were apple crumble or ice cream yoghurts and fruit. On the upstairs unit the residents were offered choices of each meal and were given tea and juice throughout the mealtime. Residents said “The grub is so so” “It’s nice” “My dinner is lovely”. The meals on all units are served from a “hot lock” trolley. They were nicely cooked and presented and of ample portion size. Soft or liquidised meals were presented attractively to encourage people to eat. The cook is very knowledgeable about caring for older people and ensuring that they receive nutritious and well-balanced meals. Stocks of food were good and there was ample fresh, frozen, tinned and dried food. Snack and individual portions (such as tinned soups) are available for residents should they want anything at other times or instead of the main meal. She said that the menus are being reviewed in line with the guidance “Food for Thought”. There are small kitchens on each unit .The cook regularly checks that there are plenty supplies of milk, juices, sandwich fillers, bread, fruit, yogurts, biscuits available to make sure residents receive a nutritious and fortified diet. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Information about making a complaint is clear and accessible. This contributes to residents’ and relatives’ views and concerns being voiced. Some staff have not received training in Safeguarding Adults so residents may potentially be at risk. EVIDENCE: The Company has a comprehensive complaints procedure, which is displayed in all areas of the home. It is also available in the Service User Guide, which is available in reception. Four complaints have been received since the last inspection. These are clearly recorded with information about what action is being taken being available. The Company is working with the Commission of Social Care Inspection and the Local Authority to resolve and improve the service provision. The Home has a Protection of Vulnerable Adults Procedure (POVA) in place and a copy of the Local Authority’s Procedural Framework for the Protection of Vulnerable Adults, is available to staff. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 19 In house training is provided, however no training has been sourced which links into the Local Authority framework. Senior and nursing staff were clear about what they should do should there be any allegations of abuse. Other staff was less clear of their role and what they must do. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The building is kept in an adequate state of cleanliness, repair and decoration. Recent improvements make sure that the environment is a comfortable, pleasant and safe for residents to live in. EVIDENCE: The home has three separate units over three floors. Residents are unable to access the garden area independently, mainly due to their state of health but also because doors are kept locked. Residents on the residential floor are only able to access the garden via a shaft lift and with the help of staff. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 21 One provides personal and social care for people who have a dementia type illness. This fifteen-bedded unit has a lounge and separate dining room with a kitchen area. A designated smoking room for residents has been provided from what used to be the staff room. These communal areas are due refurbishment and redecoration. A five-bedded unit is operational on the middle floor. There is a lounge and dining room both of which have been redecorated and refurbished to a good standard. The rest of this unit is undergoing a major refurbishment programme and is currently not occupied. The nursing unit is on the lower ground floor. It has a lounge, dining room, activities room, conservatory and a Snoezelean room. These areas are also undergoing redecoration and refurbishment. New lounge chairs, blinds for the conservatory and a wide screen wall mounted television have been provided since the last site visit. The kitchen area provides snacks and refreshments through a twenty-four hour period and the cleanliness has also improved. There are bathrooms and toilets throughout the home close to all resident areas. Only four of the bedrooms provide en-suite facilities. These areas are also being refurbished as part of the planned programme. In almost all bathrooms toilets and bedrooms there is a problem with dripping taps that cannot be turned off. As they have dripped water for some time there is a build up of lime scale on most of them that cannot be cleaned. All of the bedrooms are for single occupancy. Residents have brought small items with them making their rooms homely and reflective of their lifestyles. The quality and condition of furniture varies for example vanity units are worn and shabby. There is little in the way of signage throughout the home that would help residents find their way around Light swatches are conventional small pad types located quite high on the wall rather than “fat pad” switches, which are located at a lower level, which are easier for people with mobility problems or dementia to use. The boxed in vanity units do not enable access for wheelchair users and the towel dispensers are to high to be reached easily. The passenger lift from the lower ground floor to the middle floor remains out of use as it has some faults and has not been serviced. There is one working lift, which services the three floors. The laundry is separate from resident areas. The sink unit in the soiled laundry area has broken drawers, the sink was dirty and the wood water damaged and split. There was dust balls on the floor the area was generally grimy. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 22 There were pockets of odour in the lounge and some bedrooms on the fifteenbedded unit. The musty stale odour on the nursing floor was from a dislodged sewer cover and sludge under the lift shaft. External contractors dealt with this problem as soon as possible and by the second visit the odour had been eradicated. Sluice facilities are available, however the sluice disinfectors have not worked for some time. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are not satisfactory to address a full range of needs. This means that residents’ lifestyles are restricted and overall affects their quality of life. Domestic staff are employed in insufficient numbers to ensure the home is kept clean and hygienic all the time. This impacts on the quality of life for residents. To make sure staff have the competence to care for the residents needs further specialist training is needed..Currently qualified staff are not equipped to provide a good quality service that benefits the residents. The residents are kept safe and supported by comprehensive recruitment procedures to prevent unsuitable people from working in the home. EVIDENCE: There have been a lot of changes in staffing since the last inspection. The home has new manager, deputy manager and qualified nurses (RGN) on the nursing unit. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 24 None of these staff hold a Registered Mental Nurse qualification (RMN). In the short term the general nurses are trying to stabilise the unit and start to improve the service provision. The manager is currently recruiting for suitably trained R.M.Ns’ to work along side these nurses so that residents receive a person centred care that fully takes into account their mental health status. The staffing levels on the nursing unit consist of one RGN and two carers from eight am until 8pm and overnight there is one RGN and one carer. All of the residents on the nursing unit have complex general health and mental health needs. There has been an improvement in how the unit is managed in regard to residents being given choices of how to spend their day. However staff still have to work very hard to make sure basic care needs are met and still have little opportunity to do any activities with residents. On the five-bedded unit there is one senior carer on duty during the day and one carer overnight. The issues highlighted at the last inspection about inappropriate sexual expression by one resident towards females have been resolved. The residents in this unit are given the opportunity to go and spend their day on the upstairs unit, which they choose to do. When this happens there are three staff on the fifteen-bedded unit one of whom is a senior carer or unit manager. On the fifteen-bedded unit there was two staff on duty all day to support fourteen residents. Although residents are do not need nursing care they still need staff to help with personal hygiene and help at mealtimes. The home is trying to recruit an activities organiser. The staff on this unit tried very hard to get residents to join in various activities through out the inspection. There is only 1.5 domestic staff to cover domestic services at the three-storey home, where residents have high levels of dependency. When there are no domestic staff on duty for example on days off or holidays sometimes the staff have to complete domestic and laundry duties. This dilutes the care provision for residents. The manager confirmed that there were plans to increase the domestic hours in the near future. Dependency levels of residents on the nursing unit means that several of them need two staff to assist with all of their daily living needs. Three staff during peak times is not sufficient to make sure that all of their needs are met on an individual basis. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 25 A new handbook provided by the company addresses issues re valuing diversity of staff workforce and talks about extending beyond equal opportunities but staff haven’t yet received any formal training in this area, although some staff have covered anti-discriminatory practice within their NVQ training. Staff are continuing with NVQ level 2 training to make sure the 50 target is reached. The records for recruitment were satisfactory. There was evidence of Criminal Record Bureau checks, Protection of Vulnerable Adult checks, two written references, proof of identity and professional identity numbers for registered nurses. A training and development plan that covers mandatory training is available. Staff have completed up to date training in fire safety and moving and assisting. Further training is to be provided in first aid, Safeguarding adults, food hygiene and health and safety. The manager is to complete NVQ level 4 in care and dementia care. The deputy manager is a first level nurse and an accredited dementia care course is being sourced for her. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The manager is qualified to manage the home and is providing leadership and direction to the staff team. This is resulting in general improvements in the quality of care residents receive. The systems for consultation and quality monitoring are improving. This will make sure that the views of residents are sought and acted upon. Residents personal accounts are now being managed to ensure their best interests are protected. Without up to date training and clear record keeping the staff cannot be sure that residents are fully protected. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 27 EVIDENCE: Since the last inspection there has been a change in the management of the home. A new manager and deputy manager have been appointed however, she is yet to be registered with the Commission for Social Care Inspection. She has many years experience as a manager and holds the Registered Managers Award. She is going to complete a NVQ level 4 in care and training in dementia care. She does not hold a nursing qualification. The deputy manager is a qualified first level nurse and a suitable course in dementia care is being sourced for her. With the employment of Registered Mental Nurses the senior staff complement will be able to meet its aims and objectives. Staff said that “The manager has changed lots of things for the better”. “We are given support” “We are getting lots of training” “It’s starting to be a nice place to work”. Audits of all care and other services are now being carried out with action and outcomes recorded. The regional manager visits on a monthly basis and completes a separate report. These reports are to make sure the quality of the home continually improves. Staff and relatives meeting are now taking place with minutes kept. A quality assurance system is now in operation but is still developing. Residents’ have an individual statement of accounts and transactions that are held on computer. They are able to obtain a print out at any time during office hours. Monies are generally held in one non-interest account although some residents have had their money put into an interesting baring account Entries were clear with signatures available. A full audit of personal allowances is currently being undertaken. Accidents are clearly recorded and the manager completes monthly accident analysis to examine and track any trends. Fire training is up to date and a fire risk assessment is available. An inspection by the Fire Officer took place in April 2007 and the Environmental Health Inspection took place in February 2007. The home has been without a maintenance person. This means that the weekly and monthly in house maintenance checks have not been carried out since Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 28 March April this year. The newly appointed maintenance person is busy catching up carrying out the checks and recording the findings. A maintenance person has recently been employed and he is currently carrying out the required work with records kept. External service contracts are available and up to date. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 29 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 30 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 OP1 Regulation 4,5 Requirement The registered persons must ensure that the Service User Guide is written in plain English and made available in formats suitable for the intended residents The registered persons must ensure that the Company’s comprehensive assessments tool is completed in detail. The registered persons must ensure that the care plans are reviewed at least monthly, are person centred and reflect up to date practice This must include how to deal with behaviours that challenge. The registered persons must ensure that all fluid balance, food and positional turn charts are accurately kept so that residents nutritional and health status can be constantly reviewed. Timescale of 01/05/07 not met. The registered persons must ensure that all hand written directions on the medicine DS0000018168.V336640.R02.S.doc Timescale for action 01/10/07 2 OP3 14,15 31/08/07 3 OP7 15(1) 31/08/07 4 OP7 15 31/08/07 5 OP9 12,13 31/08/07 Birchdale Nursing & Residential Home Version 5.2 Page 31 6 OP12 12,14,16 7 OP18 12,13 8 OP20 23 9 OP21 23 10 OP24 16,23 11 OP26 13 administration records have two witness signatures. The registered persons must ensure that the staff write when eye drops have been opened and check that is not out of date. The registered persons must ensure that residents have the opportunity to exercise choice in regard to leisure, social activities and cultural interests. Activities must be recorded and up to date information about activities circulated to them in formats that suit their capacities. The registered persons must ensure that all staff receive training in safeguarding adult procedures which links into the Local Authority Procedural Framework. The registered manager must ensure that the refurbishment programme continues. The furnishings, fittings and decoration in all communal areas must be domestic in style .of good quality and suitable for the diverse needs of the residents. The registered persons must ensure the bathrooms and toilets are refurbished as part of the planned programme and repair or replace the damaged dripping taps throughout the home. The registered persons must continue with the refurbishment of the bedrooms including replacing vanity units carpets, bedroom furniture and bed lined where necessary. The registered persons must make sure that the sink unit in the laundry is replaced and the flooring kept clean of debris. The pockets of odour in the upstairs bedrooms and lounge must be eradicated. DS0000018168.V336640.R02.S.doc 31/08/07 31/12/07 31/12/07 31/12/07 31/12/07 01/09/07 Birchdale Nursing & Residential Home Version 5.2 Page 32 12 OP27 18(1a) 24(2) 16(2m) 13 OP27 18 14 OP30 13,18 15 OP31 9,1012 16 OP38 12,13,23 The sluice disinfectors must be repaired or replaced. The registered persons must ensure that the staffing levels especially on the nursing unit meet the assessed needs of the residents. The registered persons must ensure that sufficient domestic cover is made available at the home, which include appropriate holiday cover arrangements Timescale of 01/08/06 not met The registered person must ensure that Registered Mental Nurses are employed in sufficient numbers on the nursing unit. The registered persons must ensure that all staff receives suitable training to enable them to do their jobs effectively. A planned training and development plan must be produced and implemented with records kept. An appropriate training course in dementia care must be sourced for senior staff. The registered person must ensure that the newly appointed manager progresses with the application to become registered with the Commission for Social Care Inspection. The registered person must ensure that all maintenance checks are carried out with records kept. The staff must have up to date training in all safe working practices. 01/09/07 01/09/07 01/09/07 01/09/07 30/10/07 Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 33 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 3 Refer to Standard OP4 OP7 OP28 Good Practice Recommendations It is highly recommended that all assessment records should be signed and dated. It is highly recommended that plain English be used in care planning documentation. It is highly recommended that the current NVQ training continues to ensure that a minimum of 50 of care staff achieve NVQ Level 2 Award. Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Birchdale Nursing & Residential Home DS0000018168.V336640.R02.S.doc Version 5.2 Page 35 - 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. 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