Inspection on 19/04/05 for Birchdale Nursing & Residential Home

This inspection was carried out on 19th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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... 01/06/06

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

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 18/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Birchdale Nursing & Residential Home Moore Street Gateshead Tyne & Wear NE8 3PN Lead Inspector Mrs Katie Tucker Unannounced Inspection 19th April 2005 10:00 DS0000018168.V219524.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Birchdale Nursing & Residential Home DS0000018168.V219524.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 Marion Taylor Care Home 63 Category(ies) of Dementia (28), Mental disorder, excluding registration, with number learning disability or dementia (15), Old age, of places not falling within any other category (10) Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 10 Dementia - Code DE, maximum number of places 28 Mental Disorder, excluding learning disability or dementia, Code MD maximum number of places 15 The maximum number of service users who can be accommodated is: 63 2. Date of last inspection 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. The home has recently had a major refurbishment and there are now four separate units. The top floor unit is called the Gables and has seven rooms in use. The other rooms are being refurbished. This is presently an all male unit. The middle floor has two units. The Oaklands is a ten-bedded unit, which provides general nursing care and the Woodland is a seventeen bedded unit, which provides social and personal care for people with Dementia. Fernlea is the unit located on the lower ground floor and provides nursing care for people who have Dementia and Mental Health care needs. Each unit 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. All areas are accessed via a central Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 5 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: Minimum £394 to £410 per week plus the free nursing care rate which is set Nationally . Rates for privately funded people vary from £410 to £430 per week. 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.V219524.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Birchdale and was conducted as part of the routine yearly programme. Two inspectors visted and spent 8 hours at Birchdale Nursing and Residential Care Home. They spent time talking with service users, visiting relatives and staff. Both inspectors also joined people for lunch. The service user guide, assessments, care plans and risk assessments, staff files, staff rotas and medications records were examined. The staff were asked about the service user plans, the terms and conditions, the complaints procedure, access to training, staffing levels and changes to working practices, as were the service users and relatives. Staff discussed their care practices. The manager and the deputy manager discussed how improvements were being made at the home. Also the outcome of complaints and recent monitoring visits were used in the compilation of this report. Birchdale Nursing and Residential Care Home provides a service for people with a dementia-type illness (memory loss). The majority of people experienced difficulty communicating their views verbally. Therefore staff practice, attitude and approach were observed and judgements were made on the effectiveness of the approaches that were adopted. This type of observation formed a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by service users, staff, relatives and the manager. What the service does well: Staff are very friendly and caring at Birchdale. Staff will go out of their way to try to improve the quality of the lives of service users. They often come in on their days off and are unpaid to take people out or provide a bit of extra support. Where the manager has independent control she has demonstrated that she can put measures in place to improve practice. What has improved since the last inspection? The manager is providing a range of training for staff around the care of people with dementia. At times she must check the content of this to ensure it is upto-date but staff were enthusiastic about having training. The manager has been assisting staff to develop their record keeping skills. The manager Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 7 continues to pursue improvements to the building and a number of requirements made about the building at the last inspection have been sorted. What they could do better: Eighteen requirements made at the last inspection are still outstanding. CSCI are reviewing what action needs to be taken to ensure they are met. Many of the practices at the Birchdale are restricted by stringent budgetary controls. Staffing levels just meet the basic needs of individuals on the nursing unit and staff only provide a higher level of support on the residential units because of the lower occupancy. Staffing levels were recently cut prior to agreements being reached with CSCI or the relevant placing authorities. The staffing levels put in place on the nursing unit during the afternoon and evening were reduced to 1 nurse and 1 carer. Although most of the service users needed 2 staff to meet any of their personal care needs, consideration was not given to meeting these care needs. Since CSCI and placing authorities became aware of this change staffing levels have been increased to those previously agreed. Four Seasons Healthcare have not provided evidence of the criteria used to make judgements about staffing levels other than comparing costs elsewhere. The assessment forms used at Birchdale need to show how staff will meet the needs of people with dementia or mental health needs. Also staff need to have a form to routinely collect detailed information about people’s previous routines, lifestyles and ways of coping with stress. This type of information has been shown to assist staff work with people with memory loss and it helps to reduce people’s anxiety. Four Seasons operate a policy that if people want to go out on trips and need escorts, which affects all of the people living at Birchdale, staff have to come in on a voluntary basis and act as unpaid escorts. Fortunately for the people at Birchdale staff are willing to do this. However the number of times people are able to go out is extremely limited. Four Seasons Healthcare has to provide a range of opportunities for people to go out and cannot guarantee to do this if they are reliant on the good will of staff. Thus escorts must be seen as a part of the service that is given and not as a luxury. Also the company also has a policy of not providing escorts to hospital, even in emergency. At present Birchdale staff do not adhere to this policy, which is good. Again this is a policy that CSCI would not agree with and if it came in to place would take measures to prevent this poor practice occurring. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.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.V219524.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,and 3 Not all of the necessary documents are available and service users or their relatives have not been given copies of those that are kept in the home. The assessment of dependency levels is poor and leads to staffing levels being put in place that do not meet the needs of people and barely met people’s personal care needs. Also the assessment tool does not allow staff to evidence that they can meet the needs of the service user or provide all of the information that would be needed to care for individuals. EVIDENCE: Only people who have recently moved to the home have been given a copy of the service user guide and received copies of the most recent inspection report. The service user guide is designed to make people aware of the services that are available at Birchdale. Therefore without these documents people cannot make informed choices about the service that they use. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 11 Four season has not provided a terms and conditions for service users. This has been required since 2002 and not resolved. Without a contract service users or their representatives are unaware of what service they are entitled to at the Birchdale. The operational director of Four Seasons Healthcare recently confirmed to CSCI that a contract was now ready and would be issued. Four Seasons Healthcare Ltd uses an assessment form, which is based on the Roper Tierney and Logan nursing model. This tool is suitable for those people who are able to communicate fully and have general nursing needs. However it does not provide sufficient information on the care needs of people with dementia or mental health needs. The assessment has a small space to cover issues relating to mental health but the limited space does not allow staff to fully record challenging behaviours, triggers and actions that can be taken to divert or reduce such challenging behaviour. The majority of care practices will be directed at working to support people’s mental health needs and this tool does not show that staff complete any of this type of work. Therefore the tool does not allow staff to demonstrate that they could meet the needs of the people who wish to use Birchdale. Also it does not assist the staff to evidence any decisions made about staffing requirements at the home. People have a dementia-type illness and the generation of life histories for these people must be treated as a priority. People with dementia tend to revert to previous routines and patterns of behaviour and having this information allows staff to work more effectively with people and reduce the challenges that may be presented. By understanding how people have lived and their lifestyles, what often seems to be unusual behaviour when seen in the context of what people previously did becomes perfectly reasonable. Staff collectively had a good range of knowledge about triggers for behaviour, people’s preferences and how to reduce people’s anxiety. The staff spoke in a relaxed and sensitive manner towards service users. Staff until recently were not aware of developments in the care of people with dementia, particularly those around patient centred care and life history work. The manager has been putting measures in place to assist staff up date their knowledge. Four Seasons Healthcare Ltd recently reduced staffing levels at Birchdale. The staffing levels that where in place did not reflect the high dependency needs of the people at the home. On these levels staff could only offer a very basic personal care service that did not offer individuality or allow for the management of people’s anxiety. There is no evidence available to show what criteria Four Seasons Healthcare used to make these changes other than cost considerations. The manager and staff discussed recent changes to the ownership of Birchdale Nursing and Residential Care Home. Four Seasons Healthcare Ltd was said to have merged with Westminster Healthcare. Whether the company have Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 12 formally made service users or their representatives aware of these was unclear. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Good effort has been made to revise care plans to reflect service users’ mental health needs, but fail to provide practical accessible guidelines for staff in how to support service users with their individual needs. Good links are being forged with community nursing services. Staff have a friendly and respectful approach towards service users. Current staffing levels barely meet the intimate personal care needs and health needs of service users. Medication recording practices are unsatisfactory. EVIDENCE: The home is registered to provide care for older people with mental health needs and dementia. Previously care plans have not reflected people’s mental health needs or dementia care needs. Since the last inspection some of the care plans have been re-written but the information in these is now very Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 14 technical and jargonistic, and difficult for staff to understand. Care plans still do not reflect the specific individual needs of each service user, nor how staff should support them. Daily records were informative and describe people’s progress or change in needs, but this information is not reflected in care plans. Staff were observed to treat service users in an appropriate and approachable manner. Visitors and service users who took part in discussions described staff as “helpful” and “friendly”. Staff talked about service users’ needs in a sensitive and respectful way. Staff were observed to have a good interaction with service users and their visitors. The majority of service users on the nursing unit need 2 staff to assist them to attend to personal care needs. The nurse and 2 staff working on this unit were extremely task orientated, as the needs of the service users and staffing levels precluded any other type of approach being adopted. Staff managed the situations that arose as best they could but lacked at times, the ability to slowly work with someone and reassure them about how their personal care needs were to be meet. The levels of general observation on the unit were extremely limited and staff worked reactively rather than pro-actively. The manager and staff ensure that service users can access a wide range of health care specialists. The manager has forged links with the Queen Elizabeth Hospital and community psychiatric nurses’. She has found that the staff from these service will come to Birchdale and provide support and training for staff. Continence pads and other personal care equipment were on display in communal bathrooms and this compromises the dignity of the people who live here. Medication at times was not recorded as being received and returns were not being completed, as they should be. Also there were gaps in the recording of medication given out. Also where prescription sheets indicated that different amounts could be given staff were not recording, which amount they had given. These poor practices could lead to service users not receiving medication or drugs running out and must be addressed. Also the general condition of the treatment rooms was unsatisfactory and cupboards were in a state of disrepair. Throughout much of the afternoon one service user sitting in a lounge constantly shouted out due to their mental health needs. However this was clearly very distressing for other people using this lounge who also started to shout back, or tried to make the noise stop, or tried to leave the lounge if they were physically able to do so. There are sufficient sitting areas for staff to support this person away from others for their own dignity and safety, and to prevent the distress to other people living here. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, and 15 On the residential units there has been an improvement in the staff support for service users in their individual needs and in activities due to lower occupancy levels. Service users can make choices about how they spend their day and about their meals. The practices staff adopt, at times, do not meet recognised models of care and inadvertently compromise people’s rights. The mealtime experience on the nursing unit does not meet the needs of service users. EVIDENCE: The home employs an Activities Co-ordinator who arranges an activities programme for each of the units, which are displayed around the home. Staff commented that sometimes service users prefer to do a different activity and they are supported in their choice, wherever practicable. The home also publishes an informative Newsletter for service users and their relatives, which advertises forthcoming social events, such as parties and entertainment evenings. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 16 It was quiet in all of the units during most of this visit. Staff stated that there were no specific activities at this time as service users were very settled and relaxed. Service users were observed to be engaged in their own preferred activities, such as chatting to visitors, listening to music and watching TV. Due to the lower occupancy on the residential units and the manager’s ability for the moment to have keep the staffing levels to a 1:5 ratio, staff have more time to support people in their individual needs. Staff confirmed that they now able to support one service user to go out on short walks and this is good practice. However, their care plan and individual activities programme does not reflect this. It is important that this improved staff presence and support should not be lost as the occupancy of the home rises. The activity co-ordinator has organised some trips out and staff talked about forthcoming events. Four Seasons Healthcare Ltd operates a policy of not paying staff to come in an accompany people on these trips and additional staff are not included on the rota during these times. Thus Birchdale is reliant on the goodwill of staff when it comes to enabling people to go out. Fortunately the staff that were on discussed the pleasure they got from providing this service and were willing to be unpaid escorts for people. At the last inspection it was pointed out that removing a person’s wheelchair was equivalent to restraint and alternative means for dealing with the behaviour they presented needed to be found. This type of practice apart from being an inappropriate behavioural approach will also compromise the company’s insurance in the event of a fire or accident. The manager was confident that staff had found different ways to work with this person. However, the daily records indicated that at times staff still followed this practice instead of agreeing and recording a plan of suitable interventions that could be used. Dining rooms are pleasantly decorated and comfortable for the people who live here. Meals are transported to each unit by hotlock trolley and served by staff to individual service users at the tables. There are at least 2 choices of main meals and it was observed that staff offered people a number of alternatives if they did not want the main meals. Inspectors joined service users for a teatime meal which was appetising and tasty. Those service users who were able to comment stated that the food was “nice”. Staff on the nursing unit were very pressured. Out of the three available staff two were present during the meal. Of the twelve people living on the unit, 3 service users needed full assistance to eat, 3 people needed regular prompting and the remaining people either needed to be encouraged to start eating or have their food cut up. Two people had difficulty joining others for meals and did disrupt other peoples meals. The mealtime was a long drawn out process because of the high level of need and the availability of staff. Staff were often trying to assist several people at once. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 17 There are no printed menus for staff or for service users to refer to. The manager had previously stated an intention to provide menus in pictorial or photographic format to assist service users in making informed meal choices, and this should be pursued. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 The manager has demonstrated that she will listen to concerns and do what is in her power to rectify any shortfalls. EVIDENCE: The Staff and relatives spoken to were confident that the manager would deal with any concerns that were raised. The manager has ensured that the complaints procedure is readily available and referred to it in the newsletters she produces. Relatives said that the staff were ‘friendly’ and ‘approachable’. All of the relatives commented on staffing levels and felt that the staff were very ‘pushed’ and having more staff on duty would benefit the home. Several complaints have been received about poor staffing levels at the home. These were upheld, as during the period when staffing levels were cut evidence was gathered to show that staff could not meet the assessed needs of individuals at Birchdale. At a regional level work continues with Four Seasons Healthcare to find a suitable means for gauging the appropriate staffing levels that are needed at Birchdale and their other homes. At present staffing levels have reverted back to those that were previously in place. Birchdale Nursing & Residential Home DS0000018168.V219524.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26 There have been improvements to the premises and equipment. The accommodation is warm and comfortable and many areas are decorated to a good standard. There remain some premises defects, which affect the quality of the accommodation for the service users and pose risks to service users. These include: 2 baths/showers must be repaired; better lighting levels in WCs; and better odour control. EVIDENCE: There have been some good improvements to the premises since the last visit. A new call alarm system has been installed and staff stated that this is a better system for determining when and where a service user needs assistance. All Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 20 hot water outlets that are used by service users have now been fitted with the required thermostatic mixing valves so that hot water is issued at a safe temperature of around 43°C. The accommodation was warm and comfortable on the day of this visit. Some areas, such as the first floor unit, have been redecorated to a good standard as part of the home’s on-going decoration programme. The home benefits from a full time maintenance staff who can attend to such minor repairs quickly. A small number of minor premises defects of wear and tear were reported back for attention. At the time of this visit 3 bathrooms were out of use. One is being used for storage and 2 others were broken. This meant that some service users were having to use bathrooms on other units or had use of a shower only and there cumulatively were insufficient bathing facilities on each unit. Lighting in bedrooms, lounges and hallways is good. The lighting in WCs is not sufficient due to the use of energy-saving bulbs as these are not left on long enough for light to reach good levels. Good lighting levels assist in the prevention of the risk of service users’ tripping. All areas of the home that were examined were seen to be clean. However increased cleaning input is needed to light pull cords and to paper towel dispensers in WCs and bathrooms to prevent possible cross contamination. Latex gloves were not stored away to prevent possible contamination and protect the dignity of service users. The laundry equipment is sufficient for the size of the home. However the laundry floor is still peeling away and this has been reported for attention in previous reports. The plastic laundry baskets for individual service users’ clean clothes are all cracked and could cause damage to clothes. The odour control in much of the home is good. However 2 small areas of poor odour in a corridor and in a bathroom still need to be managed, in order for the people who live here and visitors to enjoy an odour-free environment. Birchdale Nursing & Residential Home DS0000018168.V219524.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 At times the staffing levels will compromise the overall well-being of service users. The staffing policy at Birchdale does not allow staff to meet the social and emotional needs of service users. Staff are starting to receive training around meeting the needs of service users with dementia and this should assist them to identify how the quality of care can be improved. EVIDENCE: Recently staffing levels were reduced markedly. Although a meeting had been held regionally with CSCI agreements had not been finalised. It has been agreed that for each of Four Seasons Healthcare Ltd homes they would provide information on the assessment of dependency levels they had made and what they would see as a suitable staffing level. Then for each home, this would be discussed and an agreement reached on satisfactory staffing levels for the home. This reduction was not discussed with CSCI. Neither were placing authorities contacted so these changes could be discussed. After consultation with the placing authorities staffing levels were increased to those previously agreed. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 22 Birchdale is now being staffed at levels previously agreed with the regulatory authorities. At the last inspection it was noted that at times these levels did not meet the needs of service users. This remains the case for the in the nursing unit. Staff again were restricted to completing personal care tasks and the time available to do anything other was extremely limited. The positive work seen on residential units primarily occurred because the reduced occupancy allowed staff to provide more than a basic service, which met the personal care needs of individuals but not their emotional or social needs. In order to assist people maintain a sense of well-being their personal, social and emotional needs, each has to be catered for, as each sphere contributes to mental health of the individual. Four Seasons Healthcare has not provided information about the criteria used to create their staffing formula. Birchdale has been collecting information about care needs, falls, incidents and pressure care for CSCI so dependency levels can be concretely compared to those suggested by Four Seasons Healthcare Ltd and need to continue to do this. The application form used by Four Seasons Healthcare Ltd does not expect that applicants will record all of their employment history. Although the POVA list is now in operation and CRB checks are completed these only came into force in 2002. Therefore anyone dismissed prior to 2002 from a care service would not have had their information submitted to this list or may not have been prosecuted. By not asking for this information the company prevents the manager from gathering all relevant information and checking with previous employers. The manager is not a signatory for the CRB and therefore should not be looking at the disclosure forms or undertaking disclosure interviews unless measures have been put in place to ensure that Data Protection Act is not compromised. Four Seasons Healthcare Ltd have recently set up as an NVQ centre and are in the process of ensuring that all of the care staff complete this award. Ten staff, as opposed to four at the last inspection, now have a NVQ Level 2 award. Some staff are now working toward the level 3 award. In June all of the staff will start a dementia care training package and some staff have just started inhouse dementia care training. Part of this training refers to reality orientation and highlighting to people when their perceptions are mistaken such as that their parents are still alive. This has been shown to be out of date practice and detrimental to the well-being of people with dementia. The pack should be supporting staff to work with people around their emotional needs and reducing stress not increasing it by highlighting people’s deficits. The manager is actively promoting training and tries to provide a range of opportunities for staff. Thus CPN’s have visited and given training sessions. The manager is also ensuring staff all the staff receive up-to–date mandatory training and sufficient staff have completed the four day at work First Aid course. Staff have also been on ‘Essence of Care Training’. This Department of Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 23 Health designed quality assurance tool assists staff to involve service users and relatives to discuss practice that needs to be reviewed and assist in positive developments within the service being made. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38 The acting manager must make decision about whether to become the registered manager for Birchdale. Four Seasons Healthcare Ltd must ensures that all aspects of service users health and safety are maintained at all times. EVIDENCE: The manager has been in post since last May and has not yet submitted an application form. The reasons she had not submitted the form were discussed. Staff, service users and relatives made positive comments about her management skills. Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 25 The door to the sluice room was not locked and this could present a risk of scalding or tripping to service users who may accidentally enter this room. The door to a bathroom being used as a storage room was also unlocked and this could present a risk of tripping to service users as this room is full of lifting equipment and mobility aids. Information was provided that suggests that service users are expected to pay for equipment such as door guards. Where a person is physically or mentally disabled or is frail the company must provide equipment to meet their health care needs. One of which would be able to access their bedroom and maintain the fire safety of themselves and others. The company is also responsible for maintaining the fire integrity of the building. Not providing this type of equipment will compromise the safety of the home. If Four Seasons Healthcare will not provide this equipment free to service user who need it either because of mobility needs or psychological needs they cannot offer a service to these individuals as they will not be able to meet the service users assessed needs. Night staff do not currently receive mandatory three monthly fire training and must do so. To check the frequency staff need to receive this type of training the fire safety officer should refer to the Tyne and Wear fire log book. A policy on the management of stress was not available for inspection and needs to be. Stress is an area that causes a lot of ill health and the manager will often be confronted by, she needs to know how to manage these situations. Birchdale Nursing & Residential Home DS0000018168.V219524.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 2 1 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X 2 X X X 2 2 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X X X 2 Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement 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. Timescale of 31/08/07 not met The registered persons must ensure that all hand written directions on the medicine administration records have two witness signatures. Timescale of 31/08/07 not met An appropriate training course in dementia care must be sourced for senior staff. Timescale of 01/09/07 not met The registered person must ensure that all maintenance checks are carried out with records kept. Timescale of 30/10/07 not met. The registered persons must ensure the treatment room on DS0000018168.V219524.R01.S.doc Timescale for action 01/10/08 2. OP9 12,13 01/10/08 3. OP30 13,18 01/10/08 4. OP38 12,13,23 01/10/08 5. OP9 12,13 01/10/08 Birchdale Nursing & Residential Home Version 5.2 Page 28 the Fernlea Unit is kept clean and the temperature monitored so that 25 C is not exceeded 6. OP14 12 The registered persons must 01/10/08 ensure that people are supported to make choices regarding their everyday lives and this must be recorded in detail The registered persons must review the organisation of the mealtimes on the Fernlea Unit The registered persons must repair or replace the sluice disinfector on the Fernlea Unit. The registered persons must ensure that there are sufficient staff at peak times on the Fernlea Unit. Timescale of 01/09/08 not met. 01/10/08 7. OP15 12,16 8. OP26 13 01/10/08 9. OP27 18,24 01/11/08 10. OP8 12,13,14 The registered persons must 01/10/08 ensure that moving and assisting assessments and profiles are detailed. Staff must follow professional guidance to make sure people health is maintained The registered persons must ensure that there is a record all medicines received with the date, amount and details of any allergies recorded. The registered persons must ensure that the kitchen in the Fernlea Unit is cleaned on a daily basis and appropriate crockery and cutlery provided. The microwave must be replaced. The lounge carpet on the Fernlea DS0000018168.V219524.R01.S.doc 11. OP9 12,13 01/10/08 12. OP20 16,23 01/10/08 Birchdale Nursing & Residential Home Version 5.2 Page 29 Unit must be cleaned. 13. OP38 13,16,23 The registered persons must 01/10/08 ensure that all food is stored and used correctly to avoid food poisoning. All kitchen areas are to be regularly cleaned and food stored and labelled in accordance with manufacturers guidance. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP20 Good Practice Recommendations The registered persons should continue to change colour schemes and provide pictures and signage to help people with memory loss find their own way around the unit. It is highly recommended that plain English be used in care planning documentation. It is highly recommended that the current NVQ training continue to ensure that a minimum of 50 of care staff achieve NVQ Level 2 Award. 2. 3. OP7 OP28 Birchdale Nursing & Residential Home DS0000018168.V219524.R01.S.doc Version 5.2 Page 30 Care Quality Commission Yorkshire and Humberside St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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