Inspection on 21/10/05 for Birchdale Nursing & Residential Home

This inspection was carried out on 21st October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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

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

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

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

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 Mrs Katie Tucker Unannounced Inspection 21st October 2005 10:00 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.V251708.R01.S.doc Version 5.0 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.V251708.R01.S.doc Version 5.0 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 Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) 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.V251708.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th April 2005 Brief Description of the Service: Birchdale Residential and Nursing home is a 63-place purpose-built facility. All of the bedrooms are single rooms. Two floors provide residential care for people with mental health needs and one floor is used to provide nursing care. The Home predominantly provides a service for people with a dementia-type illness. Each floor at the Home contains lounges, dining rooms, bathrooms, toilets and bedrooms. There is one main kitchen and a laundry. The nursing unit is on the lower ground floor. Each unit is accessed via a reception area, which is at the centre of the home. A passenger lift is available and goes to all floors. The home is enclosed in its own grounds. Birchdale Residential and Nursing home is off Sunderland Road and a short walk from a metro station. The home is in a residential area and there is a main shopping area a short drive away. Birchdale is on a sloped road and at the bottom of the road there is a bus route. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Birchdale Residential and Nursing Home, which was carried out as part of the routine yearly programme. An inspector and the Business Relationship Manager spent 7.5 hours at the home and spoke to 17 residents and visiting relatives. A sample of assessments, care plans and risk assessments plus the complaints and protection of vulnerable adults procedures, quality assurance processes, personal allowances and medication practices were examined. The acting deputy manager and staff were asked about the service user plans, the complaints procedure access to training and any changes to working practices, as were the residents and relatives. The general maintenance of the building and hygiene were checked. Birchdale provides a service for people with a dementia-type illness (memory loss). Some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were observed and judgements were made about how well the approaches that were used were working. 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. During this inspection key standards were focused on but not all were checked. What the service does well: What has improved since the last inspection? The activities co-ordinator has started to put together information about residents’ lives and is using this when designing activities. She has worked closely with the Gateshead Dementia Network Co-ordinator to make sure what she is putting in place is useful. All residents (or their relatives) now have a copy of their terms and conditions but this has taken some time to happen. This record sets out what a person should get from the service and is a contract between Four Seasons Healthcare Ltd and the resident. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 6 The latest inspection report is now kept in the entrance of the home so that residents and visitors can read it. Improvements to the building are still being made by the handyman and Four Seasons Healthcare say they are going to redecorate all areas on the middle floor. The deputy manager confirmed that this is going to happen. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 7 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.V251708.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 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 show that they can meet people’s needs 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. The service user guide and inspection report are 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. Four Seasons Healthcare Ltd has just provided terms and conditions for service users. This had been required since 2002. Without contracts residents or their representatives are not aware of the services they are entitled to. 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 Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 9 it does not give enough information about 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 aimed 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 help the staff to show any of the decisions made about staffing requirements at the home. People have a dementia-type illness and the recording 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. 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. But none of this was recorded and staff were working with people who were very challenging. Staff were asked to record what they were doing when working with one person and why, which they did during the inspection. Staff have only recently become aware of developments in the care of people with dementia, particularly those around person-centred care and life history work. Staff have received some training about this and this knowledge was starting to show in their practice. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 Care plans try 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. Staff have a friendly and respectful approach towards service users. Current staffing levels barely meet the intimate personal care needs and health needs of residents. Medication recording practices have improved. EVIDENCE: Record keeping remains a major issue at Birchdale. Care plans do not detail the action staff have to take to meet someone’s needs. Qualified and senior care staff do not have time to revise the plans because of staffing levels and no work has been completed to change them since the last inspection. The previous deputy manager introduced care plans on the residential unit that were so complex they did not make sense to the staff and these remain in place. Although staff are working to meet people’s current needs this is not written down. Staff were given advice on how to write care plans for someone who was very challenging. Four Seasons Healthcare Ltd sent a regional advisor to the home a week prior to the inspection and he gave advice to staff about how to write the care plans. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 11 Risk-taking assessments are not fully developed. These types of plans identify the strengths people have and the common day risk that would be still acceptable for someone to take. A random check of medication was completed. Staff are accurately recording the administration of tablets plus amounts of medication received and returned to the pharmacy. However up to date medicine books are not available and the BNF (medicine book) in the home does not cover new medication being used. Staff do not have access to the Royal Pharmaceutical Guidelines and these show how they should be looking after the medication that is kept. Staff work with people in a discreet and sensitive manner and residents and relatives made very positive comments about the attitude of staff at Birchdale. They described staff as “helpful” and “friendly”. The majority of residents on the nursing unit need two staff to assist them to attend to personal care needs. The nurse and three staff working on this unit were extremely task orientated, as the needs of the service users and staffing levels prevented any other type of approach being adopted. Staff managed situations that arose as best they could but sometimes lacked the ability to slowly work with someone and reassure them about how their personal care needs were to be met. The levels of general observation on the unit were extremely limited and staff worked reactively rather than pro-actively. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The activities co-ordinator is putting in a range of useful activities but at other times staff do not have time to ensure people are engaged in meaningful activity. Often residents are not offered choices about what they want to do because staffing levels preclude this type of practice. The nutritional needs of residents are not being met. EVIDENCE: Where residents wish to go out on trips or need an escort, it is Four Seasons policy for staff 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 limited. Four Seasons Healthcare Ltd 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 an inclusive part of the service. Also the company has a policy of not providing escorts to hospital, even in an 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. The range of activities on the dementia care units are in the process of being tailored to the individual’s life experiences. The home employs an Activities Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 13 Co-ordinator who arranges an activities programme for each of the units. She has been working with Dementia Network advisors on developing life histories so she could further individualise the activities. Residents who were able, as well as relatives and staff, made very positive comments about the skills of this person, how enthusiastic she was and how people looked forward to joining in her activities. When the activities co-ordinator is not at work (she works 30 hours a week) staff would like to continue to do activities with people but said they do not have the time. Research shows that stimulation and activities reduces agitation and improves peoples dementia abilities. The meal time experience is much more organised as people are able to eat at their own pace and do not have to wait for a long time to get a meal. However, during an early hours visit people were helped out of bed before 6am and did not receive a drink on the nursing unit, or breakfast on the residential unit until 9am. Staff said that cups and cereal are now available in the morning so they can offer people something if they choose to get up early. Staff stated they are not allowed to keep the dishes as they needed to be washed for the next meal. It had been commented at a staff meeting that it was not expected that breakfast would be served after 10am. The catering budget works out at less than £15 per person per week and relatives and residents made many comments about the availability of food. One resident said their relative brought them biscuits in as the home never had any. All of the residents’ files looked at showed people had gradually lost weight. Staff had not recognised the weight loss when filling in the nutritional assessment as it had occurred over some time, but some people had lost up to 3 stone. Staff felt this was to do with the person’s condition but research shows this is not the case. A number of people walked all through the day and showed signs of being hungry (eating anything that came to hand) but additional snacks are not provided because inspectors were informed the budget will not allow it. Also, people lose concentration when eating and will leave food and not take sufficient calories to maintain their weight. But if staff offered something later it would make sure people had a balanced diet. The assistant cook has not been at work and care staff have been filling in. However, this has happened when care staff were on the rota to provide personal care for residents and no extra staff were brought in to cover. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Complaints and protection of vulnerable adults matters must be dealt with appropriately and proactively. Staff recognise and are clear about staff abusive practices. EVIDENCE: Relatives said that the staff were ‘friendly’ and ‘approachable’ but felt the company did not listen to their concerns. Again 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. Complaints were received following the last inspection about poor staffing levels at the home. These were upheld, as a month ago staffing levels were cut to 1 senior care and 1 carer on the residential unit and 1 nurse and 2 care staff on the nursing unit. From early evening the levels were reduced further to 4 staff in the building and staff could not meet the assessed needs of individuals at Birchdale. This will be closely monitored to make sure they are not changed again without seeking CSCI agreement. A protection of vulnerable adults incident happened in the home but this was not dealt with appropriately and led to further incidents. Subsequently one of the requirements made at the investigation was that staff received appropriate training in this area. In addition, if increased levels of observation were needed for a person this would be put in place immediately and not wait until funding had been secured. Training has been provided. Staff talked about the training they had received and how they found it useful. They also said it made them aware of more areas where abuse could occur. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 15 Staff are given information about people who may be aggressive. The staff are aware of the actions that they need to take but risk assessments do not reflect this. Information is not recorded about the measures that should be taken if people’s behaviour deteriorates or poses a risk to others. Also none of the staff have received training around using physical interventions but are using techniques. The numbers of physical interventions that have been needed is fairly limited. But some incidents have been quite marked such as needing three care staff to work with one person. On the whole staff have been able to use a range of primary and secondary interventions to ensure incidents have not escalated to the point where a physical intervention has needed to be used. But staff need to explore any underlying reason why such incidents might be occurring and taking action to reduce triggers. This type of proactive approach reduces levels of stress for all concerned. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Some premises defects, which affect the quality of the accommodation for the residents and pose risks to residents and staff were evident. EVIDENCE: Four Seasons Healthcare Ltd was said to be in the process of fully refurbishing the middle floor. This floor has been empty for over a month and there was no evidence to suggest work was starting. The acting deputy manager said plans were also being made to redecorate and replace furniture throughout the home. Much of the decoration and furniture is very worn. The deputy manager was advised that if work commences Four Seasons Healthcare Ltd need to ensure it meets research accepted guidelines for dementia care. A number of areas around the home smelt of stale urine. But the acting deputy manager had started a deep cleaning programme and over recent monitoring visits the smell seemed to be reducing. One of the two lifts does not meet LOLA requirements and although the company had been aware of this for some time action has not been taken to rectify this problem. On a recent monitoring visit it was found that hoists were Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 17 not working properly but these have been repaired. None of the fuse boxes were covered and the handyman had found that staff had inadvertently turned the electric back on when he was working with the electrics. Thermostatic valves have been fitted everywhere apart from the hairdresser’s room and the upstairs kitchenette. Where residents can access the hot water it must be regulated. 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. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The staffing levels need to always meet the nursing, personal, social and emotional needs of the residents. Training is available for staff and staff are actively encouraged to become life long learners but further training is needed. EVIDENCE: Staffing levels were again cut prior to agreements being reached with CSCI or the relevant placing authorities. A reduction in staffing occurred without agreement in April and staff could not meet the health or safety needs of residents. The company has introduced a tool they have devised for working out staffing levels and all the available information shows that it is based on cost and not need. CSCI and placing authorities became aware of both changes to staffing levels. The dependency levels of residents were checked and Four Seasons were required to increase staffing levels and provide information about how they intended to meet people’s needs. Information was requested in April, May, September and October and how the staffing models identified differences in need. Four Seasons Healthcare have not provided this information. Birchdale is now being staffed on the nursing units at levels previously agreed with the regulatory authorities. At times these current levels do not meet the needs of residents. Staff again were restricted to completing personal care tasks and the time available to do anything other was extremely limited. Staffing levels on the residential unit at times do not meet those previously agreed. In order to assist people maintain a sense of well-being their Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 19 personal, social and emotional needs, each has to be catered for, as each sphere contributes to mental health of the individual. Currently there are only two permanent nurses at the home and agency staff cover the other shifts. The regional manager is trying to sort this out. Birchdale staff have 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. Staff need to continue to do this and submit this information to the local CSCI office. 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. This information is now required under an amendment to the regulations, which came into force in July. By not asking for this information the company prevents the manager from gathering all relevant information and checking with previous employers. A signatory for the CRB is not available at the home 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 has set up as an NVQ centre and is in the process of ensuring that all of the care staff complete this award. Twelve staff now have an NVQ Level 2 award. Some staff are working toward the level 3 award and one person has completed this award. Staff have started a dementia care training package and confidently discussed the content. All felt it had improved their practices and said it was a ‘brilliant course’. Staff need to have physical intervention training and Four Seasons Healthcare need to make sure all staff have first aid training and that sufficient staff hold a qualified first aider certificate to cover 24 hours. Also the cook and care staff need further training around nutrition and using the nutritional assessments. As doctors no longer visit care homes to confirm a death where predicted, nurses should receive validating death training. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 A registered manager needs to be in post. Four Seasons Healthcare Ltd must ensure that all aspects of service users health and safety are maintained at all times. EVIDENCE: The manager has resigned and a new manager recently recruited is not yet in post. A quality assurance system is in place but does not appear to ensure action is taken to sort problems out or improve the operation of the home. The personal allowances were checked. The system in place and administrator remain the same. Mechanisms in place ensure that two signatures are received for every monetary exchange. Any monies accrued are sent to the family or social services departments as the company account will not generate interest and thus penalises those that have saved money. The manager has been completing an audit every month and Four Seasons Healthcare Ltd Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 21 ensures an independent accountant comes and verifies practices every six months. 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, for example to help them 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 and 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 users 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 user’s assessed needs. All staff need to complete accredited physical intervention training so staff are aware of appropriate techniques and can be confident that they are following current good practice. Also at present should any injury occur when staff are using an intervention Four Seasons Healthcare Ltd is not covered by their public liability insurance and cannot demonstrate they meet the requirements of Health and Safety legislation. A policy on the management of stress was not available for inspection and needs to be. As stress is an area that causes a lot of ill-health which the manager will often be confronted by, she needs to know how to manage these situations. Information is also not available about what staff need to do if someone dies unexpectedly and this could lead to staff interfering with the requirements of the coroner’s office. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 22 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 3 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5 (1) Requirement Four Seasons Healthcare must develop and issue a standard form contract. (required at the last inspection -timescale 11.02.05) The new assessment document that has been developed by the company must be introduced. (required at the previous inspections –timescale 11.12.04) The assessment tool must include information about cultural needs. (required at the last inspection - timescale 8.04.05) Social histories must be contextually based. (required at the last inspection - timescale 8.04.05) Assessment documents must be updated as service users needs change. Care plans must include specific action to be carried out by staff. Must include meaningful evaluations, and must demonstrate the involvement of DS0000018168.V251708.R01.S.doc Timescale for action 25/03/06 2 OP3 14 (2) 25/03/06 3 OP7 15(2) 12(2) 3(3)(q) 25/03/06 Birchdale Nursing & Residential Home Version 5.0 Page 24 the service users and/or their representative. (required at previous inspections –timescale 1.12.04) Care plans must identify and address any change in need of a service user. (required at previous inspections –timescale 1.12.04) The assessment process must include individuals’ rights, decision-making skills and outline where they are limited. (required at the last inspection timescale 8.04.05) Risk assessments and risk-taking assessments must be developed. Appropriate risk assessment and records of strategies used, must be in place for people who display challenging behaviour. Residents must be able to choice when they rise and retire to bed. Suffiencient food must be provided to meet the needs of the residents. Lighting in WCs must reach a minimum luminescence of 150 lux. (required at previous inspections - timescale 6.10.04). 4 OP7 OP18 13 (7) 21/11/05 5 6 7 OP14 OP15 OP19 12 (2) 16 (2) (i) 23 (2) (p) 13 (3) 21/11/05 21/11/05 25/03/06 8 OP19 23 (2) (b) 9 OP26 23 (2) (p) Light pull cords and towel dispensers must be cleaned daily, and latex gloves stored away, to prevent potential risk of cross-infection. (Outstanding requirement from 11.2.05). Four Season Healthcare must 27/01/06 submit the plans and timescales for the refurbishment of Birchdale. Increased odour management 27/01/06 must be in place to ensure that all areas of the home are free from offensive odours. (Required DS0000018168.V251708.R01.S.doc Version 5.0 Page 25 Birchdale Nursing & Residential Home at previous inspections timescale 11.2.05). The peeling flooring in the laundry must be made good. Staffing levels at Birchdale must meet the assessed needs of service users Information about care needs, falls, incidents and pressure care must continue to be submitted to the local CSCI office Staffing levels must be provided that ensure trips are adequately supported by staff and not based on staff good will. Sufficient catering staff must be provided. If care staff provide ancilliary services their care hours must be covered. Four Seasons Healthcare ltd 27/01/06 must the application form and interview form to ensure they assist the manager to check gaps and are DDA compliant. (required at the previous inspection - timescale 11.03.05) A robust system for CRB disclosures must be in place. All care staff must receive accredited physical interventions training. All care staff and the catering staff should receive training around meeting the nutritional needs of residents. Staff must receive training around diabetes (required at the last inspection - timescale 11.03.05) Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 26 10 OP27 18(1) 24(2) 16(2)(m) 21/11/05 11 OP29 19 (4) 12 OP30 18 (1) (c) 25/03/06 13 14 OP31 OP33 9 24 15 OP38 23 (2) (n) 23 (4) (a) 16 OP38 13 (4) (a) Sufficient staff must be receipt of qualified first aider certificates to cover the 24 hour period. (required at the last inspection timescale 11.03.05) An application form must be submitted for the registration of the manager. Four Seasons Healthcare Ltd must demonstrate that the quality assurance system identifies shortfalls in the service provided and recitifies them. The cost of providing fire door guards must be borne by Four Seasons Healthcare. (Required at previous inspections – timescale 26.07.05) The fuse boxes must be covered – an immediate notice was issued. The lift must be repaired. Certificates confirming that electrical wiring checks had been completed must be submitted to the local CSCI office –immediate notice issued. The policies on stress management must be available in Birchdale. (Required at previous inspections – timescale 26.07.05) 27/01/06 27/01/06 27/01/06 21/10/05 17 OP38 13 (4) (a) 23 (4) (d) 23/05/06 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 OP10 Good Practice Recommendations The behavioural needs of a resident should be sensitively DS0000018168.V251708.R01.S.doc Version 5.0 Page 27 Birchdale Nursing & Residential Home 2 3 4 5 6 7 OP11 OP15 OP21 OP26 OP28 OP30 supported away from other residents to preserve their dignity and to prevent distress to others. A procedure on unexpected death should be developed and staff should receive training in this area. (Recommended at the previous inspection.) Menus of meal choices should be made available and accessible to service users. (Recommended at previous inspections) Personal care equipment used by staff should be discreetly stored in appropriate bathroom cabinets. (Recommended at previous inspections.) Cracked laundry baskets should be replaced to prevent any potential damage to service users clothes. (Recommended at previous inspections) A minimum of 50 of care staff should have achieved a NVQ Level II Award by 2005. (Recommended at previous inspections.) The nurses should have validating death training. Birchdale Nursing & Residential Home DS0000018168.V251708.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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