Inspection on 31/01/07 for Birchdale Nursing & Residential Home

This inspection was carried out on 31st January 2007.

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... 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 & Jeannie Eschle Bell Unannounced Inspection 31 January 2007 07:00 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.V322060.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.V322060.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) Jean Helen Wright Care Home 63 Category(ies) of Dementia (28), Dementia - over 65 years of age registration, with number (28), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (38), Physical disability over 65 years of age (3) Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration:None Date of last inspection 1st June 2006 Brief Description of the Service: Birchdale Residential and Nursing home is a 63-place purpose built facility. All of the bedrooms are single rooms. The home predominantly provides a service for older people with a dementia type illness. The home has three floors of accommodation. At this time the top floor provides residential care and the lower ground floor is used to provide nursing care. The middle floor is unoccupied. Each floor of the Home contains lounges, dining rooms, bathrooms, toilets and bedrooms. There is one main kitchen and a laundry. Each unit is accessed via a central reception area. There is a passenger lift that serves all 3 floors. Birchdale has easy ramped access into the reception entrance on the middle floor. There is also good access around the homes corridors. The home is close to local bus routes and short walk from a metro station. The home is in a residential area on a steeply sloping street. There is good car parking at the front of the home. The weekly fee 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, • £525 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.V322060.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visits on the 1st and 2nd June 2006. • How the service dealt with any complaints & 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 & their relatives, staff & other professionals The Visit: An unannounced visit was made on date on 31st January 2007. During the visit we: • • • • • • talked with people who use the service, relatives, staff, the manager & visitors looked at information about the people who use the service & how well their needs are met looked at other records which must be kept checked that staff had the knowledge, skills & training to meet the needs of the people they care for looked around parts of the building to make sure it was clean, safe & comfortable checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: Staff are warm, caring and friendly, and know residents well. They are respectful and sensitive with residents when helping them or speaking to them. Residents are encouraged to make some decisions to help them keep control of their lives. Likes and dislikes are discussed with residents and written in the care plan so that all staff know what they are. The cook keeps good records about any special diets people may eat, including their likes and dislikes. She is very clear about how to offer residents a balanced diet that is tasty and nutritious, and is very aware of the needs of people whose appetite changes as a result of their dementia, culture or age. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 6 Visitors are welcome at anytime and clear details of how to contact resident’s families are written in the care plan. Proper checks are carried out before staff are offered a job at the home to ensure the safety and well being of residents. The manager knew about the changes to employment law about equality and diversity. What has improved since the last inspection? There have been some improvements since the last inspection. The manager is now registered and has worked with other professionals to look at how the service can improve. This has included: • • • looking at how care plans are written, training for staff, redecoration of lounges and bedrooms. The home was cleaner and didn’t have any bad smells. Staff have a new handbook which tells them what the Company expects from them in their role and outlines their terms and conditions. This includes a section about ‘equality and diversity’. All but one of the requirements made at the last visit have been met due to the hard work of the manager and staff team. What they could do better: Although staffing levels at the home meet the numbers of staff Four Seasons say should be at the home, they only let staff meet people’s basic care needs. This was mentioned at the last visit and affects the quality of life by people living at the service. Routines in the home are not always planned in the best interests of the resident and need to be reviewed around mealtimes and during nightshift to ensure people’s wishes are respected. There is no activities officer in post at the moment. Therefore, any activities have to be arranged by care staff. This means that there is little for people to do during the day. More staff must be made available at peak times of the day to make sure the quality of life of residents is improved. At present there is only 1 full time and 1 part time domestic employed at the home, with some extra cover from other homes in the area. During the visit the laundry assistant had to do the cleaning on all the units and undertake laundry work as well. Domestic staff numbers must be looked at to make sure that there are enough staff to keep standards of cleanliness at a good level. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 7 Some parts of the home have been redecorated and a plan has been made to show how this will be continued throughout the building. But, a copy of the plan must be sent to the Commission showing what type of work will be carried out and when. A lot of work has been carried out to improve care planning but staff need to have regular training updates that help them plan care for and with people who have dementia. This will make sure that the best practice can be used to improve residents’ quality of life and make it more person centred. 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.V322060.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 does not apply to this service). Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. Assessments are give lots of information about the person’s needs on admission. This ensures that individual needs can be identified and planned for. EVIDENCE: Residents admitted to the home have a range of care needs assessments carried out by care managers, nurse assessors and the home manager, both prior to and on admission to the home. The Company have also introduced a new assessment document and this now includes areas specifically about the needs of people with a dementia illness or mental health needs. But staff have yet to implement the new documentation fully as this is a recent development. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 10 The new document gives staff the chance to record what a residents assessed needs are and how the staff should meet individual needs based on a “person centred approach” to care. Information written in existing assessments showed that staff are trying to apply a more person centred approach to assessing individual needs by asking people on admission about all aspects of their life before moving into care, and what their preferred choices are while living at the home. Two care plans of residents assessments showed that choices about having same gender staff to carry out personal care tasks was supported and previous lifestyles are taken into account. But two other plans showed limited information was gathered about social care needs and lifestyle choices. One of these residents had been admitted 4 years ago and one over 10 years ago. A resident who was admitted more recently had comprehensive information recorded in their plan; including a detailed health history with some information taken from a close relative where the resident was unable to provide this. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. Basic care needs of residents are outlined in a plan of care, although there is still some variation in quality. The level of improvement shows that staff are keen to provide a good level of care for residents to effectively meet their needs. Residents’ basic well-being and health is actively promoted with a good degree of involvement from other professionals. This ensures that residents’ healthcare needs are met. Robust medication systems are in place to ensure that residents receive safely. Residents are generally treated with respect and dignity but inflexible routines sometimes mean this is compromised. EVIDENCE: Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 12 Each resident has a plan outlining how their care needs will be met which include information about religion/beliefs but don’t explore other aspects of diversity in any detail. The plan is based on preadmission assessments carried out by care managers, the home manager and when necessary the nurse assessor. Additional assessment tools are kept with the plan and include pressure sore risk assessments, dependency, moving and handling, nutritional assessments using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessments. These tools generally compliment the care plan and help staff understand what level of risk has person has about their health and physical care needs. The level of risk is determined by a numerical score but it is not always clear from the assessment information whether the score means the risk is high, medium or low. The care plans were clearly written, regularly reviewed and updated according to changes in social, personal and health care needs. Residents who have reduced appetite or low weights are regularly weighed and advice is gained from dieticians, as it is needed, which is acted on. Food charts and fluid charts are kept for those people at risk of malnutrition and dehydration. These are generally well kept and show at a glance what food and drink residents have been offered and actually taken. Up to date information about changes in wound care are documented on a regular basis and care plans showed that reviews had taken place in the last year. Staff were able to explain how they put the plan together. They have tried to include residents as much as possible in planning how they would like to receive their care, where this is not possible, relatives have signed the plan to say they agree on behalf of the resident. One resident has no close relative and this was documented. But some plans on the residential floor have not yet been signed by either the resident or their family. Families are informed of any changes in their relatives health care and this includes telling them when accidents occur and when the GP has visited. They have also completed the information about past lifestyles and preferences. This helps the staff to understand what types of act ivies individuals like and provides a more ‘person centred’ approach to care. There has been an improvement in the care planning and recording since the last inspection. But where residents’ staff have lived in the service for some time the assessments are not always reviewed and up to date. Sometimes the wording used to describe needs such as “self care deficiency”, does not clearly explain what the residents needs actually are. Staff sometimes make assumptions about residents emotional well being for example, plans ask about when a persons wedding day anniversary. In one plan, staff had written ‘does Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 13 not apply’, even though this person had been married and divorced, and may still think about the event. 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. There was no evidence to show how dental health needs are being met. Appropriate pressure relieving devices are available to support the staff and residents in daily activities. Several of the residents have air cell mattresses and cushions to prevent pressure damage. Advice is gained from other professional such as psychologists, occupational therapists, tissue viability specialists, speech therapists and continence advisors. Visits from the multi disciplinary team are clearly recorded in individual care plans. The manager has set up a “named nurse” and “key worker” system of care. This is to make sure that the residents can form good relationships with the staff and staff can get to know individual residents needs. It also means that staff have accountability and responsibility for a group of residents. And they are responsible for recording the care given and the nurses are responsible for the care planning and reviews. This system of working is not yet fully established on the nursing unit but key working has been running well on the residential floor for some time. The home has comprehensive medication policies and procedures for staff to use. 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. Each resident has a photo attached to his or her medication records and allergy details were clearly recorded. Medication was given to residents after mealtimes and staff were sensitive in the way they did this. One resident who has an arthritic condition and is prescribed pain killers on an ‘as and when’ basis, was discreetly asked after each meal if they had any pain and did they need a tablet for this. There is also a register of staff who are authorised to administer medication and staff have received safe handling of medication training, and more recently have attended refresher events. Staff spoken to about medications were knowledgeable about the medication, its use, side effects and contraindications and showed that training had been understood. Although the staff were very busy with some very dependent residents they were unhurried, kind and respectful at all times. The two permanent staff were very knowledgeable about individual likes, dislikes and personal care needs. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is poor. This judgment has been made from evidence gathered both during and before the visit to this service Choices made by residents about their preferred lifestyle don’t always match their experience in a meaningful way. This sometimes limits lifestyle choices for residents. Positive contact is actively encouraged by the home and ensures that relatives and visitors can visit often. Staff generally offer good support to residents to help them continue to make decisions about everyday life. But this process is not consistent over a 24-hour period. Therefore, residents’ wishes are not always respected. Although meals offered are nutritious and take account of individual need, the timing of mid-day and evening meals is too close together. This limits choice for residents about when they want to eat. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 15 EVIDENCE: A number of residents were already up and dressed by 7am in both units. One person was having a bath, while another person sat waiting in the lounge before being taken along for a bath. The staff member said to resident “come along X do you want your bath now”, to which she replied, “not really, I don’t feel like it” but was persuaded to go along anyway. One resident was asked what time she normally got up and she replied, “when I feel like it”. This was discussed with the manager who stated that a small number of people do rise early because of their level of confusion but staff should not be disturbing residents to get them up early. Residents were offered cups of tea and biscuits while they sat in the lounge and waited a further two hours before breakfast, and many of them sat and dosed in their chairs during that time. The home doesn’t have an activities person in post, although one has been recruited, they cannot start work until all the required checks are carried out. Notices on the wall and conversations with residents and staff suggest that previously there was until recently lots of activities in the home that suited residents’ interests. There was some input from a charitable organisation Equal Arts and some of the artwork made by residents is on display on the walls. Unfortunately, Equal Arts have not visited the service since before Christmas but the manager is to contact them to find out when they can return. This has meant that residents have little to do through the day other than watch TV. For residents living in nursing unit the main events of the day were visits from the hairdresser and the optician. Otherwise residents were taken to and from the dining room, lounge and toilet. The television was on for part of the time and music during lunch. Staff were busy caring for residents other physical and healthcare needs, and had little time to arrange group or individual activities. One resident on the resident floor said, “ I like to go to the shop”, but any opportunity for this was impossible as there were only two staff on duty. The news channel played on the residential floor until after lunch when the staff had time to ask residents if they would like watch something else. Although there were few visitors on the day of inspection 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. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 16 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. However, the mealtime experience for residents is still generally poor on the nursing floor. Although, tablecloths were put on tables there were no condiments, napkins or cutlery available and tea/coffee was given with milk already added. The breakfast meal started at 9am and continued until 11am, then lunch was ready for 12.30pm and went on for over an hour. Staff were juggling their time between helping people to get up and dressed and serving meals. Residents are unable to help themselves and several struggled to eat their cereal and take their drinks, as staff were not readily available to help them. A choice of cereal was offered with fresh fruit juice, followed by poached eggs and toast but this was kept in the hot lock trolley for some time while resident finished their cereal. Work experience staff were left in the dining room for some time before regular staff were available to sit with residents. The lunchtime meal was a similar experience for residents and again work experience staff were left for some time with residents trying to help them eat. Meals were served ready plated and although there was a choice available, everyone had the same meal of pie, chips, carrots and peas. Dessert was rhubarb and custard, yogurt or a banana. Soft or liquidised meals were presented attractively to encourage people to eat. Two residents didn’t eat any of their meal during this time and one resident went to hospital with a member of staff, leaving a qualified nurse and carer to help all the residents, some of who are very frail or have behaviour, which can be challenging. Staff were sensitive in the help they gave. On the residential floor residents still have some independent living skills but meals were still served from a hot lock trolley. Residents were asked what they wanted and were given what they asked for. Fresh fruit or ice creams were offered in the afternoon and residents had good access to snacks and drinks throughout the day. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. Information about making a complaint is clear and accessible. This contributes to residents’ and relatives’ views and concerns being voiced. It also ensures any complaints are dealt with promptly. Satisfactory systems are in place to protect vulnerable people against abuse and all staff receive training, so they can identify any signs of abuse and protect residents. 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. The registered manager confirmed that all residents or their relatives are provided with a copy of the guide. The care plans showed that there is good communication with families and staff. One relative was concerned that they were not always told when gifts arrived and their care plan shows how this is to be put right. A representative of another resident has recently raised a concern about the service and after looking at the theme of the complaint; it was passed to the provider to investigate. A full report of the findings is to be sent to CSCI on completion. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The building is kept in an adequate state of cleanliness, repair and decoration. Recent improvements ensure that the environment is comfortable and safe for residents. EVIDENCE: The nursing unit has a lounge, dining room, conservatory, activities room and a Snoezelean room. All of the bedrooms are for single persons but only two bedrooms have an en suite toilet. The communal areas are reasonably furnished and decorated. However, 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.V322060.R02.S.doc Version 5.2 Page 19 Bedrooms decorated and furnished to reflect different tastes. Religious artefacts are obvious in some rooms, as well as photos of family and friends on display and items brought with them from home. A couple of rooms were less personalised where residents have little family involvement. One service user brought their cat in with them and keeps it in their room on the residential floor. The quality and condition of furniture varies for example, vanity cabinets are looking shabby and worn. Coloured mosaic tiling has been added in recent years to break up the clinical appearance of bathrooms but they are large and uninviting. But staff has used pictorial signage on the door to help people who are confused locate the bathroom. However, the home is working through a planned programme of refurbishment and redecoration. Light switches are conventional small pad type located high on the wall rather than ‘fat pad’ switches located at a more accessible height, which are easier for people to reach and use. The boxed in areas under small sinks in WC’s inhibit access for wheelchair users and towel dispensers are sited too high on the wall to be easily reached. The passenger lift from the lower ground to the middle floor remains out of use as it has some faults and has not been serviced. There is one central passenger lift, which services the three floors. The manager said that pillows have recently been replaced and linen was being replaced as needed, but some duvets and pillows were notably thin. Staff was also seen to follow infection control procedures throughout the day. The laundry was generally clean and organised but the sink unit has broken drawers and the wood is water damaged. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 20 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 judgment has been made from evidence gathered both during and before the 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. The home operates good recruitment procedures to ensure residents are protected, which ensure proper checks are carried out and minimises the risk of harm to residents. Suitable arrangements for staff training and supervision are in place, which ensure that staff are equipped to provide a good quality service that benefits the residents. EVIDENCE: There was some general improvement in the standard of cleanliness and no apparent odours in the home, even early morning. But Four Seasons currently employs only 1.5 domestic staff to cover domestic services at the three-storey home, where residents have high levels of dependency. There was no domestic cover during the visit because of holiday a member of staff from the laundry staff covered for the whole building, as well as doing the laundry. It is to her Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 21 credit that the home stayed clean and odour free all day. Sufficient arrangements are not in place to cover for holiday and sickness, or even normal arrangements. There are currently fourteen residents living on the nursing unit with two residents were very poorly, and nursed in bed. One resident was getting better and was getting up for part of the day but five residents needed two staff to make sure they were transferred safely using the hoist. During mealtimes five residents needed one carer to help them eat their meals. The rest of the residents need some supervision to make sure that they eat and drink enough. All of the residents need assistance with all personal hygiene and dressing. Two work experience students arrived at 9am on the nursing floor and helped with these tasks. The issues identified about the meal service and the fact that food spillage, body spillage and domestic tasks had to be cleaned up by the care staff it was apparent that the staffing levels did not always meet the residents needs. The day consisted of getting residents personal care, nutritional care and health care needs met. All of these activities took place at the same time and although staff were sensitive and had a good understanding of individual need they did not have the time to provide anything more than basic care. On the residential 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. Staff were very busy all day and had little opportunity to do any activities with residents. Despite this staff were courteous and didn’t rush residents. The middle floor has also opened recently and there are now six residents living on that floor. Only one member of staff is on duty throughout the day and meal, toilet and break times have to be covered by staff on the other floors. This further depletes staffing levels at busy times. In addition, all service users are male and there are currently some issues around inappropriate sexual expression by one resident towards females. Male staff only provide cover on this floor during the night and there is no clear direction to staff about how to deal with this situation appropriately. The qualified nurse on night duty came from overseas five years ago. She said that she had completed her adaptation course and had completed various other courses including Protection of Vulnerable Adults (POVA), Challenging Behaviours, Dementia Care and all statutory training. Day staff also said they are now receiving training on a regular basis. One member of staff was unsure if she had completed an induction or moving and handling training. Staff had also completed refreshers in medication handling, fire training, manual handling, care planning and, death and dying. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 22 Formal supervision of staff is now in place and offered to all staff within the specified timescales. 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. The manager also showed she has some knowledge about changes to equality legislation that affects workforce and the Company are currently impact assessing their policies and procedures to ensure they meet the various pieces of equality legislation. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. 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 from evidence gathered both during and before the visit to this service. The manager is well qualified to run the home and provides an adequate level of direction and leadership to staff. This has resulted in general improvements in the quality of care residents receive. Fixed routines and insufficient staffing sometimes mean that the home is not run in the best interests of residents. A new quality assurance system has recently been introduced and is at a developmental stage. Once fully operational, this will help to ensure shortcomings in the service are identified and put right quickly. Good systems are in place to safeguard resident’s monies. Appropriate policies, procedures and practices are in place to safeguard Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 24 residents from risk of harm. EVIDENCE: The staff spoken with said there has been a lot of improvements since the registered manager was employed. They are aware that there is still many areas that need to be improved but now understood what needed to be done and why. They also said they were working hard and were keen to make things better but realised there is still some way to go. Staff said they felt comfortable about approaching the manager and said she was approachable and listened to their concerns. Although there have been some changes to routines in the home they are not always planned in the best interests of residents but due to staffing numbers are often task directed. And while staff try to be flexible, their time is limited to carrying out personal and nursing care tasks because there is too much for them to do. This restricts residents’ choice and control over their day-to-day lives and decision-making. A quality assurance system is now in operation but is still developing. The Company encourages the residents, their families or representatives to take care of residents personal monies and keeps records of ‘personal allowance’ transactions and don’t act as ‘appointee’ for residents any longer. One resident’s money is looked after via the Court of Protection and another person has a solicitor controlling their financial affairs because of issues of capacity. They have recently changed their banking facility to an interest accruing account so that residents can gain interest on personal allowance money kept by the Company on their behalf which is over £50. Records are clear with inbuilt checking/auditing systems/spot checks and receipts that correspond with expenditure sent. Individual statements can be given to residents upon request so that they know how much money they have available. A fire risk assessment is available and up to date and staff receive regular statutory updates. The fire logbook is completed on a weekly basis. Staff receive statutory training in safe working practices. The manager said that six staff are now qualified first aiders. The manager said that six staff are now qualified first aiders. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 25 Accidents are clearly recorded and the manager completes monthly accident analysis to examine and track any trends. Copies of accidents are held in individual care plans. Action was taken following falls resulting in the review of care plans and updating to make sure residents are kept as safe as possible. The manager also carried out an analysis of all accidents that happened in 2006 and further analysis of this information should develop the practice in the future. Regular health and safety checks are carried out including checks on water temperatures, and in house health and safety. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 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 2 2 X 3 X X 2 Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 4 5 Standard OP7 OP10 OP12 OP14 OP15 OP19 Regulation 15(1) 12(4)(a) 12(2) 12(1)(a) 23 Requirement Develop care plans to ensure they are ‘person centred’ and reflect up to date practice. Ensure that residents’ wishes are respected around times for getting up and bathing. Ensure residents are encouraged to exercise choice and control over their lives. Ensure the timing of meal times is flexible and responsive to resident needs/wishes. Submit a detailed plan outlining any redecoration/refurbishment or planned maintenance to the Commission. Staffing levels at Birchdale must meet the assessed needs of residents. Outstanding since 1/8/06 Ensure that sufficient domestic cover is made available at the home, which include appropriate holiday cover arrangements. Introduce a lone working policy and carry out risk assessment where this is in place. Ensure Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 28 Timescale for action 30/06/07 01/03/07 01/03/07 01/03/07 31/03/07 6 OP27 18(1a) 24(2) 16(2m) 30/03/07 7. OP38 13(4) a 23(4) d that male staff are available to deal with intimate care tasks for specific male service users. Night staff must receive fire instruction not less than every 3 months. Outstanding since 1/8/06 28/02/07 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 All assessment records should be signed and dated. Use plain English in care planning documentation. The home should continue with the current NVQ training to ensure that a minimum of 50 of care staff achieve NVQ Level 2 Award. Birchdale Nursing & Residential Home DS0000018168.V322060.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South of Tyne Area Office St Nicholas Building St Nicholas Street Newcastle Upon Tyne 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.V322060.R02.S.doc Version 5.2 Page 30 - 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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