Inspection on 05/05/09 for Birches Grove

This inspection was carried out on 5th May 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Birches Grove 08/05/08

Birches Grove 22/06/07

Birches Grove 24/07/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Birches Grove 14 Fairmoor Close Parkend Nr Lydney Gloucestershire GL15 4HB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Simon Massey     Date: 0 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Birches Grove 14 Fairmoor Close Parkend Nr Lydney Gloucestershire GL15 4HB 01594564081 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : birches.grove@craegmoor.co.uk Parkcare Homes Ltd care home 4 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 4 4 The Registered Manager works with a mentor for a period of a minimum of 1 year. The conditions are reviewed after 1 year of registration. The mentor is a person approved by the CSCI and that the mentor can not be changed without prior agreement of the CSCI. Date of last inspection Brief description of the care home Birches Grove opened in Spring 2006. The home is situated in a quiet residential area in the village of Parkend. The service provides care and accommodation for people with a learning disability and/or mental health difficulty. People are accommodated in single rooms on the first floor. On the ground floor there is a lounge, kitchen and dining room. The home also has a patio and garden. A vehicle is provided in order for people to access the local community. Prospective service users are offered information about the home including a copy of the Statement of Purpose and Service Users Guide. Up to date information about fees was not obtained during this inspection. Care Homes for Adults (18-65 years) Page 4 of 25 Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was completed on 05/05/09. The Inspector met with the acting manager, three staff members and three of the four people living in the home. Records relating to care planning, staff recruitment, medication, health and safety were examined. An inspection of the environment was also carried out. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: 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 set out 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. Care Homes for Adults (18-65 years) Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Accurate information in the services Statement of Purpose is required to ensure that that people moving into the home know that their needs can be met. Evidence: There have been no admissions since the last inspection and the home is currently fully occupied. the written policy on admissions complies with the regulations but the implementation as criticized in last report. As there have been no admission since then it is difficult to assess this standard, however the new manger, who is yet to be registered was aware of the process and policy to be followed in the event of a new admission being made to the home. A requirement was made that the Statement of Purpose be reviewed and updated to better reflect the service the home provides and this has not yet be done. this requirement is therefore repeated. Care Homes for Adults (18-65 years) Page 9 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in the planning of their care and support and are encouraged to make choices and decisions about their daily lives. People living in the home would benefit from the implementation of a care planning system more appropriate to their needs. Evidence: examination of care plans showed that had been no reviews since the previous inspection and the new manager explained that it had been identified that a new person centered approach involving a care planning format more suited to the needs of the service user had been identified but so far had not been implemented. This was something that had been identified as priority for the coming months. The existing plans contain good details regarding many areas but short, medium and long term goals were not easily identified. People living in the home explained how they are involved in discussing and planning their care and people said they could discuss all aspects of their support with the staff Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: and the manager. Improvements in the care planning system should result in a more structured approach to developing future plans and objectives, particularly around independence skills and accessing activities in the community. People living in the home were observed being involved in the daily running of the home taking responsibility for domestic chores and making decisions about their daily activities. There is need for some risk assessments to be reviewed and updated. There was evidence of good regular recording being completed and of staff liaising with outside professional and recording the outcomes of these meetings. Care Homes for Adults (18-65 years) Page 11 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to lead lifestyles that suit their needs and are encouraged to make choices and take responsibility for their decisions. People would benefit from some clarity being provided around the use of the homes living room as a sleeping in area for staff. Evidence: All people living in the home have individual routines and all spoken with expressed satisfaction with their current mixture of activities both within the home and in the community. People are supported to maintain contact with families and and this is accurately documented in the records. The living room in the home is also used as the staff sleeping in area which is not an ideal arrangement. Whilst people have facilities in their rooms there was some Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: contradictory evidence as to when service users must vacate the living room in the evening. Some said that they could go to bed when they wanted whilst others said that had to go at certain times so that the care staff could go to bed. This issue needs to be addressed and clarified by the manager of the home. People are involved in the planning and preparation of food and all said this was of excellent quality and they enjoyed the meals that were provided. Care Homes for Adults (18-65 years) Page 13 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate support is provided with peoples personal care needs promoting their independence and dignity. Health needs are well met and people are protected by the procedures in place for the storing and administering of medication Evidence: The individual files contain good records of health appointments and people living in the home confirmed they are supported to attend appointments or can attend these on their own if they choose. All medication was correctly stored and all records were up to date. There was evidence that medication is regularly reviewed. There are plans to support people to increase their ability to self medicate. People were positive about the support they receive from the care staff in respect of what personal care they require. Care Homes for Adults (18-65 years) Page 14 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home feel safe in their environment but increased training for staff could further promote their safety. The home needs to be aware of the full requirements of regulation 37 notifications Evidence: Staff have completed training in adult protection issues and staff spoken with demonstrated their understanding of this area. Service users spoken with said they felt safe living in the home and also said they were aware of how to raise concerns or talk about any issues that concerned them. Two incidents were identified during the inspection which should have warranted notifications being made to the Commission and these issues were discussed with the new manager. There could also be more specific guidance on the managing of challenging behaviors and also some training provided to the staff in this area. Also staff have only undertaken limited training in the area of mental health and further reference is made to this under the staffing standards. Care Homes for Adults (18-65 years) Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with a homely and comfortable environment and encouraged to personalize and take responsibility for their own bedrooms. The home was clean and hygienic throughout at the time of this visit. Evidence: The home is well decorated and maintained throughout and people have been supported to personalize their rooms according to their individual tastes and preferences. The communal living room is also used as the staff sleeping-in area which is not ideal and compromises the use of this area. It is difficult though to see what alternative there is without reducing the number of people living in the home. Care Homes for Adults (18-65 years) Page 16 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a motivated and caring staff team but regular formal supervision and more input in the areas of mental and health and the managing of challenging behaviors would improve outcomes for people living in the home. Evidence: The rotas showed that sufficient staffing is provided and that these levels are maintained with the occasional use of bank staff. People living in the home were positive about the care staff and stated that they could talk about issues that concerned them. People said they were treated with respect and that their privacy was respected by staff. Records showed that staff were up to date with the required statutory training and that some additional training had been undertaken including a days course on mental health. Staff commented they had enjoyed this training but thought that more input on this area was required. Although the home is registered for learning disabilities and mental health, the primary needs of all the current people living in the home fall into this latter category. The needs of these people would be better met if further training was provided. A requirement of the last inspection was that staff should receive regular formal supervision but this has not happened. The new manager stated that this was being Care Homes for Adults (18-65 years) Page 17 of 25 Evidence: addressed as a matter of urgency. It was also required that a full employment history was supplied for one person but this also was not undertaken. Both these requirements are therefore repeated. Staff spoken with appeared motivated and committed to delivery quality care and people said they worked well as a team with good communication and support between staff. Staff demonstrated a good understanding of the needs of the people living in the home but, as at previous inspection, people expressed some reservations about the lack of knowledge of the specialist area of mental health. It was evident that the appointment of the new manager is seen as a positive development and that in the period leading up to the appointment staff have at times felt unsupported. This was partly due to the long absence of the previous manager and also due to the lack of leadership and direction that was provided under the previous regime. Care Homes for Adults (18-65 years) Page 18 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home should benefit from a period of stable management and clear leadership with a new manager in post which should produce improved outcomes for people living in the home and enable staff to better meet their needs Evidence: The Provider has recently appointed a manager and the Inspector was informed that an application will be shortly be submitted for registration. The previous manager had been absent for extended periods which had placed increased pressure upon the staff team. It is also evident that there has been a period without strong leadership and guidance in a service that does present some challenges to the care staff. The new manager was open and positive about their approach to the prioritized tasks ahead. These include improving staff supervision, introducing an improved system of care planning more suited to the needs of the people living in the home at present and providing guidance and leadership to the staff team on general day to day issues. All safety checks have been completed and recorded and safe environment has been maintained. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: Some quality assurance has been completed with regulation 26 visits being undertaken on behalf of the Provider and the manager said they felt well supported in this area. However the Commission are concerned that during the absence of the previous manager there had been a lack of progress on requirements made in the previous report Care Homes for Adults (18-65 years) Page 20 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 21 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The home must produce a Statement of Purpose that accurately reflects the services provided by the home and the needs that can be met. The current Statement of Purpose does not reflect the service provided in sufficient detail or accuracy 22/07/2009 2 9 13 All risk assessments must be 22/07/2009 reviewed and dated within the agreed timescales Some risks assessments in place were out of date and needed reviewing and updating 3 23 37 The home must complete notifications in respect of any incident that affects the well-being of any person living in the home. Incidents of challenging and aggressive behavior towards clients and staff should be 22/07/2009 Care Homes for Adults (18-65 years) Page 22 of 25 regarded as notifiable incidents 4 34 19 Ensure that there is a full employment history for all staff, together with a satisfactory written explanation of any gaps in employment all staff are required to provide a full employment history 5 36 18 Ensure that staff are appropriately supervised All staff should receive regular formal recorded supervision 6 37 8 The service must register a manager The new manager should submit an application to the Commission to be registered within the timescale specified. 01/07/2009 22/06/2009 22/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 6 16 The home should implement the change to the new care planning system as soon as possible The home should clarify the use of the living room as a sleeping in area for staff in terms of the expected times when it should be vacated by the poeple living in the home. Staff should be provided with training in the managing of challenging behaviors Staff should receive training in the managing of challenging behaviors 3 4 23 33 Care Homes for Adults (18-65 years) Page 23 of 25 5 33 Staff should receive additional training or input in the area of meeting the needs of people with mental health needs Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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