Inspection on 23/10/08 for Birchgrove

This inspection was carried out on 23rd October 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Birchgrove 25/10/06

Birchgrove 27/10/05

Birchgrove 18/05/05

Birchgrove 08/12/04

Birchgrove 28/04/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Birchgrove 82 Lumsdale Road Upper Lumsdale Matlock Derbyshire DE4 5LB three star excellent service The quality rating for this care home is: 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: Tony Barker Date: 2 3 1 0 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Birchgrove 82 Lumsdale Road Upper Lumsdale Matlock Derbyshire DE4 5LB 01629584161 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): birchgrove@unitedresponse.org.uk United Response Name of registered manager (if applicable) Mrs Deborah North Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: Date of last inspection 2 5 1 0 2 0 0 6 A bit about the care home Birchgrove is a bungalow situated in a residential area on the edge of Matlock. It blends in well with the surrounding properties. The Home provides a service for three people with learning disabilities and is run on domestic lines. Accommodation consists of 3 single bedrooms and there are also suitable bathroom/toilet facilities and lounge areas. There are spacious garden areas for the use of service users. 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: three star excellent 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 How we did our inspection: This is what the inspector did when they were at the care home This key inspection was unannounced and took place over one day. The last key inspection at this service was on 25th October 2006. The Commission had requested the Service to complete an Annual Quality Assurance Assessment (AQAA) before this inspection. We had also received five completed survey forms from staff and external professionals. The information provided in these documents is included in this report. The people living at the Service all had high levels of dependency and therefore were not able to contribute directly to the inspection process, though they were observed working with and being cared for by staff. One particular persons experience of the quality of the service was focussed on, through their personal records and discussion with staff. The Manager and one senior support worker were spoken with at this inspection and records were inspected. There was also a tour of the premises. The weekly fees at the time of this inspection ranged from £1116 to £1467 What the care home does well Individual written needs assessments and plans of care were in place showing that peoples health, personal and social care need were being met. The Service provided activities, personal support and other services that were valued by people and promoted their independence in a person centred way. Good procedures for handling complaints and abuse were in place ensuring people were fully protected. People were living in a homely, comfortable and safe environment, which was furnished and maintained to a high standard. The Service had a good level of welltrained and well-recruited staff to ensure that people living there were safe and their needs were met. The Service was well managed so that people living there were protected and their best interests were promoted by the systems in place. What has got better from the last inspection A major programme of redecoration had commenced and was almost complete. Care plans and support plans were in the early stages of taking on a person centred approach. The standard of documentation had improved. What the care home could do better There are no requirements from this inspection. Good practice recommendations are made regarding further improvements to the Services records and staff training. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Barker CSCI CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: Birchgroves Service Users Guide was not up to date with details of the Commission and it was in a standard United Response format and not personalised to Birchgrove. Other aspects of this Standard were not assessed on this occasion. Information supplied by the Manager before the inspection showed that the three people had lived at this Service for several years. A full assessment of their needs was made prior to their admission, as confirmed by detailed examination of care records at a previous inspection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People had comprehensive and individual plans of care which demonstrated that their health, personal and social care needs were being met. Evidence: Care plans were holistic and comprehensive and were being reviewed at formal review meetings. There was no clear evidence of a comprehensive in-house review system, though. For example, the case tracked persons care plans and support plans were dated 2006 with only a date of review in July 2007 and July 2008 recorded. The Manager agreed that some aspects of support plans had changed but these changes had not been recorded. The care plan documentation at Birchover was in the early stages of taking on a person centred approach. Two of the three files contained a Listen to Me booklet that included person centred items such as List of Favourite Things and Great Things about You. However, the booklet belonging to the person being case tracked was not available. The information supplied by the Manager before the inspection indicated that she had plans to incorporate each persons needs, wishes and aspirations, as recorded in these booklets, into their Support Plans. The Manager said that individuals would each have a person centred review meeting starting in 2009. She said that all but one staff member had attended person centred training although she, herself, had not attended this training. One health professional who completed a survey form said that the Service demonstrates a person centred approach to meeting individual needs. All three external professionals made mention of the Service being person centred. The senior support worker, who was spoken with, gave examples of how people made choices by, for example, picking an object, such as an item of clothing, from a choice Evidence: of two or bringing items to a member of staff. She said that objects of reference are also used to help people make choices. For example, a swimming costume or a cinema pass to decide on an activity. One staff member commented, on the completed survey, that, The people we support are given choice with most areas...they are given opportunity to try new experiences. This worker also gave examples of how staff enable people to take responsible risks as part of their developing independence. She pointed out that their use of public facilities, such as the swimming pool or riding stables, is potentially risky to them and the public and she spoke of the measures taken to reduce risks and make these experiences positive for people. Recorded risk assessments were examined. These covered a range of topics but, again, they had not been comprehensively reviewed. This worker also gave examples of how staff enable people to take responsible risks as part of their developing independence. She pointed out that their use of public facilities, such as the swimming pool or riding stables, is potentially risky to them and the public and she spoke of the measures taken to reduce risks and make these experiences positive for people. Recorded risk assessments were examined. These covered a range of topics but, again, they had not been comprehensively reviewed. 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 . The Service provided activities and services that were age-appropriate and valued by people and promoted their independence. Evidence: Two of the three people were attending day services five days a week and the third was provided with a person centred weekly timetable. This timetable included working as a volunteer at a Petting Farm - where the public visit to handle and feed livestock and pets - and at a horticultural project, both with one to one support from staff. The senior support worker, who was spoken with, gave examples of some of the valued and fulfilling activities that people are involved in. She described how the people she supports show they value these activities: for example, she said that gestures will show their enjoyment and they will make it clear, from negative behaviour, if they are not enjoying an activity. One external professional said, in a completed survey, that the Service provides a good social life, including holidays. There was evidence of a good range of contacts with community organisations that provide people at Birchgrove with a good social life. The senior support worker said that people are supported to go out to shops, the Post Office, walking in the park, swimming, theatre and social clubs. One staff member commented, on the completed survey, that, we encourage peoples involvement in the community. A health professional commented that the staff team encourage full inclusion within the community - meeting and considering ethnic needs is clearly evidenced. Evidence: Two of the people at Birchgrove have contact with their relatives - the third person has minimal contact. The Manager said that ideas were being pursued regarding a befriender for this person, from the group of people with whom the person has joint activities. The senior support worker provided examples of the Service promoting peoples independence through everyday routines such as involved in personal hygiene, mealtimes and shopping. People were being provided with privacy locks on the bathroom doors and key-operated locks on their bedroom doors. The senior support worker said that bedroom and bathroom doors were kept closed when people are changing or using the bathroom in order to meet their privacy needs. Staff also recognise peoples need to be treated with dignity when it comes to matters such as continence management. Both external professionals who completed a survey form said that the Service maintains individuals privacy and dignity. The Services menu was examined and was found to provide people with a balanced and nutritious diet. The people are involved in reviewing this menu and are enabled to do this by staff pointing out food images from magazines or the internet. Two people will, with staff support, prepare snacks and meals, the Manager said. All are involved in food shopping. Food stocks were at a good level. Peoples preferences as to where they ate their meal were met: one person sometimes chooses to eat at a table in the garden during the warmer months, the Manager said. Individual food preferences were recorded, though not consistently for all people. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service was providing people with personal support in the way they preferred and required and was meeting their physical and emotional health needs in a very person centred way. Evidence: The Manager said that each person supported at Birchgrove has a reasonable degree of understanding and one person is aware of a limited range of Makaton signs, although chooses not to use these. This persons care plan showed how communication issues were addressed, in a comprehensive and detailed way. One persons specific cultural needs were being considered through, for example, attending a multi-cultural night club in Derby. Peoples likes and dislikes were recorded on file. The Manager described the involvement of an advocate for one person prior to major hospital operations. This indicated that the Service has been recognising and respecting the rights of this person under the Mental Capacity Act. There were other examples of the Service supporting people to maximise control over their lives and this is commendable. There was evidence of peoples sexual, emotional and physical health needs being met on an individualised level. Each person had a My Health File - a small-format person centred booklet detailing health needs and appointments. One person, who has epilepsy, had a book containing a range of pictures that can be used by hospital staff to communicate with them if admitted following seizures. Support Plans gave a good overview of guidance on meeting each persons personal health needs. Records indicated a range of external health professionals involved with the people supported at Birchgrove. The Manager said there was a very good relationship with the local Community Learning Disabilities Team (CLDT). She said the CLDT workers act as good advocates for the service users regarding their health needs and have provided Evidence: training to care staff. One health professional who completed one of our survey forms said, The care staff consult and act on health professional advice. The way that the Service continues to meet individual health needs is commendable. Medication was securely stored with photographs of each person displayed beside their respective set of medicines. The Medication Administration Record (MAR) folder contained further photos of each person and a copy of Birchgrove Medication Procedures. The MAR sheets were examined and found to be satisfactory. A sheet displayed in the office indicated that the Service had been made aware, by the pharmacist, of the need to provide two signatures and dates beside all handwritten entries. A record of staff signatures/initials was in place to cross-reference any uncertain entries on MAR sheets against. As and when required (prn) medicines were administered and good practice was being followed in this area. Protocols were in place regarding the administration of controlled drugs. Records showed that all staff had, or were soon to receive, training in the safe use of medicines. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Good procedures for handling complaints and abuse were in place ensuring people were fully protected. Evidence: The Services complaints procedure was displayed, using easy read pictures for better understanding by the people living there. The Manager said there had never been any complaints made about the Service. A procedure for recording a complaint was in place. The senior support worker confirmed she had been provided with training on Safeguarding Adults to ensure understanding of adult abuse matters. She confirmed that she felt safe working at Birchgrove and that people she supports are safe too. The Manager confirmed that all staff had had this training. The Services Safeguarding Adults Procedure was satisfactory as was its Whistle Blowing Policy. The Manager said that staff have whistle-blowed in the past and she always draws their attention to United Responses position on ensuring that staff are supported, and not penalised, for such action. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People were living in a homely, comfortable and safe environment that was furnished and maintained to a high standard. Evidence: The accommodation was a spacious bungalow that was homely, attractively decorated and well furnished. Bedrooms were nicely personalised and one of these had a number of posters displayed that had been chosen by the person sleeping there, the Manager said. Appropriate and sensitive strategies had been followed to maintain a homely feel to the accommodation in the context of peoples challenging behaviour. Lockable cupboards had been provided in two bedrooms - there were appropriate reasons for not providing them in the third bedroom. On the day of this inspection the kitchen and lounge were being decorated. The Managers comments about how this decoration was being managed, and the swopping of two bedrooms, again, showed how much individuals needs were taken into account on a day-to-day basis. An attractive rear garden was surrounded by fencing to provide security for the people who are supported there. Environmental standards were commendable. During a tour of the premises the premises were found to be clean and hygienic with no unpleasant odours. The washing machine in the laundry room had a sluicing programme and the senior support worker described good practice regarding the transportation of soiled materials such as wet bedding. A policy to address this matter was in place. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service had a good level of well-trained and well-recruited staff to ensure that people living there were safe and their needs were met. Evidence: Five out of seven care staff had achieved a National Vocational Qualification (NVQ) to at least level 2 : three of these had achieved level 3 and one had achieved level 4. This exceeded the National Minimum Standard to maintain a staff group with at least 50 of staff qualified to at least level 2. One member of staff was undertaking a NVQ qualification at level 3. There had been little staff turnover during the previous 12 months. The Manager said that one staff had just retired and the rest had worked at the Service between 7 and 13 years. One staff survey made reference to the Service having been very short staffed. However, the senior support worker spoken with felt that staffing levels were adequate. The Manager said that two members of staff were always on duty unless only one person was being supported at the Service. The staff rota was examined and, from this and discussion with the Manager, indicated that adequate hours were being provided. However, the rota was not being clearly recorded. For example, whether times were am or pm was not clear and, on occasions, no hours were being recorded against a staff members name. The Manager said that she was currently holding two vacancies. These hours were being filled by staff from other United Response services and by relief staff: no agency staff were being used. The file of a relief support worker, recently appointed, was examined. It was found to contain all of the elements, required by current Regulations, regarding recruitment practices. There was recorded evidence of the above recently appointed staff member being provided with induction training to Skills for Care Common Induction Standards. Evidence: However, new staff were not pursuing the Learning Disability Qualification (LDQ) for care staff - a specialist qualification for staff working in this field. The senior support worker spoken with confirmed that she had been provided with all mandatory training during the previous 12 months and training records confirmed this. The staff members who completed a survey form confirmed that they had the right support, experience and knowledge to meet the different needs of the people who use the Service. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service was well managed so that people living there were protected and their best interests were promoted by the systems in place. Evidence: The Manager had achieved her Registered Managers Award at National Vocational Qualification (NVQ) level 4, in 2002, and had worked with people with learning disabilities for 28 years. One member of staff who completed a survey said, The staff team works well together to provide support to people. Another commented that, The Manager is very supportive and readily shares her knowledge and experience...she is very approachable. There was evidence of monthly independent audit visits to the Home on behalf of the Registered Provider, as required by Regulation 26, having been undertaken in 2008. An Annual Plan was in place for 2008/09 and this contained Outcomes of whats working and whats not working. The opinions of relatives, care managers and staff, on the quality of service provided are surveyed each year, centrally, by United Response, the Manager said. A collated document is then passed to the Service. Good food hygiene practices, and safe storage of cleaning materials, were observed. Product Information Sheets were in place in respect of the cleaning materials, as required by the Control Of Substances Hazardous to Health (COSHH) Regulations. Weekly fire alarm tests were recorded as well as monthly fire drill evacuations and two evening evacuations a year. Information supplied by the Manager before the inspection showed that the safety of electrical and gas equipment was being checked at Evidence: appropriate intervals. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 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 3 4 5 6 1 6 6 17 33 35 The Service Users Guide should be updated and personalised to Birchgrove. Care plans and risk assessments should be comprehensively reviewed on a regular basis. A person centred approach to care plan recording and formal reviews should be continued to completion. Peoples individual food preferences should be recorded. The staffing rota should provide a clear and accurate record of staff hours worked. New staff should undertake the Learning Disability Qualification (LDQ). Helpline: 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 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. Copyright © (2008) 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. 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