CARE HOMES FOR OLDER PEOPLE
Birchville Court Nursing Home Heathbourne Road Bushey Heath Hertfordshire WD23 1PB Lead Inspector
Bijayraj Ramkhelawon Key Unannounced Inspection 13th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Birchville Court Nursing Home DS0000019293.V299909.R01.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. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Birchville Court Nursing Home Address Heathbourne Road Bushey Heath Hertfordshire WD23 1PB 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) 0208 421 9110 0208 421 9117 Peach Glen Limited Mrs Christine Kelly Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home may accommodate 39 older people who require nursing care. 31st January 2006 Date of last inspection Brief Description of the Service: Birchville Court is situated on the outskirts of Bushey Heath. The two storey period building with a modern ground floor extension to the rear is set back from the road in extensive grounds. Visitors parking is provided to the side of the main building. The home has been extensively modernised in the last eighteen months providing accommodation in 39 single rooms many of which have en-suite toilets and wash hand basins. A feature of the home is the overhead tracking hoists which have been provided in the bathrooms, shower room and toilets.There is a large lounge, sunroom, conservatory and dining room on the ground floor. The rooms in the older part of the house and the entrance hall are decorated in period style. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a positive inspection. Service users said that they were being ‘well looked after’ and ‘well cared for’. The staff are ‘nice and caring’. Good interaction between staff and service users was observed. Service users were appropriately dresses and were well presented. Care plans included all the relevant information. However, a separate care plan must be devised for each nursing care provided including wound care and catheter care to enable regular monitoring and evaluation of treatment. Staff confirmed that they had attended all the mandatory training. However, fire safety regulation must be adhered to and doors must not be wedged open. What the service does well: What has improved since the last inspection? What they could do better:
Care plans in relation to pressure ulcers and catheter care must be detailed with regular evaluation and monitoring of treatment carried out. Care plans should also indicate whether service user has the use of a wheelchair. Fire safety regulation must be followed and doors must not be wedged open as this practice will put service users and staff at risk. An audit should be carried out
Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 6 to ensure that all staff have regular fire drills. Adequate storage areas should be provided and store rooms must be kept locked when not in use. Staff should ensure that meal times are unhurried and assistance with eating is given in a sensitive manner. 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. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. Each service user has an assessment of needs carried out prior to an offer of placement being made. The Statement of Purpose and Service User’s Guide should be reviewed and updated. EVIDENCE: Care plans examined included an assessment of needs for each service user. Reports from other professionals formed part of the care plans. Each service user had their plan of care and daily living based on the assessment of needs. However, the ‘statement of purpose’ and the ‘service user’s guide’ were not reviewed and updated. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. Good care practices and interactions between staff and service users were observed. The management of medicines was maintained in good order with records kept. However, documentation in care plans in relation to catheter care, frequency of bags to be changed; size, depth and evaluation of pressure ulcers must be carried out so that service users health, response to treatment and progress can be monitored. Care plans should also indicate whether service user has the use of a wheelchair with a risk assessment identifying the agreed and appropriate moving and handling techniques to be used in assisting the service user. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 10 EVIDENCE: Service users spoken to confirmed that they were well cared for and their individual needs were being met. All service users were appropriately dressed, well groomed and they confirmed that staff addressed them by their preferred names. Staff members on duty were observed to deliver care and attend to service users’ needs in a manner that respected their privacy, dignity, choice and wishes whilst actively promoting independence where possible. Personal and intimate care practices were carried out behind closed doors. A policy and procedures for care of the dying was in place. spoken said that they were aware of this policy. Staff members Records of medicines including the receipt, storage, administration and disposal were kept in good order. However, there were no specific care plans devised for catheter care including the frequency of bags being changed. It was also noted that the size, depth and evaluation of pressure ulcers were not recorded and carried out. Care plans did not indicate the use of wheelchair for service users who use wheelchairs with a risk assessment undertaken. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. Autonomy and choice were being promoted. Some day care activities were being provided. Staff should assist service users with eating in a sensitive and unhurried manner. EVIDENCE: At present there is a volunteer day care activity co-ordinator who works one day a week and care staff have been providing some activities and outings as and when possible. On the day of the inspection, it was noted that service users were listening to music, reading newspapers, chatting to others and watching T.V. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 12 The lunch was observed and tables were laid nicely and a choice of drinks was available and there was individual cutlery. Service users spoken to were complementary of the food provided. However, it was noted that staff assisted a service user to finish the last mouthfuls but did not sit and continued to stand. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 The quality outcome in this area is good. This judgement has been made using all available evidence including a visit to this service. Service users and families can feel confident that their concerns would be listened to and dealt with. EVIDENCE: A copy of the complaints procedure was available to prospective and current service users. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. Staff confirmed that they have received training on Protection of Vulnerable Adults. No complaint has been received since the last inspection. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 26 The quality outcome in this area is good. This judgement has been made using all available evidence including a visit to this service. The home was kept clean and generally well maintained. Bedrooms were personalised offering a homely, lived in feel. The first floor toilet used as storage must be kept locked and appropriate sign displayed to prevent any possible risk of someone entering the room and injuring themselves. EVIDENCE: The home and its surroundings offered a pleasant, comfortable and safe environment to its service users. These were kept clean and generally well maintained. Bedrooms were personalised offering a homely, lived in feel. Service users spoken to said that they were happy with their bedrooms and other facilities.
Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 15 The home has adequate number of domestic staff and records showed that staff have been provided with training in hygiene and infection control. However, the toilet opposite room 28 was being used as storage, making it difficult for people to access it. The manager said that there was no service user in that section of the home who accessed the toilet as they used the commodes and required staff assistance. However, the sign on the door indicated ‘toilet’ and not ‘store room’ and was kept open. It was discussed that alternative storage area should be provided and if there was any change in the needs of service users, then this room must revert back to provide toilet facilities. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 The quality outcome in this area is good. This judgement has been made using all available evidence including a visit to this service. The skills and experience of staff were varied. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. Adequate number of staff was rostered on duty to meet the needs of service users. EVIDENCE: There was adequate number of staff rostered on duty per shift during the day and night. Service users were complimentary about their rooms, staff and food. They said that ‘ staff are good, they look after us and are very kind’. Staff files examined had all the relevant documents required by this Standard. Staff spoken to confirmed that they have received appropriate training, this included statutory training. They also said that they receive regular supervision and an annual appraisal and they have been given a copy of the General Social Care Council Code of Conduct. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. There were policies and procedures in place to ensure that service users’ rights were protected. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. Staff received regular planned supervision. Fire doors must not be wedged open as this practice is unsafe for both service users and staff. An audit should be carried out to ensure that all staff have a regular fire drill as part of the fire safety regulations. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 18 EVIDENCE: Staff confirmed that the registered manager operated an open door policy to staff, service users and to their representatives. Good professional interaction between staff and service users was observed. Staff confirmed that they had undertaken all the mandatory training. However, the laundry door was wedged open. Doors must be held open only by means approved by the Fire Safety officer. An audit should be carried out to ensure that all staff have a regular fire drill. All statutory records were available for inspection and maintained in accordance with legislation. Staff spoken to were aware that service users can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures in place to ensure that the health, safety and welfare of service users but these were not promoted and protected. These records were accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. The CSCI has been kept informed of all accidents. A valid insurance certificate (expires on 17/09/06) was displayed in the reception area and this offered cover of no less than £5 million. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 1 Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. 5. Standard OP8 OP8 OP8 OP22 OP38 Regulation 12 (1) (a) & (b) 12 (1) (a) & (b) 12 (1) (a) & (b) 13 (4) (c) 23 (4) (a) Requirement A record of how often catheter bags are changed must be kept. Size and depth of pressure ulcers must be recorded. Regular evaluation of pressure ulcers must be carried out. Toilet opposite room 28 that is being used as storage must be kept locked. The Laundry door must not be wedged open. Timescale for action 04/08/06 04/08/06 04/08/06 28/07/06 13/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations Statement of Purpose and Service User’s Guide should be reviewed and updated. Care plan should indicate the use of wheelchair for service users who use wheelchairs and a risk assessment carried out.
DS0000019293.V299909.R01.S.doc Version 5.2 Page 21 Birchville Court Nursing Home 3. 4. 5. OP15 OP22 OP38 Staff should assist service users with eating in a sensitive and unhurried manner. Adequate storage area should be provided. An audit should be carried out to ensure that all staff have a regular fire drill. Birchville Court Nursing Home DS0000019293.V299909.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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