Inspection on 19/10/05 for Birchwood

This inspection was carried out on 19th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Birchwood 18/06/07

Birchwood 28/02/06

Birchwood 16/03/05

Birchwood 14/09/04

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Birchwood Fullers Close Chesham Bucks HP5 1DP Lead Inspector Rob Smith Unannounced 19th October 2005 at 1.30 p.m. 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Birchwood Address Fullers Close, Chesham. Bucks,HP5 1DP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0207 6197100 SCOPE Mr Jon Inker Care Home 15 Category(ies) of Learning Disabililty (LD) (2), Physical Disability registration, with number (PD)(13) of places Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th March 2005 Brief Description of the Service: Birchwood is situated on the outskirts of Chesham, a small Buckinghamshire town containing a variety of shops, a theatre, various restaurants, and other local amenities. The town is served by local bus routes, and is connected to national rail links via a Metropolitan line tube station. The home is run by the organisation SCOPE, and has been built to provide accommodation for 15 service users. In its construction the home has been purpose built, and is fitted with the latest in disability aids and house design. All service users rooms are on the ground floor, and staff accommodation, office and storage space is situated on the first floor. Thirteen service users are accommodated in single rooms with en-suite shower and/or bath, and extensive tracking hoist systems are present in all rooms. Two service users share an individual apartment, which is part of the main building. This apartment comprises a bedroom, kitchen, storage, bathroom and lounge. A covered car parking space is adjacent to this apartment. The homes staff team includes care staff, physiotherapists, activities organisers and speech and language therapists. Access to allied healthcare professionals is possible through direct contact or referral by the service users general practitioner. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during a week day afternoon and involved spending approximately four hours in the establishment. The inspection comprised discussion with the manager, a guided tour of the home, informal discussion with other staff and residents and scrutiny of individual and establishment records. What the service does well: As noted at previous inspections the particular strengths of the service remain as follows: • A strong commitment to empowerment of service users and to facilitating their involvement in the planning and execution of their care planning. Good management of risk with relation to service users enjoying a fulfilling and as normal as possible lifestyle. A high quality physical environment suited to service users’ needs. Effective systems for staff recruitment, support and performance management. Good overall management and robust monitoring of care quality. • • • • What has improved since the last inspection? What they could do better: The home impressed at this inspection with its continuing high standard of care for service users and the effectiveness of management arrangements. Only minor points of clarification with regard to one resident’s medication regime and closer attention to some aspects of record-keeping were noted as areas of improvement at this visit. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 6 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. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) As no new service users had been placed in the home since the last inspection at which this standard was inspected, and found to be met satisfactorily, the standard was not re-inspected on this occasion. EVIDENCE: Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 Service users were fully aware of and consulted about the drawing up and execution of their care plans. Service users were fully consulted as to the day-to-day running of the home. Service user were supported in the taking of appropriate risks. EVIDENCE: A sample of services users files were checked and contained appropriate detail in relation to service user care needs and how they would be met. Evidence from files, observation of staff practice, discussion with staff and service users confirmed they were fully involved in consultation and planning about the detail and future direction of their care arrangements. One service user was currently very fully involved in planning possible moves to a more independent living. It was evident from simple observation of the life of the home that service users had immediate and active roles in determination of areas such as daytime and evening leisure activities, food and the décor and equipping of Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 10 their rooms. The manager indicated that more formal forums for resident meetings to discuss the overall running of the home were not correctly met with particular enthusiasm by most of the residents and had, at least temporarily, fallen into abeyance. The ethos of the home was to encourage service users to normalise their experiences of life as far possible, including the taking of appropriate and assessed risks as part of their day to day living. The situation mentioned above of one service user exploring independent living options, with the support of staff and independent advocacy services as appropriate, was a good example of this approach. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,16 The home worked hard to ensure that attention was paid to identifying opportunities for service users to develop their skills and abilities. The home was exemplary in its approach to the respect of service users’ rights. EVIDENCE: Service user care plans and feedback from staff and service users confirmed that staff, in liaison with service users, sought to identify relevant activities and opportunities to develop skills and life experiences. One service user was soon to undertake a ‘consumer test’ of the accessibility and suitability of public transport services up to major London tourist attractions. Good emphasis was placed upon maximising service users’ ability to communicate. Various forms of communication equipment were available to suit individual services user’s preferred communication techniques and abilities, supplemented by input from on-site speech and language therapy services. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 12 A strong culture of service user rights was in place exemplified by the level of service user consultation, access to and use of independent advocacy, and witnessed respect by staff for service users’ individuality, choice and privacy. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 Staff met service users’ emotional and health care needs in a consistent and appropriate manner. Medication was managed, administered and stored in safe and appropriate ways EVIDENCE: Discussion with staff and examination of service user files provided evidence of appropriate attention to both emotional and health care needs. Considerable thought, consultation and planning had gone into developing strategies to help one services user whose behaviours and emotional needs had recently come to the fore. Health care needs were fully documented in care plans and records indicated these were being met as required, in terms of both specialist input and more regular health screening and checkups. Medication was safely stored and administered with particular care being taken over the use of controlled medication. The inspector was informed that a tier of senior staff had recently undergone updating medication training and would be cascading this to other staff team members. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 14 One minor point noted was the apparent lack of clarity over one service user’s medication, where prescription instructions indicated as and when required, but medication chart instructions drawn up by staff indicated a regular three day cycle of administration. This needed definitive clarification as to the correct and most beneficial pattern of usage. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Effective systems were in place to hear and respond to the views of service users. The home paid good attention to systems and procedures to try to ensure the protection of service users from abuse. EVIDENCE: As well as the good levels of consultation already commented upon, the home also had clear systems in place for raising and responding to service users’ concerns and complaints. The manager confirmed no formal complaints had been received since the last inspection and CSCI had not been approached directly with any concerns. As already noted service users had ready and direct access to external advice and advocacy services if they felt concerns could not be raised directly within the home. Staff received appropriate training opportunities in abuse awareness and clear reporting procedures were in place for any concerns that arose. Any emerging complaints or welfare concerns were subject to effective reporting and external monitoring within the Scope organisation itself. No concerns about potential abuse or exploitation of service users within the home had arisen since the last inspection. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30 The design, equipping and décor of the home fully met the needs and expectations of service users. EVIDENCE: As noted at previous inspections the physical environment of the home was of the highest standard, designed around the specific needs and wishes of the service user group who had transferred from another, outdated establishment. As a consequence the building more than met all the expectations of the relevant environmental standards. Service users spoken to expressed their satisfaction with the design layout, and space, both communal and private, that was available. Specialist beds, ceiling tracking and bathroom facilities were in place. Decor in rooms and communal areas was to service users’ choice. Some minor problems with flooring were due to be sorted as part of the ongoing attention to ‘snagging’ problems by the builders of the home. The home was clean and tidy at the time of the inspection. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,36 The home had a competent and stable staff team who were able to meet the needs of service users appropriately. Staff recruitment practices helped ensure services users were safeguarded. The staff team was well supported in its work. EVIDENCE: The staff team was very stable with a relatively low level of turnover and low current levels of vacancy. Minimal use was made of agency staff. Levels of staff on duty, as demonstrated by the rota and seen in practice during the inspection, were satisfactory; a fact also reflected in feedback from staff spoken with. Where necessary extra levels of targeted staffing were introduced to meet the needs of individual service users. Such an arrangement was currently under consideration for one service user whose behaviours were causing some concern. Staffing recruitment procedures were sound, as evidenced by the sample of recruitment files looked at during this inspection. These also provided good evidence of early identification and follow-up of staff performance concerns Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 18 during probationary periods. The vetting of agency staff had improved with the provision of clearer and more detailed background information from supplying agencies, as suggested at the last inspection. Scrutiny of a sample of staff files showed evidence of regular formal supervision and a new appraisal system was in the process of introduction. Staff spoken with confirmed they felt well supported in their work, with ready access to advice and support on both a planned and ‘ad hoc’ basis. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,41,42,43 The home was well run with a clear focus on the primacy of service user needs. Record keeping was of a high standard. The health and safety of staff and services users was appropriately addressed. The home’s operation was effectively monitored both internally by the manager and externally by the provider organisation. EVIDENCE: Discussion with the manager and staff and scrutiny of record-keeping systems and rotas indicated that the home was run in an effective and organised manner, with the needs of service users at the forefront. Discussion took place between the inspector and manager over further clarification on the home’s certificate of the categories of service users catered for. This will be resolved in separate communication with the home and provider organisation. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 20 Record-keeping systems for all aspects of the home’s operation were well organised and maintained. The only minor shortfall noted was the occasional failure of staff to sign and date entries and/or reports on service users files. Health and safety monitoring, on which the manager took the lead, was of a high standard. Records showed due attention was paid to areas such as risk assessments, food hygiene, fire safety, reporting of accidents and incidents. Through his records monitoring, and direct observation of and involvement in day to day contact with services users, it appeared the manager had a very clear oversight of all key areas of practice in the home. This was supplemented by regular monthly external monitoring visits by the provider organisation, Scope. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 4 4 4 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 4 3 4 3 4 3 Standard No 11 12 13 14 15 16 17 3 x x x x 4 x Standard No 31 32 33 34 35 36 Score x x 3 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Birchwood Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x 3 4 3 Version 1.40 Page 22 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc No 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. Standard Regulation Requirement Timescale for action 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 20 41 Good Practice Recommendations That the home ensures any potential confusion on administration regularity for service user medication is clarified That staff are reminded of the importance of ensuring all file entries are consistently signed and dated by the staff concerned. Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 23 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close, Aylesbury Bucks. HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Birchwood 20051019_Birchwood_S61743_V239814_UI_Stage 2_H53_RS_ces.doc Version 1.40 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!