Inspection on 22/02/06 for Birchwood

This inspection was carried out on 22nd February 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Birchwood 13/09/08

Birchwood 18/09/07

Birchwood 14/11/06

Birchwood 07/05/05

Birchwood 29/12/04

Birchwood 05/10/04

Birchwood 03/03/04

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

CARE HOMES FOR OLDER PEOPLE Birchwood 35 Birchwood Road St Annes Brislington Bristol BS4 4QL Lead Inspector Sandra Gibson Unannounced Inspection 22nd February 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 Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 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. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Birchwood Address 35 Birchwood Road St Annes Brislington Bristol BS4 4QL 0117 9712266 NONE 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) Bristol City Council Miss Debra Jane Clifford Care Home 30 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30) of places Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 30 persons aged 60 years and over. Date of last inspection 7th May 2005 Brief Description of the Service: Birchwood is a large purpose built residential home operated by Bristol City Council. It is registered by The Commission for Social Care Inspection to provide personal care to 30 persons aged sixty five years and over with dementia. There is a condition to the registration which allows the home to accommodate 30 persons aged sixty years and over. All rooms are single and have been tastefully furnished to meet the individual needs of the occupants. The home is alarmed and secured, with a door entry system. There are spacious bright lounges for service users and their relatives to relax in and the dining room is well proportioned with ample space for moving around. There is an attractive courtyard with shrubs, plants and sitting area. Within the home there are aids and adaptations to aid mobility and this also includes hoists in the bathroom. Birchwood is situated in the south of Bristol and is on a major bus route. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place midweek between the hours of 10am and 4pm. Evidence was gathered from: talking to/observing residents, talking to relatives, talking to two assistant officers/ talking to and observing staff, examining records, policies and procedures. Birchwood currently accommodates two residents aged over sixty years but younger than sixty-five years. What the service does well: What has improved since the last inspection? The system in place to assess a prospective residents needs has improved since the last inspection which ensures that adequate information is now collected so that care needs will be fully identified prior to admission. Residents’ physical and mental care needs continue to be fully met and there have been considerable improvements in the medication administration system since the last inspection so that residents are better protected from risk of harm. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 6 The opportunities to experience a stimulating and varied life have improved since the last inspection with a result that the residents’ quality of life has also improved. Arrangements for protecting residents from harm have improved since the last inspection which ensures that residents are better protected from harm What they could do better: 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 DS0000036679.V267151.R01.S.doc Version 5.0 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 Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 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 Minor attention is still required to be made to the information provided to residents and their representatives to ensure that new residents can make informed choices about the home and that they can be sure their rights will be safeguarded. The system in place to assess a prospective residents needs has improved since the last inspection which ensures that adequate information is now collected so that an individuals care needs will be fully identified prior to admission. EVIDENCE: The statement of purpose states that Birchwood will provide accommodation for men and women aged over 60 years and that it will reserve up to two beds as a respite and emergency facility for people who are aged over 60 years or in exceptional and extreme cases, not younger than 55 years. There is currently one permanent resident accommodated who is now 60 years and another resident who is 61 years. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 9 It is noted that this home has an additional condition to the registration so it can accommodate residents 60 years and over. However residents under 60 years can only be accommodated following an application to vary the age range, which must be agreed with the Commission For Social Care Inspection before a resident is admitted. This information must be made clear in the statement of purpose and service users’ guide. It must also be made clear in these documents how the home meet the national minimum standards for younger adults for example, staff training provided and exactly what facilities and activities are available for any residents under sixty five years. It was pleasing to note that evidence seen at the time of the inspection confirmed that these younger residents individual needs were being met by the staff team based at Birchwood. The management team has reviewed the assessment document since the last inspection and it now meets the national minimum standards. There is also an admission procedure checklist in place. A sample of needs assessments were examined and it was noted that they were up to date and accurate. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 10 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 There has been some attention given to the completition of care plans with residents and their represenatatives since the last inspection but further improvement is required to ensure that residents’ needs are fully met. Residents’ physical and mental care needs are fully met and there have been considerable improvements in the medication administration system since the last inspection so that residents are better protected from risk of harm. EVIDENCE: Individual care plans are available and there has been further improvement in their development. However, it was noted that are still gaps in the information recorded and signatures of residents or their representatives were not found on a sample of care plans examined. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 11 It was also noted that care plans are not always update following a change in need. For example one resident’s case was followed and it was observed from the case records that she had a history of falls over a few months starting from December 2005. This change in need had not been followed up in the care plan or manual handling risk assessment despite a review of the resident’s care being held on the 1/02/06. The manual handling assessment was dated 12/05/05 and stated that the resident had no history of falls. There was evidence in place to confirm that General Practitioners, psychiatrists, district nurses, opticians, dentists and chiropodists are all contacted at the appropriate time. Records all confirmed that residents were assisted to attend hospital appointments where planned. Equipment was observed to be in place to prevent pressure sores in residents who were at risk. The medication administration system was examined and a sample check of medication administered was carried out. The records were found to be up to date and accurate. It was noted that night staff had received medication training in January 2005 and all officers had received medication training from a qualified pharmacist in November 2004. Records confirmed that several officers have received up dated training in May 2005n and it was understood that all officers would receive up dated training with in the next year. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 12 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): 12,13, The opportunities to experience a stimulating and varied life have improved since the last inspection with a result that the residents’ quality of life has also improved. EVIDENCE: A member of the management team told the inspector about the outings that had taken place from the home following the last inspection. It was noted that each officer takes the responsibility for organising a trip and the trips that took place included outings to Bristol Zoo, Cadbury Garden Centre and Harry Ramsden’s Restaurant. It was noted that no outings had been booked for this year, but the officers on duty confirmed that there were plans in place to organise trips for the summer time. There was evidence in place to confirm that the following social activities take place in the home on a regular basis; a church choir, an organ player, a bingo player, a keyboard player and aromatherapist. Records confirmed that a clothes show had taken place during the last few weeks. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 13 Staff now spend regular time with residents on a one to one basis either taking them to the local shops, chatting with the resident and some times their family, spending time reminiscing. The inspector was informed that one of the several lounges in the home is to be made into a reminiscence room using posters and memorabilia. It was noted that one of the residents under 65 years had been assisted to choose her / his own clothes, which are appropriate to his age. Also staff had accompanied this resident to the video shop to choose videos s/he enjoyed and to buy take away curries or other fast food that was not provided in the home. On the day of the inspection residents were spending time listening to music or talking to members of staff or visitors. Visitors confirmed that they were made very welcome in the home and that staff were very approachable. One relative spoken to said that her mother had recently moved to Birchwood from another home. She said, “Mum does not spend much time in room. Staff are well trained and really understanding. I cannot say anything against them. Residents are free to come and go in the home. Staff have a laugh with residents. They are down to earth and it is a nice atmosphere.” Another relative said, “Staff treat residents well. I have never heard a bad word spoken to residents. They are open and honest “ Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 14 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 Residents and their relatives continue to be confident that their concerns will be listened too and have been made aware of the complaints procedure Arrangements for protecting residents from harm have improved since the last inspection which ensures that residents are better protected from harm possible risk or harm. EVIDENCE: Residents, visitors and staff told the inspector that they were comfortable talking to the manager or one of the management team about any concerns. Residents were seen actively seeking out the members of the management team on duty that day with any concerns they had. No complaints have been received either by the manager, complaints manager for Social Services and Health or The Commission for Social Care Inspection since the last inspection. One relative confirmed that he was aware of the complaints procedure and said, “ I would talk to officer if concerned about anything”. Another relative said, “I would go the office if I was concerned about anything, but there is no reason to complain”. A third relative said, “I am very happy with care my mother receives. It is much better than previous home. I am happy with the food I have seen. It is cooked nicely and presented nicely. I would talk to staff in office if concerned.” Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 15 No Secrets in Bristol (Local authority Adult Protection procedure) is in place in the home. And the majority of staff have now received adult protection training provided by the Local Authority Safe guarding Adults Coordinator. It was also noted that the home now regularly informs the Commission for Social Care Inspection regarding any events that affect the welfare of a resident. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 16 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): These standards were not assessed on this occasion they were all met at the last unannounced inspection conducted on 7th May 2005. It was noted however that access arrangements and toilet facilities have improved for disabled adults since the last inspection. EVIDENCE: Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 17 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 staffing levels at Birchwood are satisfactory. However, attention must be given to the employment of permanent staff in sufficient numbers to ensure that residents’ needs are consistently met. The majority of staff are trained and competent to do their job. However attention is required for new staff to receive the specialist training they need to ensure that residents are in safe hands at all times. EVIDENCE: Staffing levels have remained the same following a requirement made at a previous inspection. They were noted to be satisfactory on the day of the inspection. There are still four care staff vacancies at this home and gaps in the staff rota continue to be filled with permanent staff in the home who wish to do extra hours. Agency staff are still used but the shifts they cover have been reduced. The staff rota confirmed this information. It was also confirmed by two members of staff seen during the inspection who said that they both did extra hours now to help with staff shortages. They also commented that although agency staff were still used, in their opinion they were regular staff and “they were very good”. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 18 There is a programme of statutory training which includes basic food hygiene, first aid, manual handling and Protection of vulnerable Adults. Records confirmed that NVQ training is progressing well. Communication between residents and staff was noted to be very good and all staff observed were very sensitive to residents’ needs and spoke to with respect and understanding of residents needs. Training in this care home also includes dementia care training, mental health training and loss and bereavement. However it was noted that the two members of staff seen a the last inspection who had been in post for 6months and eight months and were due to attend dementia care training have still not received this specialist training after more than a year in post. One of the officers explained that this training had now been planned and was to be provided by one of the managers from another Local Authority home which provides care to residents with dementia. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 19 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): 36,37 Residents and their representatives benefit from the knowledge that the staff team is well supervised. There are satisfactory arrangements in place to ensure that residents’ finances are well protected. EVIDENCE: There was information in place to confirm that staff attend regular staff meetings and that supervision is provided on a regular basis. The staff and officers seen at the time of the inspection confirmed this information. Staff said, “They felt listened to” Records confirmed that the finances held on behalf of residents are well managed l and there are systems in place to protect the resident best interests including their finances. Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 3 X Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard op1 Regulation 4 Requirement The statement of purpose / service users guide must be clear that residents aged over 60 years can be accommodated and what training and facilities are in place to meet this younger persons needs This is an outstanding requirement from the inspection completed on 5th May 2005 2. op7 15 Care plans must be kept up to date and accurate. They must be completed where possible with the involvement of the resident / and representative where possible. Following a change in need risk assessments must be updated accordingly This is an outstanding requirement from an inspection conducted on 5th May 2005 previous inspection 31/05/06 Timescale for action 31/05/06 Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 22 3 OP27 18(1) (a)(b) A review of the staffing team numbers must be completed. The staff vacancies must be addressed in this review and a plan sent to the CSCI demonstrating how the vacancies are going to be filled and what arrangements are in plan to ensure consistent care for the residents of Birchwood All new staff must receive training on dementia care within the first six months of employment 31/05/06 4 OP30 18 (1)(c) 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Birchwood DS0000036679.V267151.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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